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Caggiano C, Morselli M, Qian X, Celona B, Thompson M, Wani S, Tosevska A, Taraszka K, Heuer G, Ngo S, Steyn F, Nestor P, Wallace L, McCombe P, Heggie S, Thorpe K, McElligott C, English G, Henders A, Henderson R, Lomen-Hoerth C, Wray N, McRae A, Pellegrini M, Garton F, Zaitlen N. Tissue informative cell-free DNA methylation sites in amyotrophic lateral sclerosis. medRxiv 2024:2024.04.08.24305503. [PMID: 38645132 PMCID: PMC11030489 DOI: 10.1101/2024.04.08.24305503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Cell-free DNA (cfDNA) is increasingly recognized as a promising biomarker candidate for disease monitoring. However, its utility in neurodegenerative diseases, like amyotrophic lateral sclerosis (ALS), remains underexplored. Existing biomarker discovery approaches are tailored to a specific disease context or are too expensive to be clinically practical. Here, we address these challenges through a new approach combining advances in molecular and computational technologies. First, we develop statistical tools to select tissue-informative DNA methylation sites relevant to a disease process of interest. We then employ a capture protocol to select these sites and perform targeted methylation sequencing. Multi-modal information about the DNA methylation patterns are then utilized in machine learning algorithms trained to predict disease status and disease progression. We applied our method to two independent cohorts of ALS patients and controls (n=192). Overall, we found that the targeted sites accurately predicted ALS status and replicated between cohorts. Additionally, we identified epigenetic features associated with ALS phenotypes, including disease severity. These findings highlight the potential of cfDNA as a non-invasive biomarker for ALS.
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Affiliation(s)
- C Caggiano
- Department of Neurology, UCLA, Los Angeles, California
- Institute of Genomic Health, Icahn School of Medicine at Mt Sinai, New York, New York
| | - M Morselli
- Department of Molecular, Cell, and Developmental Biology, UCLA; Los Angeles, California
- Department of Chemistry, Life Sciences, and Environmental Sustainability, University of Parma, Parma, Italy
| | - X Qian
- Institute for Molecular Biology, University of Queensland, Brisbane, Australia
| | - B Celona
- Cardiovascular Research Institute, UCSF, San Francisco, California
| | - M Thompson
- Department of Neurology, UCLA, Los Angeles, California
- Systems and Synthetic Biology, Centre for Genomic Regulation, Barcelona, Spain
| | - S Wani
- Cardiovascular Research Institute, UCSF, San Francisco, California
| | - A Tosevska
- Department of Molecular, Cell, and Developmental Biology, UCLA; Los Angeles, California
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - K Taraszka
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - G Heuer
- Computational and Systems Biology Interdepartmental Program, UCLA, Los Angeles, California
| | - S Ngo
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - F Steyn
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - P Nestor
- Queensland Brain Institute, Unviversity of Queensland, Brisbane, Australia
- Mater Public Hospital, Brisbane, Australia
| | - L Wallace
- Institute for Molecular Biology, University of Queensland, Brisbane, Australia
| | - P McCombe
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S Heggie
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - K Thorpe
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | - G English
- Institute for Molecular Biology, University of Queensland, Brisbane, Australia
| | - A Henders
- Institute for Molecular Biology, University of Queensland, Brisbane, Australia
| | - R Henderson
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - C Lomen-Hoerth
- Department of Neurology, UCSF, San Francisco, California
| | - N Wray
- Institute for Molecular Biology, University of Queensland, Brisbane, Australia
| | - A McRae
- Institute for Molecular Biology, University of Queensland, Brisbane, Australia
| | - M Pellegrini
- Department of Chemistry, Life Sciences, and Environmental Sustainability, University of Parma, Parma, Italy
| | - F Garton
- Institute for Molecular Biology, University of Queensland, Brisbane, Australia
| | - N Zaitlen
- Department of Neurology, UCLA, Los Angeles, California
- Department of Human Genetics, University of California Los Angeles, Los Angeles, California
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Witzel S, Micca V, Müller HP, Huss A, Bachhuber F, Dorst J, Lulé DE, Tumani H, Kassubek J, Ludolph AC. Primary lateral sclerosis: application and validation of the 2020 consensus diagnostic criteria in an expert opinion-based PLS cohort. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333023. [PMID: 38388486 DOI: 10.1136/jnnp-2023-333023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Validation of the 2020 consensus criteria for primary lateral sclerosis (PLS) is essential for their use in clinical practice and future trials. METHODS In a large cohort of patients diagnosed with PLS by expert opinion prior to the new criteria with detailed clinical baseline evaluation (n=107) and longitudinal follow-up (n=63), we applied the new diagnostic criteria and analysed the clinical phenotype, electromyography (EMG), diagnostic accuracy and prognosis, adding neurofilaments and MRI as potential biomarkers. RESULTS The criteria for definite PLS were met by 28% and those for probable PLS by 19%, whereas 53% did not meet the full criteria at baseline, mainly due to the time, EMG and region criteria. Patients not meeting the criteria had less generalised upper motor neuron involvement but were otherwise similar in demographic and clinical characteristics. All patients with definite and probable PLS maintained PLS diagnosis during follow-up, while four patients not meeting the criteria developed clinical lower motor neuron involvement. Definite PLS cases showed improved survival compared with probable PLS and patients who did not meet the criteria. Despite a clinical PLS phenotype, fibrillation potentials/positive sharp waves and fasciculations in one or more muscles were a frequent EMG finding, with the extent and prognostic significance depending on disease duration. Serum neurofilament light and a multiparametric MRI fibre integrity Z-score correlated with clinical parameters and were identified as potential biomarkers. CONCLUSION Validation of the 2020 PLS consensus criteria revealed high diagnostic certainty and prognostic significance, supporting their value for research and clinical practice.
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Affiliation(s)
- Simon Witzel
- Department of Neurology, Ulm University, Ulm, Germany
| | | | - Hans P Müller
- Department of Neurology, Ulm University, Ulm, Germany
| | - André Huss
- Department of Neurology, Ulm University, Ulm, Germany
| | | | | | | | | | - Jan Kassubek
- Department of Neurology, Ulm University, Ulm, Germany
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Vacchiano V, Bonan L, Liguori R, Rizzo G. Primary Lateral Sclerosis: An Overview. J Clin Med 2024; 13:578. [PMID: 38276084 PMCID: PMC10816328 DOI: 10.3390/jcm13020578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Primary lateral sclerosis (PLS) is a rare neurodegenerative disorder which causes the selective deterioration of the upper motor neurons (UMNs), sparing the lower motor neuron (LMN) system. The clinical course is defined by a progressive motor disability due to muscle spasticity which typically involves lower extremities and bulbar muscles. Although classically considered a sporadic disease, some familiar cases and possible causative genes have been reported. Despite it having been recognized as a rare but distinct entity, whether it actually represents an extreme end of the motor neuron diseases continuum is still an open issue. The main knowledge gap is the lack of specific biomarkers to improve the clinical diagnostic accuracy. Indeed, the diagnostic imprecision, together with some uncertainty about overlap with UMN-predominant ALS and Hereditary Spastic Paraplegia (HSP), has become an obstacle to the development of specific therapeutic trials. In this study, we provided a comprehensive analysis of the existing literature, including neuropathological, clinical, neuroimaging, and neurophysiological features of the disease, and highlighting the controversies still unsolved in the differential diagnoses and the current diagnostic criteria. We also discussed the current knowledge gaps still present in both diagnostic and therapeutic fields when approaching this rare condition.
