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Boentert M, Hermann A, Großkreutz J. Amyotrophic Lateral Sclerosis: Advances and Prospects. J Clin Med 2023; 12:5055. [PMID: 37568457 PMCID: PMC10419512 DOI: 10.3390/jcm12155055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023] Open
Abstract
The JCM Topical Collection "Amyotrophic Lateral Sclerosis: Latest Advances and Prospects" started in 2020 and currently includes 11 publications reflecting a broad range of clinical research areas in the ALS field [...].
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Affiliation(s)
- Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, Münster University Hospital, 48149 Münster, Germany
- Department of Medicine, UKM Marienhospital Steinfurt, 48565 Steinfurt, Germany
| | - Andreas Hermann
- Translational Degeneration Section ‘‘Albrecht Kossel”, Department of Neurology, University of Rostock, 18057 Rostock, Germany;
- German Center for Neurodegenerative Diseases Rostock/Greifswald, 18057 Rostock, Germany
| | - Julian Großkreutz
- Department of Neurology, Precision Medicine, University of Lübeck, 23538 Lübeck, Germany;
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Bhadola S, Tang C, Marks A, Kaku MC, Zhou L, Siao P, Vincent Lau K. Disparate healthcare access and telehealth-based hybrid consultations during the COVID-19 pandemic. Work 2022; 73:377-382. [DOI: 10.3233/wor-211463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The coronavirus disease-2019 pandemic led to rapid expansion of telehealth services. This was speculated to improve healthcare access among underserved populations, including individuals unable to take time off work or arrange transportation. OBJECTIVE: We completed a quality improvement project to evaluate the feasibility of hybrid consultations that combined televisits and abbreviated in-person visits for neuromuscular referrals. METHODS: Using a censoring date of August 5, 2021, we reviewed all outpatient neuromuscular consultations from August 5, 2020 to February 5, 2021. For both hybrid and traditional in-person consultations, we reviewed no-show rates, completion rates of ordered diagnostic workup, and billing codes. For hybrid consultations only, we also reviewed intervals between initial televisit and subsequent examination and rates of video-enhanced versus audio-only televisits. RESULTS: During the study period, we completed 153 hybrid and 59 in-person new-patient consultations (no-show rates 9% and 27% respectively.) For hybrid consultations, 77% and 73% of laboratory and imaging studies were completed respectively, compared to 89% and 91% for in-person consultations. For hybrid visits, average RVUs (a marker for reimbursement) per consultation depended on whether audio-only televisits were billed as telephone calls or E/M visits per insurance payer rules, while video-enhanced televisits were uniformly billed as E/M visits. This resulted in average RVUs between 2.09 and 2.26, compared to 2.30 for in-person consultations. CONCLUSIONS: Telehealth-based hybrid neuromuscular consultations are feasible with minor caveats. However, the future of telehealth may be restricted by decreasing reimbursement rates particularly for audio-only televisits, limiting its potential to improve healthcare access.
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Affiliation(s)
- Shivkumar Bhadola
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Connie Tang
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Ariel Marks
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Michelle C. Kaku
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Lan Zhou
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Peter Siao
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - K.H. Vincent Lau
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Pugliese R, Sala R, Regondi S, Beltrami B, Lunetta C. Emerging technologies for management of patients with amyotrophic lateral sclerosis: from telehealth to assistive robotics and neural interfaces. J Neurol 2022; 269:2910-2921. [PMID: 35059816 PMCID: PMC8776511 DOI: 10.1007/s00415-022-10971-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 12/17/2022]
Abstract
Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease, is characterized by the degeneration of both upper and lower motor neurons, which leads to muscle weakness and subsequently paralysis. It begins subtly with focal weakness but spreads relentlessly to involve most muscles, thus proving to be effectively incurable. Typically, death due to respiratory paralysis occurs in 3–5 years. To date, it has been shown that the management of ALS patients is best achieved with a multidisciplinary approach, and with the help of emerging technologies ranging from multidisciplinary teleconsults (for monitoring the dysphagia, respiratory function, and nutritional status) to brain-computer interfaces and eye tracking for alternative augmentative communication, until robotics, it may increase effectiveness. The COVID-19 pandemic created a spasmodic need to accelerate the development and implementation of such technologies in clinical practice, to improve the daily lives of both ALS patients and caregivers. However, despite the remarkable strides that have been made in the field, there are still issues to be addressed. This review will be discussed on the eureka moment of emerging technologies for ALS, used as a blueprint not only for neurodegenerative diseases, examining the current technologies already in place or being evaluated, highlighting the pros and cons for future clinical applications.
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Affiliation(s)
| | - Riccardo Sala
- NeMO Lab, ASST Niguarda Cà Granda Hospital, Milan, Italy
| | - Stefano Regondi
- NeMO Lab, ASST Niguarda Cà Granda Hospital, Milan, Italy
- NEuroMuscolar Omnicentre, Milan, Italy
| | | | - Christian Lunetta
- NeMO Lab, ASST Niguarda Cà Granda Hospital, Milan, Italy.
