1
|
Price TR, Hodgkinson V, Westbury G, Korngut L, Innes MA, Marshall CR, Nelson TN, Huang L, Parboosingh J, Mah JK. A Study on the Incidence and Prevalence of 5q Spinal Muscular Atrophy in Canada Using Multiple Data Sources. Can J Neurol Sci 2024:1-12. [PMID: 38178730 DOI: 10.1017/cjn.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Spinal muscular atrophy (SMA) is a leading genetic cause of infant death and represents a significant burden of care. An improved understanding of the epidemiology of SMA in Canada may help inform strategies to improve the standard of care for individuals living with SMA. METHODS We employed a multisource approach to estimate the minimal incidence and prevalence of 5q SMA and to gain greater insight into recent clinical practices and treatment trends for the Canadian SMA population. Data sources included the Canadian Paediatric Surveillance Program (CPSP), Canadian Neuromuscular Disease Registry (CNDR), and molecular genetics laboratories in Canada. RESULTS The estimated annual minimum incidence of 5q SMA was 4.38, 3.44, and 7.99 cases per 100,000 live births in 2020 and 2021, based on CPSP, CNDR, and molecular genetics laboratories data, respectively, representing approximately 1 in 21,472 births (range 12,516-29,070) in Canada. SMA prevalence was estimated to be 0.85 per 100,000 persons aged 0-79 years. Delay in diagnosis exists across all SMA subtypes. Most common presenting symptoms were delayed milestones, hypotonia, and muscle weakness. Nusinersen was the most common disease-modifying treatment received. Most patients utilized multidisciplinary clinics for management of SMA. CONCLUSION This study provides data on the annual minimum incidence of pediatric 5q SMA in Canada. Recent therapeutic advances and newborn screening have the potential to drastically alter the natural history of SMA. Findings underline the importance of ongoing surveillance of the epidemiology and long-term health outcomes of SMA in the Canadian population.
Collapse
Affiliation(s)
- Tiffany R Price
- Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Victoria Hodgkinson
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Grace Westbury
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Micheil A Innes
- Departments of Pediatrics and Medical Genetics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christian R Marshall
- Division of Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Tanya N Nelson
- Division of Genome Diagnostics, Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lijia Huang
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jillian Parboosingh
- Department of Medical Genetics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean K Mah
- Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
2
|
Zubair AS, Saab L, Scharer K, Khokhar B. Patients' experiences with methylcobalamin injections in amyotrophic lateral sclerosis. Brain Circ 2024; 10:60-66. [PMID: 38655443 PMCID: PMC11034440 DOI: 10.4103/bc.bc_17_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease with no definitive treatment. Vitamin B12 is not a Food and Drug Administration-approved treatment in the United States, although it has been prescribed off-label as ultra-high-dose methylcobalamin, which has been shown to be safe and effective in slowing functional decline in patients with ALS. This study evaluates the impact of Vitamin B12 injections on the quality of life of five patients. METHODS Semi-structured interviews were conducted with the patients and caregivers. The data was carefully read, coded, and organized into themes and sub-themes by two independent researchers. RESULTS The study found four themes and 11 subthemes from the data, including initial circumstances, administration of the injection, subjective experience with Vitamin B12, and outcomes and expectations. All participants recognized some benefits from Vitamin B12 injections, specifically increased energy, reduced fatigue, and improved balance. However, some patients had difficulty monitoring its specific effect due to the progressive nature of the disease. DISCUSSION The flexibility offered by this intervention is beneficial for patients with declining mobility and strength who wish to adapt their treatment to their schedule. This work is a modest call to fill the existing gap in the literature and push for more randomized controlled trials investigating and clarifying the effects of Vitamin B12 injections on disease progression, muscle function, and quality of life in a small but diverse pool of patients with ALS.
Collapse
Affiliation(s)
- Adeel S. Zubair
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
| | - Lea Saab
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
| | - Kirsten Scharer
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
| | - Babar Khokhar
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
| |
Collapse
|
3
|
Riley M, Brotherston S, Samuels M, Pike KC, Kelly P. 'It gives me more freedom': Family perspectives on travelling with children on nocturnal ventilation. Child Care Health Dev 2024; 50:e13188. [PMID: 37929931 DOI: 10.1111/cch.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/29/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Children with neuromuscular weakness or central hypoventilation often require nocturnal ventilation. Children with these conditions are living longer and the numbers of children affected are increasing. The challenges associated with managing ventilation at home have been documented; however, there has been limited investigation into accessing wider experiences such as travel. Air travel, in particular, may be considered challenging for children with these conditions because oxygen levels are lower in airplane cabins than at sea levels. OBJECTIVE We sought to understand experiences of and attitudes towards travel amongst families of children using nocturnal ventilation for neuromuscular weakness or central hypoventilation. METHODS Two semi-structured interviews were conducted amongst participants enrolled in a trial of a new pre-flight assessment of their tolerance of reduced oxygen levels during flight (known as a hypoxic challenge test). Children participating in the trial were aged 19 months to 18 years. Parents were interviewed and provided proxy views for younger children, and older children were encouraged to present their own views during these interviews. One interview was conducted immediately after the assessment, and a second 3 months later. Data were analysed utilising the framework approach to thematic analysis. RESULTS Seventeen families participated in the first interview with 14 of these families completing the follow-up interview. Three further families participated in the follow-up interview only. Here, we report three themes relating to participant experience of travel and how this is impacted by their condition. The three themes and their sub-themes were (1) insight into children's lives: hospital attendances, gaining knowledge and confidence, and child as a person; (2) travelling with your child: planes, trains and automobiles, rules of air travel, and uncertainty; and (3) the meaning of travel: normalisation, connection to extended family, expanded experiences, and freedom and equality. CONCLUSIONS This population of children and their families aspire to travel but face challenges from clinical and social barriers. It is essential that we further our understanding of the physiological, social and cultural aspects of their experience to facilitate their access to broadened life experiences.