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Affiliation(s)
- Veria Vacchiano
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40139 Bologna, Italy; (V.V.); (R.L.)
| | - Luigi Bonan
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
| | - Rocco Liguori
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40139 Bologna, Italy; (V.V.); (R.L.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
| | - Giovanni Rizzo
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40139 Bologna, Italy; (V.V.); (R.L.)
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Beswick E, Forbes D, Johnson M, Newton J, Dakin R, Glasmcher S, Abrahams S, Carson A, Chandran S, Pal S. Non-motor symptoms in motor neuron disease: prevalence, assessment and impact. Brain Commun 2023; 6:fcad336. [PMID: 38162906 PMCID: PMC10754319 DOI: 10.1093/braincomms/fcad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/27/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024] Open
Abstract
People with motor neuron disease often experience non-motor symptoms that may occur secondary to, or distinct from, motor degeneration and that may significantly reduce quality of life, despite being under-recognized and evaluated in clinical practice. Non-motor symptoms explored in this population-based study include pain, fatigue, gastrointestinal issues, poor sleep, low mood, anxiety, problematic saliva, apathy, emotional lability, cognitive complaints and sexual dysfunction. People registered on the Clinical Audit Research and Evaluation of motor neuron disease platform, the Scottish Motor Neuron Disease Register, were invited to complete a questionnaire on non-motor symptoms and a self-reported Amyotrophic Lateral Sclerosis Functional Rating Scale. The questionnaire comprised a pre-defined list of 11 potential non-motor symptoms, with the opportunity to list additional symptoms. A total of 120 individuals participated in this cross-sectional study, a 39% response rate of those sent questionnaires (n = 311); 99% of participants recruited (n = 120) experienced at least one non-motor symptom, with 72% (n = 120) reporting five or more. The symptoms most often reported were pain and fatigue (reported by 76% of participants, respectively). The symptoms reported to be most impactful were gastrointestinal issues (reported as 'severe' by 54% of participants who experienced them), followed by pain and problematic saliva (51%, respectively). Lower Amyotrophic Lateral Sclerosis Functional Rating Scale scores, indicating more advanced disease and being a long survivor [diagnosed over 8 years ago; Black et al. (Genetic epidemiology of motor neuron disease-associated variants in the Scottish population. Neurobiol Aging. 2017;51:178.e11-178.e20.)], were significantly associated with reporting more symptoms; 73% of respondents were satisfied with the frequency that non-motor symptoms were discussed in clinical care; 80% of participants indicated they believe evaluation of non-motor symptom is important to include as outcomes in trials, independent of their personal experience of these symptoms. The preferred method of assessment was completing questionnaires, at home. The overwhelming majority of people with motor neuron disease report non-motor symptoms and these frequently co-occur. Pain, fatigue, gastrointestinal issues, sleep, mood, anxiety, problematic saliva, apathy, emotional lability, cognitive complaints and sexual dysfunction are prevalent. People with motor neuron disease who had worse physical function and those who were long survivors were more likely to report more symptoms. Where reported, these symptoms are frequent, impactful and a priority for people with motor neuron disease in clinical care and trial design.
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Affiliation(s)
- Emily Beswick
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Deborah Forbes
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Micheala Johnson
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Judith Newton
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Rachel Dakin
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Stella Glasmcher
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
- Human Cognitive Neurosciences, Psychology, School of Philosophy, Psychology and Language Sciences, the University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, the University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, the University of Edinburgh, Edinburgh, UK
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Pottinger TD, Motelow JE, Povysil G, Moreno CAM, Ren Z, Phatnani H, Aitman TJ, Santoyo-Lopez J, Mitsumoto H, Goldstein DB, Harms MB. Rare variant analyses validate known ALS genes in a multi-ethnic population and identifies ANTXR2 as a candidate in PLS. medRxiv 2023:2023.09.30.23296353. [PMID: 37873269 PMCID: PMC10593055 DOI: 10.1101/2023.09.30.23296353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting over 30,000 people in the United States. It is characterized by the progressive decline of the nervous system that leads to the weakening of muscles which impacts physical function. Approximately, 15% of individuals diagnosed with ALS have a known genetic variant that contributes to their disease. As therapies that slow or prevent symptoms, such as antisense oligonucleotides, continue to develop, it is important to discover novel genes that could be targets for treatment. Additionally, as cohorts continue to grow, performing analyses in ALS subtypes, such as primary lateral sclerosis (PLS), becomes possible due to an increase in power. These analyses could highlight novel pathways in disease manifestation. Methods Building on our previous discoveries using rare variant association analyses, we conducted rare variant burden testing on a substantially larger cohort of 6,970 ALS patients from a large multi-ethnic cohort as well as 166 PLS patients, and 22,524 controls. We used intolerant domain percentiles based on sub-region Residual Variation Intolerance Score (subRVIS) that have been described previously in conjunction with gene based collapsing approaches to conduct burden testing to identify genes that associate with ALS and PLS. Results A gene based collapsing model showed significant associations with SOD1, TARDBP, and TBK1 (OR=19.18, p = 3.67 × 10-39; OR=4.73, p = 2 × 10-10; OR=2.3, p = 7.49 × 10-9, respectively). These genes have been previously associated with ALS. Additionally, a significant novel control enriched gene, ALKBH3 (p = 4.88 × 10-7), was protective for ALS in this model. An intolerant domain based collapsing model showed a significant improvement in identifying regions in TARDBP that associated with ALS (OR=10.08, p = 3.62 × 10-16). Our PLS protein truncating variant collapsing analysis demonstrated significant case enrichment in ANTXR2 (p=8.38 × 10-6). Conclusions In a large multi-ethnic cohort of 6,970 ALS patients, rare variant burden testing validated known ALS genes and identified a novel potentially protective gene, ALKBH3. A first-ever analysis in 166 patients with PLS found a candidate association with loss-of-function mutations in ANTXR2.