- NEuroMuscolar Omnicentre, Milan, Italy.
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Torrieri MC, Manera U, Mora G, Canosa A, Vasta R, Fuda G, Salamone P, Grassano M, Cugnasco P, Launaro N, De Marchi F, Mattei A, Mazzini L, Moglia C, Calvo A, Chiò A. Tailoring patients' enrollment in ALS clinical trials: the effect of disease duration and vital capacity cutoffs. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:108-115. [PMID: 34355622 DOI: 10.1080/21678421.2021.1936063] [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: 10/20/2022]
Abstract
Objective: To evaluate how Amyotrophic Lateral Sclerosis (ALS) patients' mortality rates change, based on different levels of forced vital capacity (FVC) and disease duration, providing a scheme of mortality rates of a real population of ALS patients to improve the design of future RCTs. Methods: One random spirometry for each ALS patient was selected during four time intervals from disease onset: (1) ≤12 months; (2) ≤18 months; (3) ≤24 months; (4) ≤36 months. Date of spirometry corresponded to date of trial entry, while time interval onset-spirometry to disease duration at enrollment. Mortality rates from inclusion were computed at different time intervals. Based on progression rates, patients were stratified in slow, intermediate and fast progressors. Survival from recruitment was calculated depending on FVC, disease duration and progression rate. Results: We included 659 patients in group 1, 888 in group 2, 1019 in group 3 and 1102 in group 4. Mortality rates were higher in each group at reducing the FVC cutoff used for recruitment (p < 0.001). Median survival decreased when lowering FVC and disease duration cutoffs (p < 0.001); a higher median disease progression rate of included patients led to lower median survival from recruitment. The proportion of recruited fast progressors raised when shortening disease duration and lowering FVC cutoff. Conclusions: This is a simple model for setting eligibility criteria, based on mortality rates of patients depending on FVC and disease duration, to select the best population for RCTs, tailored to trials' primary endpoints and duration.
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Affiliation(s)
| | - Umberto Manera
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Gabriele Mora
- Neurorehabilitation Department, Institute of Milan, ICS Maugeri IRCCS, Milan, Italy
| | - Antonio Canosa
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Rosario Vasta
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Giuseppe Fuda
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Paolina Salamone
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Maurizio Grassano
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Paolo Cugnasco
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Nicola Launaro
- Respiratory Intensive Care Unit, Presidio Ospedaliero di Saluzzo, Saluzzo, Italy
| | - Fabiola De Marchi
- Department of Neurology and ALS Centre, Maggiore della Carità Hospital, University of Piemonte Orientale, Novara, Italy, and
| | - Alessio Mattei
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, S.C. Pneumologia U, Turin, Italy
| | - Letizia Mazzini
- Department of Neurology and ALS Centre, Maggiore della Carità Hospital, University of Piemonte Orientale, Novara, Italy, and
| | - Cristina Moglia
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Calvo
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Adriano Chiò
- Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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Steinbach R, Prell T, Gaur N, Roediger A, Gaser C, Mayer TE, Witte OW, Grosskreutz J. Patterns of grey and white matter changes differ between bulbar and limb onset amyotrophic lateral sclerosis. Neuroimage Clin 2021; 30:102674. [PMID: 33901988 PMCID: PMC8099783 DOI: 10.1016/j.nicl.2021.102674] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/18/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that is characterized by a high heterogeneity in patients' disease course. Patients with bulbar onset of symptoms (b-ALS) have a poorer prognosis than patients with limb onset (l-ALS). However, neuroimaging correlates of the assumed biological difference between b-ALS and l-ALS may have been obfuscated by patients' diversity in the disease course. We conducted Voxel-Based-Morphometry (VBM) and Tract-Based-Spatial-Statistics (TBSS) in a group of 76 ALS patients without clinically relevant cognitive deficits. The subgroups of 26 b-ALS and 52 l-ALS patients did not differ in terms of disease Phase or disease aggressiveness according to the D50 progression model. VBM analyses showed widespread ALS-related changes in grey and white matter, that were more pronounced for b-ALS. TBSS analyses revealed that b-ALS was predominantly characterized by frontal fractional anisotropy decreases. This demonstrates a higher degree of neurodegenerative burden for the group of b-ALS patients in comparison to l-ALS. Correspondingly, higher bulbar symptom burden was associated with right-temporal and inferior-frontal grey matter density decreases as well as fractional anisotropy decreases in inter-hemispheric and long association tracts. Contrasts between patients in Phase I and Phase II further revealed that b-ALS was characterized by an early cortical pathology and showed a spread only outside primary motor regions to frontal and temporal areas. In contrast, l-ALS showed ongoing structural integrity loss within primary motor-regions until Phase II. We therefore provide a strong rationale to treat both onset types of disease separately in ALS studies.
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Affiliation(s)
- Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
| | - Tino Prell
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena
| | - Nayana Gaur
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Christian Gaser
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Thomas E Mayer
- Department of Neuroradiology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena
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