Collapse
Affiliation(s)
- Mollie Riley
- Lung Function Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephanie Brotherston
- Lung Function Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Martin Samuels
- Lung Function Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Paula Kelly
- Centre for Outcomes and Experience Research in Children's Health Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Wolfson C, Gauvin DE, Ishola F, Oskoui M. Global Prevalence and Incidence of Amyotrophic Lateral Sclerosis: A Systematic Review. Neurology 2023; 101:e613-e623. [PMID: 37308302 PMCID: PMC10424837 DOI: 10.1212/wnl.0000000000207474] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disorder affecting upper and lower motor neurons. Due to its rarity and rapidly progressive nature, studying the epidemiology of ALS is challenging, and a comprehensive picture of the global burden of this disease is lacking. The objective of this systematic review was to describe the global incidence and prevalence of ALS. METHODS We searched MEDLINE, Embase, Global Health, PsycInfo, Cochrane Library, and CINAHL to identify articles published between January 1, 2010, and May 6, 2021. Studies that were population based and reported estimates of prevalence, incidence, and/or mortality of ALS were eligible for inclusion. This study focuses on the incidence and prevalence. Quality assessment was performed using a tool developed to evaluate methodology relevant to prevalence and incidence studies. This review was registered with PROSPERO, CRD42021250559. RESULTS This search generated 6,238 articles, of which 140 were selected for data extraction and quality assessment. Of these, 85 articles reported on the incidence and 61 on the prevalence of ALS. Incidence ranged from 0.26 per 100,000 person-years in Ecuador to 23.46 per 100,000 person-years in Japan. Point prevalence ranged from 1.57 per 100,000 in Iran to 11.80 per 100,000 in the United States. Many articles identified cases with ALS from multiple data sources. DISCUSSION There is variation in reported incidence and prevalence estimates of ALS across the world. While registries are an important and powerful tool to quantify disease burden, such resources are not available everywhere. This results in gaps in reporting of the global epidemiology of ALS, as highlighted by the degree of variation (and quality) in estimates of incidence and prevalence reported in this review.
Collapse
Affiliation(s)
- Christina Wolfson
- From the Neuroepidemiology Research Unit (C.W., D.E.G.), Research Institute of the McGill University Health Centre; Department of Medicine (C.W.), Faculty of Medicine and Health Sciences, Department of Epidemiology (C.W., F.I.), Biostatistics and Occupational Health, School of Population and Global Health, and Department of Pediatrics (M.O.), Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Danielle E Gauvin
- From the Neuroepidemiology Research Unit (C.W., D.E.G.), Research Institute of the McGill University Health Centre; Department of Medicine (C.W.), Faculty of Medicine and Health Sciences, Department of Epidemiology (C.W., F.I.), Biostatistics and Occupational Health, School of Population and Global Health, and Department of Pediatrics (M.O.), Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Foluso Ishola
- From the Neuroepidemiology Research Unit (C.W., D.E.G.), Research Institute of the McGill University Health Centre; Department of Medicine (C.W.), Faculty of Medicine and Health Sciences, Department of Epidemiology (C.W., F.I.), Biostatistics and Occupational Health, School of Population and Global Health, and Department of Pediatrics (M.O.), Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Maryam Oskoui
- From the Neuroepidemiology Research Unit (C.W., D.E.G.), Research Institute of the McGill University Health Centre; Department of Medicine (C.W.), Faculty of Medicine and Health Sciences, Department of Epidemiology (C.W., F.I.), Biostatistics and Occupational Health, School of Population and Global Health, and Department of Pediatrics (M.O.), Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Gil-Rojas Y, Suárez-Obando F, Amaya-Granados D, Prieto-Pinto L, Samacá-Samacá D, Ortiz B, Hernández F. Burden of disease of spinal muscular atrophy linked to chromosome 5q (5q-SMA) in Colombia. Expert Rev Pharmacoecon Outcomes Res 2023:1-12. [PMID: 37096565 DOI: 10.1080/14737167.2023.2206569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE This article estimates the disease burden of 5q-SMA in Colombia by using the Disability-Adjusted Life Years (DALYs) metric. METHODS Epidemiological data were obtained from local databases and medical literature and were adjusted in the DisMod II tool. DALYs were obtained by adding years of life lost due to premature death (YLL) and years lived with disability (YLD). RESULTS The modeled prevalence of 5q-SMA in Colombia was 0.74 per 100,000 population. The fatality rate for all types was 14.1%. The disease burden of 5q-SMA was estimated at 4,421 DALYs (8.6 DALYs/100,000), corresponding to 4,214 (95.3%) YLLs and 207 (4.7%) YLDs. Most of the DALYs were accounted in the 2-17 age group. Of the total burden, 78% correspond to SMA type 1, 18% to type 2, and 4% to type 3. CONCLUSIONS Although 5q-SMA is a rare disease, it is linked to a significant disease burden due to premature mortality and severe sequelae. The estimates shown in this article are important inputs to inform public policy decisions on how to ensure adequate health service provision for patients with 5q-SMA.
Collapse
Affiliation(s)
| | - Fernando Suárez-Obando
- Instituto de Genética Humana, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | | | | | - Blair Ortiz
- Universidad de Antioquia, Hospital San Vicente Fundación, Medellín, Colombia
| | | |
Collapse
|
6
|
Carey IM, Nirmalananthan N, Harris T, DeWilde S, Chaudhry UAR, Limb E, Cook DG. Prevalence of co-morbidity and history of recent infection in patients with neuromuscular disease: A cross-sectional analysis of United Kingdom primary care data. PLoS One 2023; 18:e0282513. [PMID: 36857388 PMCID: PMC9977045 DOI: 10.1371/journal.pone.0282513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND People with neuromuscular disease (NMD) experience a broader range of chronic diseases and health symptoms compared to the general population. However, no comprehensive analysis has directly quantified this to our knowledge. METHODS We used a large UK primary care database (Clinical Practice Research Datalink) to compare the prevalence of chronic diseases and other health conditions, including recent infections between 23,876 patients with NMD ever recorded by 2019 compared to 95,295 age-sex-practice matched patients without NMD. Modified Poisson regression estimated Prevalence Ratios (PR) to summarise the presence of the disease/condition ever (or for infections in 2018) in NMD patients versus non-NMD patients. RESULTS Patients with NMD had significantly higher rates for 16 of the 18 conditions routinely recorded in the primary care Quality and Outcomes Framework (QOF). Approximately 1-in-10 adults with NMD had ≥4 conditions recorded (PR = 1.39, 95%CI 1.33-1.45). Disparities were more pronounced at younger ages (18-49). For other (non-QOF) health conditions, significantly higher recorded levels were observed for rarer events (pulmonary embolism PR = 1.96 95%CI 1.76-2.18, hip fractures PR = 1.65 95%CI 1.47-1.85) as well as for more common primary care conditions (constipation PR = 1.52 95%CI 1.46-1.57, incontinence PR = 1.52 95%CI 1.44-1.60). The greatest co-morbidity burden was in patients with a myotonic disorder. Approximately 1-in-6 (17.1%) NMD patients had an infection recorded in the preceding year, with the risk of being hospitalised with an infection nearly double (PR = 1.92, 95%CI 1.79-2.07) compared to non-NMD patients. CONCLUSION The burden of chronic co-morbidity among patients with NMD is extremely high compared to the general population, and they are also more likely to present in primary and secondary care for acute events such as infections.