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Affiliation(s)
- Tess D. Pottinger
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Joshua E. Motelow
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Gundula Povysil
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | | | - Zhong Ren
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Hemali Phatnani
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, United States of America
- Center for Motor Neuron Biology and Disease, Columbia University Irving Medical Center, New York, New York, United States of America
- New York Genome Center, New York, New York, United States of America
| | | | - Timothy J. Aitman
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, Scotland
| | | | | | - Hiroshi Mitsumoto
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, United States of America
| | | | | | | | - David B. Goldstein
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Matthew B. Harms
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, United States of America
- Center for Motor Neuron Biology and Disease, Columbia University Irving Medical Center, New York, New York, United States of America
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Schito P, Russo T, Domi T, Mandelli A, Pozzi L, Del Carro U, Carrera P, Agosta F, Quattrini A, Furlan R, Filippi M, Riva N. Clinical Features and Biomarkers to Differentiate Primary and Amyotrophic Lateral Sclerosis in Patients With an Upper Motor Neuron Syndrome. Neurology 2023; 101:352-356. [PMID: 36927885 PMCID: PMC10449441 DOI: 10.1212/wnl.0000000000207223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Differentiation between primary (PLS) and amyotrophic lateral sclerosis (ALS) entails relevant consequences for prognosis and management but is mostly unreliable at early stages. The objectives of the study are (1) to determine the features at onset that could help to differentiate between PLS and ALS, (2) to evaluate the diagnostic performance of an integrated serum biomarker panel, and (3) to identify the prognostic factors for patients presenting with upper motor neuron (UMN) syndrome. METHODS We selected and retrospectively analyzed the clinical data of patients presenting with UMN syndrome. At the first evaluation, when available, serum biomarkers were measured using ultrasensitive single molecule array. RESULTS The study population included 55 patients with PLS and 50 patients with ALS. Patients with PLS presented a longer time to first neurologic evaluation (PLS: 35.0 months, interquartile range [IQR] 17.0-38.0 months; ALS: 12.5 months, IQR 7.0-21.3 months; p < 0.01) and lower levels of neurofilament light chain (NfL) (PLS: 81.8 pg/mL, IQR 38.4-111.1 pg/mL; ALS: 155.9 pg/mL, IQR 85.1-366.4 pg/mL; p = 0.01). Two patients with PLS and 3 patients with ALS carried the C9orf72 expansion. NfL resulted an independent predictor of final diagnosis (odds ratio 1.01, 95% CI 1.00-1.02; p = 0.04) and an independent prognostic factor (hazard ratio 1.01, 95% CI 1.00-1.01; p < 0.01). DISCUSSION NfL might help to differentiate patients with PLS from patients with ALS and to predict prognosis in patients with UMN syndrome.
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Affiliation(s)
- Paride Schito
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Tommaso Russo
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Teuta Domi
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Mandelli
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Pozzi
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ubaldo Del Carro
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paola Carrera
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federica Agosta
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Angelo Quattrini
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Furlan
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Massimo Filippi
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nilo Riva
- From the Experimental Neuropathology Unit (P.S., T.R., T.D., L.P., A.Q., N.R.), Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute; Neurology Unit (P.S., T.R., M.F.), Neurophysiology Unit (P.S., U.D.C., M.F.), and Neurorehabilitation Unit (P.S., M.F.), IRCCS San Raffaele Scientific Institute; Clinical Neuroimmunology Unit (A.M., R.F.), Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute; Division of Genetics and Cell Biology (P.C.), Unit of Genomics for Human Disease Diagnosis, Laboratory of Clinical Molecular Biology, IRCCS Ospedale San Raffaele; Neuroimaging Research Unit (F.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (F.A., M.F.); and 3rd Neurology Unit and Motor Neuron Disease Centre (N.R.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
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7
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Alves I, Gromicho M, Oliveira Santos M, Pinto S, Pronto-Laborinho A, Swash M, de Carvalho M. Demographic changes in a large motor neuron disease cohort in Portugal: a 27 year experience. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-11. [PMID: 37295966 DOI: 10.1080/21678421.2023.2220747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
Objective: Motor Neuron Diseases (MND) have a large clinical spectrum, being the most common amyotrophic lateral sclerosis (ALS) but there is significant clinical heterogeneity. Our goal was to investigate this heterogeneity and any potential changes during a long period. Methods: We performed a retrospective cohort study among a large Portuguese cohort of MND patients (n = 1550) and investigated changing patterns in clinical and demographic characteristics over the 27-year period of our database. With that aim, patients were divided into three 9-year groups according to the date of their first visit to our unit: P1, 1994-2002; P2, 2003-2011; P3, 2012-2020. Results: The overall cohort's clinical and demographic characteristics are consistent with clinical experience, but our findings point to gradual changes over time. Time pattern analysis revealed statistically significant differences in the distribution of clinical phenotypes, the average age of onset, diagnostic delay, the proportin of patients using respiratory support with noninvasive ventilation (NIV), time to NIV, and survival. Across time, in the overall cohort, we found an increasing age at onset (p = 0.029), a decrease of two months in diagnostic delay (p < 0.001) and a higher relative frequency of progressive muscular atrophy patients. For ALS patients with spinal onset, from P1 to P2, there was a more widespread (54.8% vs 69.4%, p = 0.005) and earlier (36.9 vs 27.2 months, p = 0.05) use of NIV and a noteworthy 13-month increase in median survival (p = 0.041). Conclusions: Our results probably reflect better comprehensive care, and they are relevant for future studies exploring the impact of new treatments on ALS patients.
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Affiliation(s)
- Inês Alves
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Marta Gromicho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Oliveira Santos
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal, and
| | - Susana Pinto
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Pronto-Laborinho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Michael Swash
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Mamede de Carvalho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal, and
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8
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Leighton DJ, Ansari M, Newton J, Parry D, Cleary E, Colville S, Stephenson L, Larraz J, Johnson M, Beswick E, Wong M, Gregory J, Carod Artal J, Davenport R, Duncan C, Morrison I, Smith C, Swingler R, Deary IJ, Porteous M, Aitman TJ, Chandran S, Gorrie GH, Pal S. Genotype-phenotype characterisation of long survivors with motor neuron disease in Scotland. J Neurol 2023; 270:1702-1712. [PMID: 36515702 PMCID: PMC9971124 DOI: 10.1007/s00415-022-11505-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND We investigated the phenotypes and genotypes of a cohort of 'long-surviving' individuals with motor neuron disease (MND) to identify potential targets for prognostication. METHODS Patients were recruited via the Clinical Audit Research and Evaluation for MND (CARE-MND) platform, which hosts the Scottish MND Register. Long survival was defined as > 8 years from diagnosis. 11 phenotypic variables were analysed. Whole genome sequencing (WGS) was performed and variants within 49 MND-associated genes examined. Each individual was screened for C9orf72 repeat expansions. Data from ancestry-matched Scottish populations (the Lothian Birth Cohorts) were used as controls. RESULTS 58 long survivors were identified. Median survival from diagnosis was 15.5 years. Long survivors were significantly younger at onset and diagnosis than incident patients and had a significantly longer diagnostic delay. 42% had the MND subtype of primary lateral sclerosis (PLS). WGS was performed in 46 individuals: 14 (30.4%) had a potentially pathogenic variant. 4 carried the known SOD1 p.(Ile114Thr) variant. Significant variants in FIG4, hnRNPA2B1, SETX, SQSTM1, TAF15, and VAPB were detected. 2 individuals had a variant in the SPAST gene suggesting phenotypic overlap with hereditary spastic paraplegia (HSP). No long survivors had pathogenic C9orf72 repeat expansions. CONCLUSIONS Long survivors are characterised by younger age at onset, increased prevalence of PLS and longer diagnostic delay. Genetic analysis in this cohort has improved our understanding of the phenotypes associated with the SOD1 variant p.(Ile114Thr). Our findings confirm that pathogenic expansion of C9orf72 is likely a poor prognostic marker. Genetic screening using targeted MND and/or HSP panels should be considered in those with long survival, or early-onset slowly progressive disease, to improve diagnostic accuracy and aid prognostication.
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Affiliation(s)
- Danielle J Leighton
- School of Psychology & Neuroscience, University of Glasgow, Glasgow, UK.
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK.
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK.
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Morad Ansari
- South East Scotland Genetics Service, Western General Hospital, Edinburgh, UK
| | - Judith Newton
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Parry
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Elaine Cleary
- South East Scotland Genetics Service, Western General Hospital, Edinburgh, UK
| | - Shuna Colville
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Laura Stephenson
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
| | - Juan Larraz
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
| | - Micheala Johnson
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
| | - Emily Beswick
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
| | - Michael Wong
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
| | - Jenna Gregory
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Richard Davenport
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
| | - Callum Duncan
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ian Morrison
- Department of Neurology, NHS Tayside, Dundee, UK
| | - Colin Smith
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Robert Swingler
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Lothian Birth Cohorts Group, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mary Porteous
- South East Scotland Genetics Service, Western General Hospital, Edinburgh, UK
| | - Timothy J Aitman
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - George H Gorrie
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Suvankar Pal
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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9
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Agarwal A, Desai A, Gupta V. Primary Lateral Sclerosis. Mayo Clin Proc 2023; 98:299-300. [PMID: 36737118 DOI: 10.1016/j.mayocp.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/17/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Amit Agarwal
- Department of Radiology, Mayo Clinic, Jacksonville, FL.
| | - Amit Desai
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - Vivek Gupta
- Department of Radiology, Mayo Clinic, Jacksonville, FL
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10
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Meo G, Ferraro PM, Cillerai M, Gemelli C, Cabona C, Zaottini F, Roccatagliata L, Villani F, Schenone A, Caponnetto C. MND Phenotypes Differentiation: The Role of Multimodal Characterization at the Time of Diagnosis. Life (Basel) 2022; 12:life12101506. [PMID: 36294940 PMCID: PMC9604895 DOI: 10.3390/life12101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Pure/predominant upper motor neuron (pUMN) and lower motor neuron (pLMN) diseases have significantly better prognosis compared to amyotrophic lateral sclerosis (ALS), but their early differentiation is often challenging. We therefore tested whether a multimodal characterization approach embedding clinical, cognitive/behavioral, genetic, and neurophysiological data may improve the differentiation of pUMN and pLMN from ALS already by the time of diagnosis. Dunn’s and chi-squared tests were used to compare data from 41 ALS, 34 pLMN, and 19 pUMN cases with diagnoses confirmed throughout a 2-year observation period. Area under the curve (AUC) analyses were implemented to identify the finest tools for phenotypes discrimination. Relative to ALS, pLMN showed greater lower limbs weakness, lower UMN burden, and progression rate (p < 0.001−0.04). PUMN showed a greater frequency of lower limbs onset, higher UMN burden, lower ALSFRS-r and MRC progression rates (p < 0.001−0.03), and greater ulnar compound muscle action potential (CMAP) amplitude and tibial central motor conduction time (CMCT) (p = 0.05−0.03). The UMN progression rate was the finest measure to identify pLMN cases (AUC = 90%), while the MRC progression rate was the finest tool to identify pUMN (AUC = 82%). Detailed clinical and neurophysiological examinations may significantly improve MNDs differentiation, facilitating prognosis estimation and ameliorating stratification strategies for clinical trials enrollment.
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Affiliation(s)
- Giuseppe Meo
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Pilar M. Ferraro
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-01-0353-7040
| | - Marta Cillerai
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Chiara Gemelli
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Corrado Cabona
- Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Federico Zaottini
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy
| | - Flavio Villani
- Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Angelo Schenone
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Claudia Caponnetto
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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11
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Witzel S, Wagner M, Zhao C, Kandler K, Graf E, Berutti R, Oexle K, Brenner D, Winkelmann J, Ludolph AC. Fast Versus Slow Disease Progression in Amyotrophic Lateral Sclerosis – Clinical and Genetic Factors at the Edges of the Survival Spectrum. Neurobiol Aging 2022. [DOI: 10.1016/j.neurobiolaging.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
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12
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Hassan A, Mittal SO, Hu WT, Josephs KA, Sorenson EJ, Ahlskog JE. Does limited EMG denervation in early primary lateral sclerosis predict amyotrophic lateral sclerosis? Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:554-561. [PMID: 35170382 DOI: 10.1080/21678421.2022.2039714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective: We assessed whether a cohort of patients with primary lateral sclerosis (PLS) and limited electromyography (EMG) motor unit denervation changes evolve into amyotrophic lateral sclerosis (ALS) with prolonged follow-up. Methods: We initially ascertained all PLS patients diagnosed at Mayo Clinic-Rochester (1990-2016). Of 64 total cases, 43 had normal EMGs ("pure" PLS) during the first 4 years after symptom onset and were the focus of a prior publication, documenting absence of evolution to ALS. The remaining 21 patients had limited motor unit changes on EMG needle examination (denervation and most with fibrillation or fasciculation potentials) but insufficient to raise a strong suspicion of ALS; these 21 patients were followed to determine whether they evolved into ALS. Results: Of these 21 patients, the median follow-up was 7 years' disease duration (range: 4-27 years; IQR 5-8.5). They included 11 females (52%) with median onset-age of 57 years (range: 42-72 years). Two patients (10%) subsequently met revised El Escorial criteria for ALS after 7 and 13 years, respectively. The remainder had stable EMG changes with a persistent PLS phenotype. Among these remaining 19 patients, the PLS course was somewhat more aggressive than our previously reported series of 43 patients devoid of EMG denervation. The paraparetic variant was more common than the hemiparetic and bulbar variants, similar to "pure" PLS. Conclusions: Among PLS patients with definite but limited EMG denervation, 2/21 (10%) later developed ALS. The patients in this series had a more progressive clinical course compared to our previously reported pure PLS cases.
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Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Shivam O Mittal
- Department of Neurology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, and
| | - William T Hu
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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13
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Behzadi A, Pujol-Calderón F, Tjust AE, Wuolikainen A, Höglund K, Forsberg K, Portelius E, Blennow K, Zetterberg H, Andersen PM. Neurofilaments can differentiate ALS subgroups and ALS from common diagnostic mimics. Sci Rep 2021; 11:22128. [PMID: 34764380 DOI: 10.1038/s41598-021-01499-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022] Open
Abstract
Delayed diagnosis and misdiagnosis are frequent in people with amyotrophic lateral sclerosis (ALS), the most common form of motor neuron disease (MND). Neurofilament light chain (NFL) and phosphorylated neurofilament heavy chain (pNFH) are elevated in ALS patients. We retrospectively quantified cerebrospinal fluid (CSF) NFL, CSF pNFH and plasma NFL in stored samples that were collected at the diagnostic work-up of ALS patients (n = 234), ALS mimics (n = 44) and controls (n = 9). We assessed the diagnostic performance, prognostication value and relationship to the site of onset and genotype. CSF NFL, CSF pNFH and plasma NFL levels were significantly increased in ALS patients compared to patients with neuropathies & myelopathies, patients with myopathies and controls. Furthermore, CSF pNFH and plasma NFL levels were significantly higher in ALS patients than in patients with other MNDs. Bulbar onset ALS patients had significantly higher plasma NFL levels than spinal onset ALS patients. ALS patients with C9orf72HRE mutations had significantly higher plasma NFL levels than patients with SOD1 mutations. Survival was negatively correlated with all three biomarkers. Receiver operating characteristics showed the highest area under the curve for CSF pNFH for differentiating ALS from ALS mimics and for plasma NFL for estimating ALS short and long survival. All three biomarkers have diagnostic value in differentiating ALS from clinically relevant ALS mimics. Plasma NFL levels can be used to differentiate between clinical and genetic ALS subgroups.