Collapse
Affiliation(s)
- Iain M. Carey
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- * E-mail:
| | - Niranjanan Nirmalananthan
- Department of Neurology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tess Harris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Stephen DeWilde
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Umar A. R. Chaudhry
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Elizabeth Limb
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Derek G. Cook
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| |
Collapse
|
7
|
Turk MA, Gans BM, Kim H, Alter KE. A call for action: Increasing the pediatric rehabilitation medicine workforce. J Pediatr Rehabil Med 2023; 16:449-455. [PMID: 37718879 PMCID: PMC10578265 DOI: 10.3233/prm-230044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Pediatric Rehabilitation Medicine (PRM) is a unique blend of traditional medical rehabilitation knowledge and skills primarily focused on temporary and/or permanent disability conditions of childhood onset throughout the age continuum, with an emphasis on promoting function and participation. Although there are two established pathways to enhance knowledge and skills in PRM, one a combined residency with Pediatrics and the other a PRM fellowship, there has been a relative decline in participants in this training, as has been seen across other subspecialties in Physical Medicine and Rehabilitation (PM&R) and other medical specialties. Based on pediatric rehabilitation physician surveys and the increasing prevalence of children with disabilities, there has been a call to consider opening PRM fellowships to physicians not trained in PM&R. This commentary proposes establishing a commission to lead a transparent and inclusive process to assure that all options to address issues related to optimizing PRM care are considered and provide a course of action to address the needs of children and adults with childhood onset disabilities.
Collapse
Affiliation(s)
- Margaret A. Turk
- Departments of Physical Medicine and Rehabilitation, Pediatrics, Public Health & Preventive Medicine, SUNY Upstate Medical University, Norton College of Medicine, Syracuse, NY, USA
| | - Bruce M. Gans
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Heakyung Kim
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Katharine E. Alter
- Mount Washington Pediatric Hospital, An Affiliate of The University of Maryland System and Johns Hopkins Medical Institution, Baltimore, MD, USA
| |
Collapse
|
8
|
Strickland JB, Davis-Anderson K, Micheva-Viteva S, Twary S, Iyer R, Harris JF, Solomon EA. Optimization of Application-Driven Development of In Vitro Neuromuscular Junction Models. TISSUE ENGINEERING. PART B, REVIEWS 2022; 28:1180-1191. [PMID: 35018825 PMCID: PMC9805869 DOI: 10.1089/ten.teb.2021.0204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Neuromuscular junctions (NMJs) are specialized synapses responsible for signal transduction between motor neurons (MNs) and skeletal muscle tissue. Malfunction at this site can result from developmental disorders, toxic environmental exposures, and neurodegenerative diseases leading to severe neurological dysfunction. Exploring these conditions in human or animal subjects is restricted by ethical concerns and confounding environmental factors. Therefore, in vitro NMJ models provide exciting opportunities for advancements in tissue engineering. In the last two decades, multiple NMJ prototypes and platforms have been reported, and each model system design is strongly tied to a specific application: exploring developmental physiology, disease modeling, or high-throughput screening. Directing the differentiation of stem cells into mature MNs and/or skeletal muscle for NMJ modeling has provided critical cues to recapitulate early-stage development. Patient-derived inducible pluripotent stem cells provide a personalized approach to investigating NMJ disease, especially when disease etiology cannot be resolved down to a specific gene mutation. Having reproducible NMJ culture replicates is useful for high-throughput screening to evaluate drug toxicity and determine the impact of environmental threat exposures. Cutting-edge bioengineering techniques have propelled this field forward with innovative microfabrication and design approaches allowing both two-dimensional and three-dimensional NMJ culture models. Many of these NMJ systems require further validation for broader application by regulatory agencies, pharmaceutical companies, and the general research community. In this summary, we present a comprehensive review on the current state-of-art research in NMJ models and discuss their ability to provide valuable insight into cell and tissue interactions. Impact statement In vitro neuromuscular junction (NMJ) models reveal the specialized mechanisms of communication between neurons and muscle tissue. This site can be disrupted by developmental disorders, toxic environmental exposures, or neurodegenerative diseases, which often lead to fatal outcomes and is therefore of critical importance to the medical community. Many bioengineering approaches for in vitro NMJ modeling have been designed to mimic development and disease; other approaches include in vitro NMJ models for high-throughput toxicology screening, providing a platform to limit or replace animal testing. This review describes various NMJ applications and the bioengineering advancements allowing for human NMJ characteristics to be more accurately recapitulated. While the extensive range of NMJ device structures has hindered standardization attempts, there is still a need to harmonize these devices for broader application and to continue advancing the field of NMJ modeling.
Collapse
Affiliation(s)
- Julie B. Strickland
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Katie Davis-Anderson
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | | | - Scott Twary
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Rashi Iyer
- Information System and Modeling, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | | | - Emilia A. Solomon
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA.,Address correspondence to: Emilia A. Solomon, PhD, Bioscience Division, Los Alamos National Laboratory, PO Box 1663 MS M888, Los Alamos, NM 87545, USA
| |
Collapse
|
9
|
Toussaint M, Wijkstra PJ, McKim D, Benditt J, Winck JC, Nasiłowski J, Borel JC. Building a home ventilation programme: population, equipment, delivery and cost. Thorax 2022; 77:thoraxjnl-2021-218410. [PMID: 35868847 PMCID: PMC9606503 DOI: 10.1136/thoraxjnl-2021-218410] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
Home mechanical ventilation (HMV) improves quality of life and survival in patients with neuromuscular disorders (NMD). Developing countries may benefit from published evidence regarding the prevalence, cost of equipment, technical issues and organisation of HMV in NMD, facilitating the development of local turn-key HMV programmes. Unfortunately, such evidence is scattered in the existing literature. We searched Medline for publications in English and French from 2005 to 2020. This narrative review analyses 24 international programmes of HMV. The estimated prevalence (min-max) of HMV is ±7.3/100 000 population (1.2-47), all disorders combined. The prevalence of HMV is associated with the gross domestic product per capita in these 24 countries. The prevalence of NMD is about 30/100 000 population, of which ±10% would use HMV. Nocturnal (8/24 hour), discontinuous (8-16/24 hours) and continuous (>16/24 hours) ventilation is likely to concern about 60%, 20% and 20% of NMD patients using HMV. A minimal budget of about 168€/patient/year (504€/100 000 population), including the cost of equipment solely, should address the cost of HMV equipment in low-income countries. When services and maintenance are included, the budget can drastically increase up to between 3232 and 5760€/patient/year. Emerging programmes of HMV in developing countries reveal the positive impact of international cooperation. Today, at least 12 new middle, and low-income countries are developing HMV programmes. This review with updated data on prevalence, technical issues, cost of equipment and services for HMV should trigger objective dialogues between the stakeholders (patient associations, healthcare professionals and politicians); potentially leading to the production of workable strategies for the development of HMV in patients with NMD living in developing countries.
Collapse
Affiliation(s)
- Michel Toussaint
- Centre de Référence Neuromusculaire, Cliniques Universitaires de Bruxelles (ULB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Neurology, Hospital Erasme, Brussels, Belgium
| | - Peter J Wijkstra
- Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Doug McKim
- CANVent Respiratory Services, Ottawa Hospital Respiratory Rehabilitation and The Ottawa Hospital Sleep Centre and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Benditt
- Respiratory Care Services, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Jacek Nasiłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland, Warsaw, Poland
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum. Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Jean-Christian Borel
- Sleep Laboratory and EFCR, Grenoble University Hospital, Grenoble Cedex 09, France
- R&D, AGIR a dom, Meylan, France
| |
Collapse
|
10
|
London ZN, Gable KL, Govindarajan R, Guidon AC, Gwathmey KG, Hehir MK, Imperioli M, Laughlin RS, Price RS, Sakamuri S, Sokol J, Baer M. The neuromuscular fellowship portal and match. Muscle Nerve 2022; 65:640-645. [PMID: 35213933 PMCID: PMC9314681 DOI: 10.1002/mus.27525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/02/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022]
Abstract
For many years, Neuromuscular Medicine programs lacked a standardized means of handling fellowship applications and offering positions. Programs interviewed applicants and made offers as early as the first half of Post Graduate Year 3 (PGY3), a suboptimal timeline for applicants who may have had little prior exposure to neuromuscular or electrodiagnostic medicine. In 2021, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) developed the Neuromuscular Fellowship Portal to standardize a later timeline and establish a process for fellowship applications and offers. In its first year, the Neuromuscular Fellowship Portal used a unique one-way match, in which the portal released serial offers to applicants based on rank order lists submitted by programs. Fifty-two Neuromuscular Medicine programs and seven electromyography (EMG)-focused Clinical Neurophysiology programs participated. Sixty-eight positions were filled, a similar number to previous years. A survey of fellowship directors and applicants following this process showed overwhelming support for the standardized timeline and application portal, but all program directors and most applicants favored moving to a traditional match. To maintain the existing application timeline and minimize costs for all parties, the AANEM Neuromuscular Fellowship Portal will host a two-way match, based on existing commercial match algorithms, in 2022. A match will afford a fair and efficient process for all involved. Both Neuromuscular Medicine and EMG-focused Clinical Neurophysiology programs will be encouraged to participate. The process undertaken by the AANEM can stand as an example for other neurologic subspecialties who are interested in standardizing their application timeline.
Collapse
Affiliation(s)
- Zachary N London
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Karissa L Gable
- Department of Neurology, Division of Neuromuscular Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Amanda C Guidon
- Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly G Gwathmey
- Department of Neurology, Division of Neuromuscular Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael K Hehir
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Matthew Imperioli
- Department of Neurology, Division of Neuromuscular Medicine, UConn Health, Farmington, Connecticut, USA
| | - Ruple S Laughlin
- Department of Neurology, Division of Neuromuscular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymond S Price
- Department of Neurology, Division of Neuromuscular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sarada Sakamuri
- Department of Neurology & Neurological Sciences, Division of Neuromuscular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jacob Sokol
- Staff, American Association of Neuromuscular and Electrodiagnostic Medicine, Rochester, Minnesota, USA
| | - Michael Baer
- Department of Neurology, Division of Neuromuscular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Ansaripour A, Roehrich K, Mashayekhi A, Wanjala M, Noel S, Hemami MR, Murray A, Javanbakht M. Budget Impact of the Vest™ High Frequency Chest Wall Oscillation System for Managing Airway Clearance in Patients with Complex Neurological Disorders: A US Healthcare Payers' Perspective Analysis. PHARMACOECONOMICS - OPEN 2022; 6:169-178. [PMID: 34468966 PMCID: PMC8864050 DOI: 10.1007/s41669-021-00299-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE As a recognized therapy to improve airway clearance, high-frequency chest wall oscillation (HFCWO) is used to manage reduced vital capacity in patients with complex neuromuscular disorders (cNMD). This study aimed to investigate the budget impact of HFCWO versus chest wall physical therapy (CWPT) from a US-commercial payer perspective. METHODS In combination with a previously developed cost-effectiveness model, a budget impact model was developed to evaluate the incremental budgetary impact associated with introducing a HFCWO device over a 5-year time horizon. The model compared the cost implications associated with the commonly used CWPT procedure, as the current scenario, with a new scenario consisting of 80% of market share for HFCWO. The resource use and costs included in the analyses were costs associated with the HFCWO device (Vest™ System) and its consumables, patient training, and medical services such as hospitalization, medications, emergency room, and outpatient visits. The primary outcome measures included total and incremental budgetary impact per member per year (PMPY). RESULTS In a hypothetical plan of 1,000,000 members (men: 49.2%), 2099 patients with cNMD were estimated to be eligible to receive airway clearance services over 5 years. The new scenario (HFCWO and CWPT [US$24 PMPY]) was cost-saving compared with the current scenario (CWPT only [$34 PMPY]) with a cost reduction of US$9.46 PMPY. The model estimated a net cost-saving of US$1,594,131 and US$9,591,343 over 1 and 5 years, respectively. CONCLUSION This study suggests the HFCWO technique to manage the reduction in vital capacity in patients with cNMD would lead to favorable budget impact results.