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14
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Barohn RJ, Fink JK, Heiman-Patterson T, Huey ED, Murphy J, Statland JM, Turner MR, Elman L. The clinical spectrum of primary lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2021; 21:3-10. [PMID: 33602013 DOI: 10.1080/21678421.2020.1837178] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Primary lateral sclerosis is a distinct entity that has recently been classified as a "restricted phenotype" of ALS. It is characterized by a pattern of isolated upper motor neuron involvement that often begins in the legs and spreads diffusely. Distinction from other conditions requires careful consideration of clinical presentation and time course of disease. Mills' Syndrome is a rare unilateral variant of primary lateral sclerosis. Cognitive and behavioral involvement may occur.
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Affiliation(s)
- Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - John K Fink
- Department of Neurology, Ann Arbor Veterans Affairs Medical Center, University of Michigan, Ann Arbor, MI, USA
| | - Terry Heiman-Patterson
- Department of Neurology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Edward D Huey
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jennifer Murphy
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Martin R Turner
- Nuffield Department of Neurosciences, University of Oxford, Oxford, UK
| | - Lauren Elman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Vucic S, Ferguson TA, Cummings C, Hotchkin MT, Genge A, Glanzman R, Roet KCD, Cudkowicz M, Kiernan MC. Gold Coast diagnostic criteria: Implications for ALS diagnosis and clinical trial enrollment. Muscle Nerve 2021; 64:532-537. [PMID: 34378224 DOI: 10.1002/mus.27392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/10/2022]
Abstract
Diagnostic criteria for amyotrophic lateral sclerosis (ALS) are complex, incorporating multiple levels of certainty from possible through to definite, and are thereby prone to error. Specifically, interrater variability was previously established to be poor, thereby limiting utility as diagnostic enrollment criteria for clinical trials. In addition, the different levels of diagnostic certainty do not necessarily reflect disease progression, adding confusion to the diagnostic algorithm. Realizing these inherent limitations, the World Federation of Neurology, the International Federation of Clinical Neurophysiology, the International Alliance of ALS/MND Associations, the ALS Association (United States), and the Motor Neuron Disease Association convened a consensus meeting (Gold Coast, Australia, 2019) to consider the development of simpler criteria that better reflect clinical practice, and that could merge diagnostic categories into a single entity. The diagnostic accuracy of the novel Gold Coast criteria was subsequently interrogated through a large cross-sectional study, which established an increased sensitivity for ALS diagnosis when compared with previous criteria. Diagnostic accuracy was maintained irrespective of disease duration, functional status, or site of disease onset. Importantly, the Gold Coast criteria differentiated atypical phenotypes, such as primary lateral sclerosis, from the more typical ALS phenotype. It is proposed that the Gold Coast criteria should be incorporated into routine practice and clinical trial settings.
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Affiliation(s)
- Steve Vucic
- Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Angela Genge
- The Neuro, Montreal Neurological Institute, Montreal, Quebec, Canada
| | | | | | - Merit Cudkowicz
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney & Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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16
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Fullam T, Statland J. Upper Motor Neuron Disorders: Primary Lateral Sclerosis, Upper Motor Neuron Dominant Amyotrophic Lateral Sclerosis, and Hereditary Spastic Paraplegia. Brain Sci 2021; 11:brainsci11050611. [PMID: 34064596 PMCID: PMC8151104 DOI: 10.3390/brainsci11050611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Following the exclusion of potentially reversible causes, the differential for those patients presenting with a predominant upper motor neuron syndrome includes primary lateral sclerosis (PLS), hereditary spastic paraplegia (HSP), or upper motor neuron dominant ALS (UMNdALS). Differentiation of these disorders in the early phases of disease remains challenging. While no single clinical or diagnostic tests is specific, there are several developing biomarkers and neuroimaging technologies which may help distinguish PLS from HSP and UMNdALS. Recent consensus diagnostic criteria and use of evolving technologies will allow more precise delineation of PLS from other upper motor neuron disorders and aid in the targeting of potentially disease-modifying therapeutics.
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17
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Couratier P, Lautrette G, Luna JA, Corcia P. Phenotypic variability in amyotrophic lateral sclerosis. Rev Neurol (Paris) 2021; 177:536-543. [PMID: 33902945 DOI: 10.1016/j.neurol.2021.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Clinically, ALS phenotypes depend on the areas of the body that are affected, the different degrees of involvement of upper and lower motor neurons, the degrees of involvement of other systems, particularly cognition and behavior, and rates of progression. Phenotypic variability of ALS is characteristic and can be declined on the distribution of motor manifestations but also on the presence of extra-motor signs present in a variable manner in ALS patients. Neuropathologically, ALS is defined by the loss of UMN and LMN and the presence of two representative motor neuronal cytoplasmic inclusions, Bunina bodies and 43kDa Transactivation Response DNA Binding Protein (TDP-43) - positive cytoplasmic inclusions. The distribution of cytopathology and neuronal loss in patients is variable and this variability is directly related to phenotypic variability. Key regulators of phenotypic variability in ALS have not been determined. The functional decrement of TDP-43, and region-specific neuronal susceptibility to ALS, may be involved. Due to the selective vulnerability among different neuronal systems, lesions are multicentric, region-oriented, and progress at different rates. They may vary from patient to patient, which may be linked to the clinicopathological variability across patients.
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Affiliation(s)
- P Couratier
- Service de neurologie, centre de référence maladies rares SLA et autres maladies du neurone moteur, CHU de Limoges, Limoges, France; Inserm, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, université de Limoges, CHU de Limoges, Limoges, France; Fédération des Centres SLA de Limoges et Tours, Litorals, Limoges, France.
| | - G Lautrette
- Service de neurologie, centre de référence maladies rares SLA et autres maladies du neurone moteur, CHU de Limoges, Limoges, France; Fédération des Centres SLA de Limoges et Tours, Litorals, Limoges, France
| | - J A Luna
- Inserm, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, université de Limoges, CHU de Limoges, Limoges, France
| | - P Corcia
- Fédération des Centres SLA de Limoges et Tours, Litorals, Limoges, France; Centre de référence maladies rares SLA et autres maladies du neurone moteur, CHU Bretonneau, Tours, France
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18
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McMackin R, Dukic S, Costello E, Pinto-Grau M, McManus L, Broderick M, Chipika R, Iyer PM, Heverin M, Bede P, Muthuraman M, Pender N, Hardiman O, Nasseroleslami B. Cognitive network hyperactivation and motor cortex decline correlate with ALS prognosis. Neurobiol Aging 2021; 104:57-70. [PMID: 33964609 DOI: 10.1016/j.neurobiolaging.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
We aimed to quantitatively characterize progressive brain network disruption in Amyotrophic Lateral Sclerosis (ALS) during cognition using the mismatch negativity (MMN), an electrophysiological index of attention switching. We measured the MMN using 128-channel EEG longitudinally (2-5 timepoints) in 60 ALS patients and cross-sectionally in 62 healthy controls. Using dipole fitting and linearly constrained minimum variance beamforming we investigated cortical source activity changes over time. In ALS, the inferior frontal gyri (IFG) show significantly lower baseline activity compared to controls. The right IFG and both superior temporal gyri (STG) become progressively hyperactive longitudinally. By contrast, the left motor and dorsolateral prefrontal cortices are initially hyperactive, declining progressively. Baseline motor hyperactivity correlates with cognitive disinhibition, and lower baseline IFG activities correlate with motor decline rate, while left dorsolateral prefrontal activity predicted cognitive and behavioural impairment. Shorter survival correlates with reduced baseline IFG and STG activity and later STG hyperactivation. Source-resolved EEG facilitates quantitative characterization of symptom-associated and symptom-preceding motor and cognitive-behavioral cortical network decline in ALS.