Collapse
Affiliation(s)
- Amir Ansaripour
- Optimax Access, Gustav Mahlerplein 2, 1082 MA, Amsterdam, The Netherlands.
| | | | - Atefeh Mashayekhi
- Optimax Access, University of Southampton Science Park, Chilworth, Hampshire, UK
| | | | | | | | | | - Mehdi Javanbakht
- Optimax Access, University of Southampton Science Park, Chilworth, Hampshire, UK
- Device Access, University of Southampton Science Park, Chilworth, Hampshire, UK
| |
Collapse
|
12
|
Ito M, Yamauchi A, Urano M, Kato T, Matsuo M, Nakashima K, Saito K. Epidemiological investigation of spinal muscular atrophy in Japan. Brain Dev 2022; 44:2-16. [PMID: 34452804 DOI: 10.1016/j.braindev.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND International reporting of epidemiological surveys of spinal muscular atrophy (SMA) in Japan has been limited to Shikoku, despite the epidemiology of the disease in countries worldwide becoming clearer. Treatments of 5q-SMA have been developed, and epidemiological studies are needed. PURPOSE This study aimed to conduct a nationwide epidemiological survey of SMA in Japan to clarify the actual situation of SMA in Japan. METHOD Patients with all clinical types of SMA, including neonates and adults, were selected from 1,005 medical facilities in Japan. RESULTS As of December 2017, the actual number of reported patients with SMA was 658 and the genetic testing rate was 79.5%. The estimated number of patients was 1,478 (95% confidence interval (CI), 1,122-1,834), with a prevalence of 1.17 (95%CI, 0.89-1.45) per 100,000 people and an incidence of 0.51 (95%CI, 0.32-0.71) per 10,000 live births. Incidence rates of 5q-SMA by clinical type were 0.27 (95%CI, 0.17-0.38) and 0.08 (95%CI, 0.04-0.11) per 10,000 live births for type 1 and 2, respectively, in cases with a definitive diagnosis by genetic testing. We found that 363 cases (82.7%) occurred less than 2 years and 88 (20.0%) occurred age of 2 months old or under. CONCLUSION This study clarifies the prevalence and incidence of SMA in Japan. As infantile onset accounts for most cases of SMA, newborn screening and subsequent treatment are important to save lives.
Collapse
Affiliation(s)
- Mayuri Ito
- Institute of Medical Genetics, Tokyo Women's Medical University, Japan
| | - Akemi Yamauchi
- Institute of Medical Genetics, Tokyo Women's Medical University, Japan
| | - Mari Urano
- Institute of Medical Genetics, Tokyo Women's Medical University, Japan
| | - Tamaki Kato
- Institute of Medical Genetics, Tokyo Women's Medical University, Japan
| | - Mari Matsuo
- Institute of Medical Genetics, Tokyo Women's Medical University, Japan
| | - Kenji Nakashima
- National Hospital Organization, Matsue Medical Center, Japan
| | - Kayoko Saito
- Institute of Medical Genetics, Tokyo Women's Medical University, Japan.
| |
Collapse
|
13
|
Carey IM, Banchoff E, Nirmalananthan N, Harris T, DeWilde S, Chaudhry UAR, Cook DG. Prevalence and incidence of neuromuscular conditions in the UK between 2000 and 2019: A retrospective study using primary care data. PLoS One 2021; 16:e0261983. [PMID: 34972157 PMCID: PMC8719665 DOI: 10.1371/journal.pone.0261983] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the UK, large-scale electronic primary care datasets can provide up-to-date, accurate epidemiological information on rarer diseases, where specialist diagnoses from hospital discharges and clinic letters are generally well recorded and electronically searchable. Current estimates of the number of people living with neuromuscular disease (NMD) have largely been based on secondary care data sources and lacked direct denominators. OBJECTIVE To estimate trends in the recording of neuromuscular disease in UK primary care between 2000-2019. METHODS The Clinical Practice Research Datalink (CPRD) database was searched electronically to estimate incidence and prevalence rates (per 100,000) for a range of NMDs in each year. To compare trends over time, rates were age standardised to the most recent CPRD population (2019). RESULTS Approximately 13 million patients were actively registered in each year. By 2019, 28,230 active patients had ever received a NMD diagnosis (223.6), which was higher among males (239.0) than females (208.3). The most common classifications were Guillain-Barre syndrome (40.1), myasthenia gravis (33.7), muscular dystrophy (29.5), Charcot-Marie-Tooth (29.5) and inflammatory myopathies (25.0). Since 2000, overall prevalence grew by 63%, with the largest increases seen at older ages (≥65-years). However, overall incidence remained constant, though myasthenia gravis incidence has risen steadily since 2008, while new cases of muscular dystrophy fell over the same period. CONCLUSIONS Lifetime recording of many NMDs on primary care records exceed current estimates of people living with these conditions; these are important data for health service and care planning. Temporal trends suggest this number is steadily increasing, and while this may partially be due to better recording, it cannot be simply explained by new cases, as incidence remained constant. The increase in prevalence among older ages suggests increases in life expectancy among those living with NMDs may have occurred.
Collapse
Affiliation(s)
- Iain M. Carey
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Emma Banchoff
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | | | - Tess Harris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Stephen DeWilde
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Umar A. R. Chaudhry
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Derek G. Cook
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| |
Collapse
|
14
|
Hydrogen Peroxide and Amyotrophic Lateral Sclerosis: From Biochemistry to Pathophysiology. Antioxidants (Basel) 2021; 11:antiox11010052. [PMID: 35052556 PMCID: PMC8773294 DOI: 10.3390/antiox11010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/18/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
Abstract
Free radicals are unstable chemical reactive species produced during Redox dyshomeostasis (RDH) inside living cells and are implicated in the pathogenesis of various neurodegenerative diseases. One of the most complicated and life-threatening motor neurodegenerative diseases (MND) is amyotrophic lateral sclerosis (ALS) because of the poor understanding of its pathophysiology and absence of an effective treatment for its cure. During the last 25 years, researchers around the globe have focused their interest on copper/zinc superoxide dismutase (Cu/Zn SOD, SOD1) protein after the landmark discovery of mutant SOD1 (mSOD1) gene as a risk factor for ALS. Substantial evidence suggests that toxic gain of function due to redox disturbance caused by reactive oxygen species (ROS) changes the biophysical properties of native SOD1 protein thus, instigating its fibrillization and misfolding. These abnormal misfolding aggregates or inclusions of SOD1 play a role in the pathogenesis of both forms of ALS, i.e., Sporadic ALS (sALS) and familial ALS (fALS). However, what leads to a decrease in the stability and misfolding of SOD1 is still in question and our scientific knowledge is scarce. A large number of studies have been conducted in this area to explore the biochemical mechanistic pathway of SOD1 aggregation. Several studies, over the past two decades, have shown that the SOD1-catalyzed biochemical reaction product hydrogen peroxide (H2O2) at a pathological concentration act as a substrate to trigger the misfolding trajectories and toxicity of SOD1 in the pathogenesis of ALS. These toxic aggregates of SOD1 also cause aberrant localization of TAR-DNA binding protein 43 (TDP-43), which is characteristic of neuronal cytoplasmic inclusions (NCI) found in ALS. Here in this review, we present the evidence implicating the pivotal role of H2O2 in modulating the toxicity of SOD1 in the pathophysiology of the incurable and highly complex disease ALS. Also, highlighting the role of H2O2 in ALS, we believe will encourage scientists to target pathological concentrations of H2O2 thereby halting the misfolding of SOD1.
Collapse
|
15
|
Olorunmoteni OE, Kareem AJ, Ayogu M. Pediatric Neuromuscular Disorders in Ile-Ife, Nigeria: Pattern and the Challenges with Management. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1714094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe aim of this study was to describe the presentation pattern and challenges with the management of pediatric neuromuscular disorders (NMDs) in Ile-Ife, Nigeria through retrospective review of their clinical records. We recruited 24 children aged 14 days to 15 years with a male preponderance (male-to-female ratio = 2.4:1). Late presentation was a prominent feature which was highest among children with myopathies with a mean duration of symptoms of 46.5 ± 33.4 months before presentation. Peripheral neuropathy was the most common type of NMDs (63.0%). Among these, injection nerve palsy from the use of wrong site for intramuscular injections was the most common (60.0%). Nonavailability of electrophysiologic and genetic testing as well as appropriate medications was the major challenges. Acquired NMDs are common in our setting. There is a need to improve preventive measures of acquired NMDs and early diagnosis of the inherited types.
Collapse
Affiliation(s)
| | - Abiodun J. Kareem
- Department of Pediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Musa Ayogu
- Department of Pediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| |
Collapse
|
16
|
Clinical profile and multidisciplinary needs of patients with neuromuscular disorders transitioning from paediatric to adult care. Neuromuscul Disord 2021; 32:206-212. [DOI: 10.1016/j.nmd.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 09/19/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022]
|
17
|
Chen G, Sharif B, Gerber B, Farris MS, Cowling T, Cabalteja C, Wu JW, Maturi B, Klein-Panneton K. Epidemiology, healthcare resource utilization and healthcare costs for spinal muscular atrophy in Alberta, Canada. J Med Econ 2021; 24:51-59. [PMID: 34906030 DOI: 10.1080/13696998.2021.2013676] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Spinal muscular atrophy (SMA) is a progressive neuromuscular disease associated with the degeneration of motor neurons in the brainstem and spinal cord. Studies examining the epidemiology and economic impact of SMA are limited in Canada. This study aimed to estimate the epidemiology as well as healthcare resource utilization (HRU) and healthcare costs for children with SMA in Alberta, Canada. MATERIALS AND METHODS We conducted a retrospective study using anonymized data from administrative healthcare databases provided by Alberta Health. Data from 1 April 2010 to 31 March 2018, were extracted for patients <18 years of age identified with SMA. Five-year incidence and prevalence were calculated for cases identified between 1 April 2012 and 31 March 2017. HRU and healthcare costs were assessed one year after SMA diagnosis, including hospitalizations, physician visits, ambulatory care visits and long-term care admissions. RESULTS The five-year incidence and prevalence of pediatric onset SMA were 1.03 per 100,000 person-years and 9.97 per 100,000 persons, respectively. General practitioner, specialist, and ambulatory care visits were common among children with SMA in the first-year post-diagnosis. The mean (SD) total annual direct cost per patient in the first-year post-diagnosis was $29,774 ($38,407); hospitalizations accounted for 41.7% of these costs ($12,412 [$21,170]), followed by practitioner visits at 32.3% ($9,615 [$13,054]), and ambulatory care visits at 26.0% ($7,746 [$9,988]). CONCLUSIONS Children with SMA experience substantial HRU, particularly for hospitalizations and practitioner visits, following diagnosis. Given the high costs of SMA, timely access to effective treatment strategies, such as the novel survival motor neuron (SMN)-restoring treatments recently approved for use, are needed to improve health outcomes and HRU.
Collapse
Affiliation(s)
- Guanmin Chen
- Medlior Health Outcomes Research Ltd., Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Behnam Sharif
- Medlior Health Outcomes Research Ltd., Calgary, Alberta, Canada
| | - Brittany Gerber
- Medlior Health Outcomes Research Ltd., Calgary, Alberta, Canada
| | - Megan S Farris
- Medlior Health Outcomes Research Ltd., Calgary, Alberta, Canada
| | - Tara Cowling
- Medlior Health Outcomes Research Ltd., Calgary, Alberta, Canada
| | | | - Jennifer W Wu
- Hoffmann-La Roche Limited, Mississauga, Ontario, Canada
| | | | | |
Collapse
|
18
|
Møller LA, Martinsen B, Werlauf U, Dreyer P. Ageing with neuromuscular disease: Implications for a lifeworld-led care through a humanising approach. J Clin Nurs 2021; 31:2507-2517. [PMID: 34590372 DOI: 10.1111/jocn.16065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To understand the care and support needs in ageing with neuromuscular disease from a patient-user perspective. BACKGROUND The term neuromuscular disease covers several chronic hereditary or acquired disease subtypes. In the developed countries, advances in symptoms management, technical advancements and rehabilitation initiatives have resulted in increased life expectancy for some subtypes. Life with neuromuscular disease is thus likely to continue into adulthood and old age. However, knowledge of the care and support needs of patients ageing with neuromuscular disease remains sparse. DESIGN Adopting a user-participatory approach embedded in a phenomenological hermeneutic tradition, we conducted two user-group discussions focusing on care and support needs in people ageing with neuromuscular disease. Twenty-five users with neuromuscular disease participated in the group discussions. Data were analysed using a three-stepped analysis method inspired by the French Philosopher Paul Ricoeur. In the analysis process, dialectical movements between a surface interpretation and an in-depth understanding occur. The COREQ checklist was used to report the study. RESULTS Two themes were identified; 'Changes in the sheltering relationships of life require preparation' and 'Ageing introduces a dichotomy between circumstantial normalcy and minority groupness'. An understanding of care and support needs in life with neuromuscular disease was reached revealing a need for a lifeworld-led approach. CONCLUSION Persons ageing with neuromuscular disease crave a fusion of disease- and age-led care and support. This fusion may be achieved through the introduction of a lifeworld-led approach to care and support. RELEVANCE FOR CLINICAL PRACTICE Unmet care and support needs in people ageing with neuromuscular disease may result in patients experiencing fear and concern about their life situation. Healthcare professionals may play a crucial role in creating coherent lives for these persons if they understand the approach proposed herein to uncover the care and support needs in people ageing with neuromuscular disease.