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Affiliation(s)
- Roisin McMackin
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Stefan Dukic
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Emmet Costello
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Marta Pinto-Grau
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland; Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht University, Utrecht, The Netherlands
| | - Lara McManus
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Michael Broderick
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland; Trinity Centre for Bioengineering, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Rangariroyashe Chipika
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland; Computational Neuroimaging Group, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Parameswaran M Iyer
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland; Beaumont Hospital Dublin, Department of Neurology, Dublin 9, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland; Computational Neuroimaging Group, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Johannes-Gutenberg-University Hospital, Mainz, Germany
| | - Niall Pender
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland; Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht University, Utrecht, The Netherlands; Beaumont Hospital Dublin, Department of Neurology, Dublin 9, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland; Beaumont Hospital Dublin, Department of Neurology, Dublin 9, Ireland.
| | - Bahman Nasseroleslami
- Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin 2, Ireland
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19
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Hassan A, Mittal SO, Hu WT, Josephs KA, Sorenson EJ, Ahlskog JE. Natural History of "Pure" Primary Lateral Sclerosis. Neurology 2021; 96:e2231-e2238. [PMID: 33637635 DOI: 10.1212/wnl.0000000000011771] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/13/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess whether primary lateral sclerosis (PLS), classified as pure when the EMG is normal, converts to amyotrophic lateral sclerosis (ALS) after longitudinal follow-up. METHODS Retrospective chart review was performed of patients with pure PLS at Mayo Clinic in Rochester, MN (1990-2016). Inclusion criteria required a normal EMG during the first 4 years of symptoms. RESULTS Forty-three patients had pure PLS (25 female, 58%) with a median onset age of 50 years (range 38-78 years) and median follow-up at 9 years' disease duration (range 4-36 years). The ascending paraparesis phenotype (n = 30, 70%) was most common, followed by hemiparetic onset (n = 9, 21%) and bulbar onset (n = 4, 9%). Among the 30 paraparetic-onset cases, bladder symptoms (n = 18, 60%) and dysarthria (n = 15, 50%) were more common than pseudobulbar affect (n = 9, 30%) and dysphagia (n = 8, 27%). By the last follow-up, 17 of 30 (56%) used a cane and 6 (20%) required a wheelchair. The paraparetic variant, compared with hemiparetic and bulbar onset, had the youngest onset (48 vs 56 vs 60 years, respectively; p = 0.02). Five patients died; 1 patient required a feeding tube; and none required permanent noninvasive ventilation. Two patients developed an idiopathic multisystem neurodegenerative disorder, which surfaced after 19 and 20 years. Two patients developed minor EMG abnormalities. The remainder 39 had persistently normal EMGs. CONCLUSIONS Pure PLS did not convert to ALS after a median of 9 years' disease duration follow-up in our study population. The ascending paraparetic phenotype was most common, with earlier onset and frequent bladder involvement. After years of pure PLS, <5% develop a more pervasive neurodegenerative disorder.
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Affiliation(s)
- Anhar Hassan
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA.
| | - Shivam Om Mittal
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
| | - William T Hu
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
| | - Keith A Josephs
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
| | - Eric J Sorenson
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
| | - J Eric Ahlskog
- From the Department of Neurology (A.H., K.A.J., E.J.S., J.E.A.), Mayo Clinic, Rochester, MN; Department of Neurology (S.O.M.), Cleveland Clinic Abu Dhabi, United Arab Emirates; and Department of Neurology (W.T.H.), Emory University, Atlanta, GA
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20
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Verschueren A, Grapperon AM, Delmont E, Attarian S. Prevalence of spasticity and spasticity-related pain among patients with Amyotrophic Lateral Sclerosis. Rev Neurol (Paris) 2021; 177:694-698. [PMID: 33423807 DOI: 10.1016/j.neurol.2020.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Although they are common symptoms of ALS, there is little information on the prevalence of spasticity and spasticity-related pain. Consecutive patients were prospectively recruited from an ALS referral center. Clinical assessment, functional scores, features of spasticity-related pains has been recorded. In a cohort of 150 patients, 36% presented with spasticity. Spastic patients were younger, with a longer duration of disease. Spasticity accelerates the functional decline of patients. Spasticity-related pain was reported in 42.5% of spastic patients with mild pain. However, 16.7% of spastic patients presented significant pain with numeric rating scale≥4. More clinical trials are needed to treat spasticity more effectively and to relieve ALS patients.
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Affiliation(s)
- A Verschueren
- Reference Centre for Neuromuscular Disorders and ALS, CHU de La Timone, Aix-Marseille University, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - A-M Grapperon
- Reference Centre for Neuromuscular Disorders and ALS, CHU de La Timone, Aix-Marseille University, 264, rue Saint-Pierre, 13005 Marseille, France
| | - E Delmont
- Reference Centre for Neuromuscular Disorders and ALS, CHU de La Timone, Aix-Marseille University, 264, rue Saint-Pierre, 13005 Marseille, France
| | - S Attarian
- Reference Centre for Neuromuscular Disorders and ALS, CHU de La Timone, Aix-Marseille University, 264, rue Saint-Pierre, 13005 Marseille, France
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21
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Zubair AS, Raymond M, Patwa HS. Utility of intrathecal baclofen pump in primary lateral sclerosis. J Neurol Sci 2021; 420:117227. [PMID: 33239209 DOI: 10.1016/j.jns.2020.117227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/23/2022]
Abstract
Primary lateral sclerosis is a disorder categorized by insidious onset of progressive upper motor neuron dysfunction without lower motor neuron involvement. PLS often presents with gradual-onset, progressive lower extremity stiffness and pain due to muscle spasticity. Intrathecal Baclofen pumps (ITB) have been used to effectively treat spasticity in several neurologic conditions including MS and spinal cord injury. This study aimed at reviewing a cohort of PLS patients with spasticity requiring ITB to assess the clinical course, benefits, and complications in these patients. A series of 5 patients were identified who were diagnosed with PLS and received ITB as treatment for spasticity. The average age of the patients at the time of ITB insertion was 56.4 years. The average length of treatment was 10.4 years with a range of 4-15 years. All patients reported improvement in spasticity as measured by clinical examinations and Ashworth scores; 1/5 had complications with the pump related to migration of catheter. No patients required permanent removal of the ITB. ITB is a safe and effective treatment for spasticity in PLS and should be considered in other patients.