Collapse
Affiliation(s)
| | - Bente Martinsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Ulla Werlauf
- The Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,University of Bergen, Bergen, Norway
| |
Collapse
|
19
|
Thompson KM, Kalkowska DA, Badizadegan K. Hypothetical emergence of poliovirus in 2020: part 1. Consequences of policy decisions to respond using nonpharmaceutical interventions. Expert Rev Vaccines 2021; 20:465-481. [PMID: 33624568 DOI: 10.1080/14760584.2021.1891888] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES As efforts to control COVID-19 continue, we simulate hypothetical emergence of wild poliovirus assuming an immunologically naïve population. This differs from the current global experience with polio and serves as a model for responding to future pandemics. METHODS Applying an established global model, we assume a fully susceptible global population to polioviruses, independently introduce a virus with properties of each of the three stable wild poliovirus serotypes, and explore the impact of strategies that range from doing nothing to seeking global containment and eradication. RESULTS We show the dynamics of paralytic cases as the virus spreads globally. We demonstrate the difficulty of eradication unless aggressive efforts begin soon after initial disease detection. Different poliovirus serotypes lead to different trajectories and burdens of disease. In the absence of aggressive measures, the virus would become globally endemic in 2-10 years, and cumulative paralytic cases would exceed 4-40 million depending on serotype, with the burden of disease shifting to younger ages. CONCLUSIONS The opportunity to eradicate emerging infections represents an important public policy choice. If the world first observed the emergence of wild poliovirus in 2020, adopting aggressive control strategies would have been required to prevent a devastating global pandemic.
Collapse
|
20
|
Withers A, Ching Man TC, D'Cruz R, de Vries H, Fisser C, Ribeiro C, Shah N, Van Hollebecke M, Vosse BAH, Heunks L, Patout M. Highlights from the Respiratory Failure and Mechanical Ventilation 2020 Conference. ERJ Open Res 2021; 7:00752-2020. [PMID: 33585653 PMCID: PMC7869593 DOI: 10.1183/23120541.00752-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/10/2020] [Indexed: 01/19/2023] Open
Abstract
The Respiratory Intensive Care Assembly of the European Respiratory Society organised the first Respiratory Failure and Mechanical Ventilation Conference in Berlin in February 2020. The conference covered acute and chronic respiratory failure in both adults and children. During this 3-day conference, patient selection, diagnostic strategies and treatment options were discussed by international experts. Lectures delivered during the event have been summarised by Early Career Members of the Assembly and take-home messages highlighted. During #RFMV2020, patient selection, diagnostic strategies and treatment options were discussed by international experts. This review summarises the most important take-home messages.https://bit.ly/3murkoa
Collapse
Affiliation(s)
- Adelaide Withers
- Respiratory Medicine, Perth Children's Hospital, Perth, Australia
| | - Tiffany Choi Ching Man
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong
| | - Rebecca D'Cruz
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Heder de Vries
- Intensive Care Department, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Christoph Fisser
- Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Carla Ribeiro
- Pulmonology Dept, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Neeraj Shah
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | | | - Bettine A H Vosse
- Dept of Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Centre of Home Mechanical Ventilation Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leo Heunks
- Intensive Care Department, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| |
Collapse
|
21
|
Abstract
Research and drug development concerning rare diseases are at the cutting edge of scientific technology. To date, over 7,000 rare diseases have been identified. Despite their individual rarity, 1 in 10 individuals worldwide is affected by a rare condition. For the majority of these diseases, there is no treatment, much less cure; therefore, there is an urgent need for new therapies to extend and improve quality of life for persons who suffer from them. Here we focus specifically on rare neuromuscular diseases. Currently, genetic medicines using short antisense oligonucleotides (ASO) or small interfering ribonucleic acids that target RNA transcripts are achieving spectacular success in treating these diseases. For Duchenne muscular dystrophy (DMD), the state-of-the-art is an exon skipping therapy using an antisense oligonucleotide, which is prototypical of advanced precision medicines. Very recently, golodirsen and viltolarsen, for treatment of DMD patients amenable to skipping exon 53, have been approved by regulatory agencies in the USA and Japan, respectively. Here, we review scientific and clinical progress in developing new oligonucleotide therapeutics for selected rare neuromuscular diseases, discussing their efficacy and limitations.
Collapse
Affiliation(s)
- Yoshitsugu Aoki
- Department of Molecular Therapy, National Institute of Neuroscience, National Centre of Neurology and Psychiatry, Kodaira-shi, Tokyo, Japan
| | - Matthew J.A. Wood
- Department of Paediatrics, University of Oxford, Oxford, UK
- Oxford Harrington Rare Disease Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
22
|
Abstract
Many neuromuscular disorders (NMD) are complicated by respiratory failure. These patients are best managed in a multidisciplinary outpatient clinic to provide timely access to the various disciplines they require. The key mainstay of treatment of respiratory failure in patients with NMD is noninvasive ventilation, supported by secretion clearance, speech and language therapy, optimisation of nutrition and the maintenance of mobility. Patients with specific conditions may also require cardiology, neurology, orthopaedics, urology and psychological services. The respiratory NMD multidisciplinary team should also provide access to palliative care, and caregiver health and wellbeing should also be reviewed at clinical reviews. The future of care for the respiratory NMD patient will increasingly involve home services and telehealth and the clinic should be equipped and resourced to deliver these. Although not all health systems will be able to provide all elements of the multidisciplinary team discussed here, this review provides the “ideal” recipe for the adult multidisciplinary team and the evidence base underpinning this from which a clinic can be developed. Care for neuromuscular-related respiratory failure is complex and is best delivered in a multidisciplinary context. The future will increasingly involve home services and telehealth, and their burden needs to be considered when establishing this service.https://bit.ly/33fNsMT
Collapse
Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Patrick B Murphy
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| |
Collapse
|
23
|
Lee JJ, Oh SH, Jeong YH, Park SM, Jeon HS, Kim HC, An SB, Shin DA, Yi S, Kim KN, Yoon DH, Shin JJ, Ha Y. Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders. Neurospine 2020; 17:513-524. [PMID: 33022156 PMCID: PMC7538346 DOI: 10.14245/ns.2040464.232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/22/2020] [Indexed: 12/26/2022] Open
Abstract
Neuromuscular disorders (NMDs) are diseases involving the upper and lower motor neurons and muscles. In patients with NMDs, cervical spinal deformities are a very common issue; however, unlike thoracolumbar spinal deformities, few studies have investigated these disorders. The patients with NMDs have irregular spinal curvature caused by poor balance and poor coordination of their head, neck, and trunk. Particularly, cervical deformity occurs at younger age, and is known to show more rigid and severe curvature at high cervical levels. Muscular physiologic dynamic characteristics such as spasticity or dystonia combined with static structural factors such as curvature flexibility can result in deformity and often lead to traumatic spinal cord injury. In addition, postoperative complication rate is higher due to abnormal involuntary movement and muscle tone. Therefore, it is important to control abnormal involuntary movement perioperatively along with strong instrumentation for correction of deformity. Various methods such as botulinum toxin injection, physical therapy, muscle division technique, or intrathecal baclofen pump implant may help control abnormal involuntary movements and improve spinal stability. Surgical management for cervical deformities associated with NMDs requires a multidisciplinary effort and a customized strategy.