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22
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Paganoni S, De Marchi F, Chan J, Thrower SK, Staff NP, Datta N, Kisanuki YY, Drory V, Fournier C, Pioro EP, Goutman SA, Atassi N, Jeon M, Caldwell S, Mcdonough T, Gentile C, Liu J, Turner M, Denny C, Felice K, Green M, Scarberry S, Abu-Saleh S, Nefussy B, Hastings D, Kim S, Swihart B, Arcila-Londono X, Newman DS, Silverman M, Genge A, Salmon K, Elman L, Mccluskey L, Almasy K, Gotkine M, Goslin K, Cummings A, Edwards EK, Rivner M, Bouchard K, Quarles B, Kwan J, Jaffa M, Baloh R, Allred P, Walk D, Maiser S, Manousakis G, Ferment V, Fernandes JAM, Thaisetthawatkul P, Heimes D, Phillips M, Sams L, Kahler M, Corcoran A, Larriviere DG, Chotto S, Juba G. The NEALS primary lateral sclerosis registry. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:74-81. [PMID: 32915077 DOI: 10.1080/21678421.2020.1804591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Primary lateral sclerosis (PLS) is a neurodegenerative disease characterized by progressive upper motor neuron dysfunction. Because PLS patients represent only 1 to 4% of patients with adult motor neuron diseases, there is limited information about the disease's natural history. The objective of this study was to establish a large multicenter retrospective longitudinal registry of PLS patients seen at Northeast ALS Consortium (NEALS) sites to better characterize the natural progression of PLS. Methods: Clinical characteristics, electrophysiological findings, laboratory values, disease-related symptoms, and medications for symptom management were collected from PLS patients seen between 2000 and 2015. Results: The NEALS registry included data from 250 PLS patients. Median follow-up time was 3 years. The mean rate of functional decline measured by ALSFRS-R total score was -1.6 points/year (SE:0.24, n = 124); the mean annual decline in vital capacity was -3%/year (SE:0.55, n = 126). During the observational period, 18 patients died, 17 patients had a feeding tube placed and 7 required permanent assistive ventilation. Conclusions: The NEALS PLS Registry represents the largest available aggregation of longitudinal clinical data from PLS patients and provides a description of expected natural disease progression. Data from the registry will be available to the PLS community and can be leveraged to plan future clinical trials in this rare disease.
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Affiliation(s)
- Sabrina Paganoni
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Fabiola De Marchi
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - James Chan
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Sara K Thrower
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | - Neil Datta
- Hospital for Special Care, New Britain, CT/University of Connecticut School of Medicine, Farmington, CT, USA
| | - Yaz Y Kisanuki
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vivian Drory
- Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | | | - Erik P Pioro
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Nazem Atassi
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | - Maryangel Jeon
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Caldwell
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Timothy Mcdonough
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Gentile
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | - Jianing Liu
- Department of Neurology, Sean M. Healey & AMG Center for ALS at Mass General, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Kevin Felice
- Hospital for Special Care, New Britain, CT/University of Connecticut School of Medicine, Farmington, CT, USA
| | - Misty Green
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Scarberry
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Debbie Hastings
- Neuromuscular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sangri Kim
- Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Blake Swihart
- Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Angela Genge
- Montreal Neurological Institute & Hospital, Montreal, Canada
| | | | - Lauren Elman
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Leo Mccluskey
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Kelly Almasy
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Marc Gotkine
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | - Michael Rivner
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Kristy Bouchard
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Brandy Quarles
- Department of Neurology, Augusta University, Augusta, GA, USA
| | - Justin Kwan
- University of Maryland Medical Center, College Park, MD, USA
| | - Matthew Jaffa
- University of Maryland Medical Center, College Park, MD, USA
| | - Robert Baloh
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peggy Allred
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Walk
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Samuel Maiser
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Georgios Manousakis
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Valerie Ferment
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - J Americo M Fernandes
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Deborah Heimes
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Laura Sams
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Melissa Kahler
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Alecia Corcoran
- Department of Neuroscience, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | - Gracy Juba
- Ochsner Health System, New Orleans, LA, USA
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23
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Abstract
The misfolding, aggregation, and deposition of specific proteins is the key hallmark of most progressive neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS). ALS is characterized by the rapid and progressive degenerations of motor neurons in the spinal cord and motor cortex, resulting in paralysis of those who suffer from it. Pathologically, there are three major aggregating proteins associated with ALS, including TAR DNA-binding protein of 43kDa (TDP-43), superoxide dismutase-1 (SOD1), and fused in sarcoma (FUS). While there are ALS-associated mutations found in each of these proteins, the most prevalent aggregation pathology is that of wild-type TDP-43 (97% of cases), with the remaining split between mutant forms of SOD1 (~2%) and FUS (~1%). Considering the progressive nature of ALS and its association with the aggregation of specific proteins, a growing notion is that the spread of pathology and symptoms can be explained by a prion-like mechanism. Prion diseases are a group of highly infectious neurodegenerative disorders caused by the misfolding, aggregation, and spread of a transmissible conformer of prion protein (PrP). Pathogenic PrP is capable of converting healthy PrP into a toxic form through template-directed misfolding. Application of this finding to other neurodegenerative disorders, and in particular ALS, has revolutionized our understanding of cause and progression of these disorders. In this chapter, we first provide a background on ALS pathology and genetic origin. We then detail and discuss the evidence supporting a prion-like propagation of protein misfolding and aggregation in ALS with a particular focus on SOD1 and TDP-43 as these are the most well-established models in the field.
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Affiliation(s)
- L McAlary
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia
| | - J J Yerbury
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia
| | - N R Cashman
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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24
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Zhao C, Lange DJ, Wymer JP. Management of Primary Lateral Sclerosis. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Bhattarai A, Chen Z, Ward PGD, Talman P, Mathers S, Phan TG, Chapman C, Howe J, Lee S, Lie Y, Egan GF, Chua P. Serial assessment of iron in the motor cortex in limb-onset amyotrophic lateral sclerosis using quantitative susceptibility mapping. Quant Imaging Med Surg 2020; 10:1465-1476. [PMID: 32676365 PMCID: PMC7358415 DOI: 10.21037/qims-20-187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dysregulation of iron in the cerebral motor areas has been hypothesized to occur in individuals with amyotrophic lateral sclerosis (ALS). There is still limited knowledge regarding iron dysregulation in the progression of ALS pathology. Our objectives were to use magnetic resonance based quantitative susceptibility mapping (QSM) to investigate the association between iron dysregulation in the motor cortex and clinical manifestations in patients with limb-onset ALS, and to examine changes in the iron concentration in the motor cortex in these patients over a 6-month period. METHODS Iron concentration was investigated using magnetic resonance based QSM in the primary motor cortex and the pre-motor area in 13 limb-onset ALS patients (including five lumbar onset, six cervical onset and two flail arm patients), and 11 age- and sex-matched control subjects. Nine ALS patients underwent follow-up scans at 6 months. RESULTS Significantly increased QSM values were observed in the left posterior primary motor area (P=0.02, Cohen's d =0.9) and right anterior primary motor area (P=0.02, Cohen's d =0.92) in the group of limb-onset ALS patients compared to that of control subjects. Increased QSM was observed in the primary motor and pre-motor area at baseline in patients with lumbar onset ALS patients, but not cervical limb-onset ALS patients, compared to control subjects. No significant change in QSM was observed at the 6-month follow-up scans in the ALS patients. CONCLUSIONS The findings suggest that iron dysregulation can be detected in the motor cortex in limb-onset ALS, which does not appreciably change over a further 6 months. Individuals with lumbar onset ALS appear to be more susceptible to motor cortex iron dysregulation compared to the individuals with cervical onset ALS. Importantly, this study highlights the potential use of QSM as a quantitative radiological indicator in early disease diagnosis in limb-onset ALS and its subtypes. Our serial scans results suggest a longer period than 6 months is needed to detect significant quantitative changes in the motor cortex.