Collapse
Affiliation(s)
- Jong Joo Lee
- Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Sung Han Oh
- Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Yeong Ha Jeong
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Man Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeong Seok Jeon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Cheol Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Bae An
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Uysal H, Taghiyeva P, Türkay M, Köse F, Aktekin M. Amyotrophic lateral sclerosis in Antalya, Turkey. A prospective study, 2016-2018. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:101-107. [PMID: 32924617 DOI: 10.1080/21678421.2020.1817089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the study is to find the prevalence and incidence of amyotrophic lateral sclerosis in Antalya and to define patient characteristics. METHODS The study represents five major districts in the Antalya metropolitan region, with a population of 1,286,943, which is defined as the provincial center. In cooperation with the neurology departments of all hospitals and private practices, existing cases were identified and new cases were recorded with continuous monitoring. Detailed demographic and clinical features of each patient were recorded, Revised El-Escorial Criteria were used for diagnosis. Incidence and prevalence rates are standardized by age based on USA 2016 population. RESULTS Point prevalence rates of 2016, 2017 and 2018 are 3.7, 4.7 and 5.4 per hundred thousand, respectively. Standardized prevalence rates for the US population are 5.5, 7.1 and 8.6 per hundred thousand in the same order. The incidence rate in 2017 is 1.4 per hundred thousand, and 2018 is 1.2. Standardized incidence rates for the US population are 2.1 and 1.8 per hundred thousand, respectively. About 75.6% of the cases were classified as definite, 11.0% probable, 11.0% possible, 2.4% probable laboratory-supported. The male/female ratio is 2.0 for total cases and 2.8 for new cases. The site of onset is spinal in 81.7% of patients and bulbar in 18.3%. CONCLUSIONS ALS rates detected in Antalya and the general features of the disease show similarities with European countries rather than Asian countries and comply with the literature.
Collapse
Affiliation(s)
- Hilmi Uysal
- Department of Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey, and
| | - Parvin Taghiyeva
- Department of Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey, and
| | - Mehtap Türkay
- Department of Public Health, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Fırat Köse
- Department of Public Health, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mehmet Aktekin
- Department of Public Health, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| |
Collapse
|
25
|
Araujo ECA, Marty B, Carlier PG, Baudin P, Reyngoudt H. Multiexponential Analysis of the Water
T2
‐Relaxation in the Skeletal Muscle Provides Distinct Markers of Disease Activity Between Inflammatory and Dystrophic Myopathies. J Magn Reson Imaging 2020; 53:181-189. [DOI: 10.1002/jmri.27300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ericky C. A. Araujo
- NMR laboratory, Neuromuscular Investigation Center Institute of Myology Paris France
- CEA, DRF, IBFJ, MIRCen Paris France
| | - Benjamin Marty
- NMR laboratory, Neuromuscular Investigation Center Institute of Myology Paris France
- CEA, DRF, IBFJ, MIRCen Paris France
| | - Pierre G. Carlier
- NMR laboratory, Neuromuscular Investigation Center Institute of Myology Paris France
- CEA, DRF, IBFJ, MIRCen Paris France
| | | | - Harmen Reyngoudt
- NMR laboratory, Neuromuscular Investigation Center Institute of Myology Paris France
- CEA, DRF, IBFJ, MIRCen Paris France
| |
Collapse
|
26
|
Abstract
The cause of amyotrophic lateral sclerosis (ALS) remains unknown for most of the patients with the disease. Epidemiologic studies can help describe disease burden and examine its potential risk factors, providing thereby evidence base for future mechanistic studies. With this review, we aimed to provide a summary of epidemiologic studies published during the past 18 months, which studied the incidence and risk factors for ALS.
Collapse
|
27
|
Stevenson V, Farrell R, Ramdharry G, Swayne O, Ward N, Leary S, Holmes S. Hospital based rehabilitation services; Rising to the challenge of the COVID-19 pandemic. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2020. [DOI: 10.47795/cigb9925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
28
|
Klawonn MA, Klamar K, Turk MA. Trends in publications about cerebral palsy 1990 to 2020. J Pediatr Rehabil Med 2020; 13:107-117. [PMID: 32568124 DOI: 10.3233/prm-200697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cerebral palsy (CP) is associated with complex health care needs and, although improved, a continued shortened life expectancy. In order to quantify and understand advances in the diagnosis and management of CP, systematic literature searches of key word groupings in the PubMed database were completed and revealed a recent increased incidence of publications focusing on quality of life, physical activity, exercise, and treatment options. Our bibliometric exploration revealed growing emphasis on function, performance, aging, and health compared to earlier studies when diagnostic features and brain pathology dominated research. Our findings highlight the transition from diagnosis and identification to management of specific conditions and providing guidance for the continuum of needs our patients experience over the course of a lifetime. The field must be prepared to advance our understanding of best practices and implement evidence-based interventions and management options.
Collapse
Affiliation(s)
- Meghan A Klawonn
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Karl Klamar
- Pediatric Rehabilitation Medicine, Nationwide Children's Hospital, Physical Medicine and Rehabilitation, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Margaret A Turk
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|