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Affiliation(s)
- Anjan Bhattarai
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Phillip G. D. Ward
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Paul Talman
- Department of Neuroscience, Barwon Health, Geelong, Victoria, Australia
| | - Susan Mathers
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
- Department of Neurology, Monash Health, and School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Thanh G. Phan
- Department of Neurology, Monash Health, and School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Caron Chapman
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - James Howe
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Sarah Lee
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Yennie Lie
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Phyllis Chua
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
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McCombe PA, Garton FC, Katz M, Wray NR, Henderson RD. What do we know about the variability in survival of patients with amyotrophic lateral sclerosis? Expert Rev Neurother 2020; 20:921-941. [PMID: 32569484 DOI: 10.1080/14737175.2020.1785873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION ALS is a fatal neurodegenerative disease. However, patients show variability in the length of survival after symptom onset. Understanding the mechanisms of long survival could lead to possible avenues for therapy. AREAS COVERED This review surveys the reported length of survival in ALS, the clinical features that predict survival in individual patients, and possible factors, particularly genetic factors, that could cause short or long survival. The authors also speculate on possible mechanisms. EXPERT OPINION a small number of known factors can explain some variability in ALS survival. However, other disease-modifying factors likely exist. Factors that alter motor neurone vulnerability and immune, metabolic, and muscle function could affect survival by modulating the disease process. Knowing these factors could lead to interventions to change the course of the disease. The authors suggest a broad approach is needed to quantify the proportion of variation survival attributable to genetic and non-genetic factors and to identify and estimate the effect size of specific factors. Studies of this nature could not only identify novel avenues for therapeutic research but also play an important role in clinical trial design and personalized medicine.
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Affiliation(s)
- Pamela A McCombe
- Centre for Clinical Research, The University of Queensland , Brisbane, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane, Australia
| | - Fleur C Garton
- Institute for Molecular Biosciences, The University of Queensland , Brisbane, Australia
| | - Matthew Katz
- Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane, Australia
| | - Naomi R Wray
- Institute for Molecular Biosciences, The University of Queensland , Brisbane, Australia.,Queensland Brain Institute, The University of Queensland , Brisbane, Australia
| | - Robert D Henderson
- Centre for Clinical Research, The University of Queensland , Brisbane, Australia
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Gois AM, Mendonça DMF, Freire MAM, Santos JR. IN VITRO AND IN VIVO MODELS OF AMYOTROPHIC LATERAL SCLEROSIS: AN UPDATED OVERVIEW. Brain Res Bull 2020; 159:32-43. [PMID: 32247802 DOI: 10.1016/j.brainresbull.2020.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/04/2020] [Accepted: 03/20/2020] [Indexed: 12/11/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive, neurodegenerative disease characterized by loss of upper motor neurons (UMN) and lower motor neurons (LMN). Disease affects people all over the world and is more prevalent in men. Patients with ALS develop extensive muscle wasting, paralysis and ultimately death, with a median survival of usually fewer than five years after disease onset. ALS may be sporadic (sALS, 90%) or familial (fALS, 10%). The large majority of fALS cases are associated with genetic alterations, which are mainly related to the genes SOD1, TDP-43, FUS, and C9ORF72. In vitro and in vivo models have helped elucidate ALS etiology and pathogenesis, as well as its molecular, cellular, and physiological mechanisms. Many studies in cell cultures and animal models, such as Caenorhabditis elegans, Drosophila melanogaster, zebrafish, rodents, and non-human primates have been performed to clarify the relationship of these genes to ALS disease. However, there are inherent limitations to consider when using experimental models. In this review, we provide an updated overview of the most used in vitro and in vivo studies that have contributed to a better understanding of the different ALS pathogenic mechanisms.
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Affiliation(s)
- Auderlan M Gois
- Behavioral and Evolutionary Neurobiology Laboratory, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil
| | - Deise M F Mendonça
- Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil
| | - Marco Aurelio M Freire
- Postgraduation Program in Health and Society, Faculty of Health Sciences, University of the State of Rio Grande do Norte, Mossoró, RN, Brazil
| | - Jose R Santos
- Behavioral and Evolutionary Neurobiology Laboratory, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil.
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Wimmer T, Schreiber F, Hensiek N, Garz C, Kaufmann J, Machts J, Vogt S, Prudlo J, Dengler R, Petri S, Heinze HJ, Nestor PJ, Vielhaber S, Schreiber S. The upper cervical spinal cord in ALS assessed by cross-sectional and longitudinal 3T MRI. Sci Rep 2020; 10:1783. [PMID: 32020025 DOI: 10.1038/s41598-020-58687-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/20/2020] [Indexed: 02/08/2023] Open
Abstract
The upper cervical spinal cord is measured in a large longitudinal amyotrophic lateral sclerosis (ALS) cohort to evaluate its role as a biomarker. Specifically, the cervical spinal cord´s cross-sectional area (CSA) in plane of the segments C1–C3 was measured semi-automatically with T1-weighted 3T MRI sequences in 158 ALS patients and 86 controls. Six-month longitudinal follow-up MRI scans were analyzed in 103 patients. Compared to controls, in ALS there was a significant mean spinal cord atrophy (63.8 mm² vs. 60.8 mm², p = 0.001) which showed a trend towards worsening over time (mean spinal cord CSA decrease from 61.4 mm² to 60.6 mm² after 6 months, p = 0.06). Findings were most pronounced in the caudal segments of the upper cervical spinal cord and in limb-onset ALS. Baseline CSA was related to the revised ALS functional rating scale, disease duration, precentral gyrus thickness and total brain gray matter volume. In conclusion, spinal cord atrophy as assessed in brain MRIs in ALS patients mirrors the extent of overall neurodegeneration and parallels disease severity.
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Takeda T, Kitagawa K, Arai K. Phenotypic variability and its pathological basis in amyotrophic lateral sclerosis. Neuropathology 2019; 40:40-56. [PMID: 31802540 DOI: 10.1111/neup.12606] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is characterized by its inherent clinicopathological variability. The concurrence of upper and lower motor neuron signs is a common feature in the majority of patients with ALS. However, some patients manifest an atypical clinical course, with only upper or lower motor neuron signs, or various extra-motor symptoms including cognitive dysfunction, parkinsonism, autonomic dysfunction, or ophthalmoparesis. This variability indicates different manifestations of ALS and is reflected by ALS pathology spreading into the central nervous system. The presence of cytoplasmic inclusions positive for transactivation response DNA-binding protein 43 kDa (TDP-43) is a key feature in ALS. Loss of TDP-43 from the nucleus and its subsequent aggregation in the cytoplasm may occur in susceptible regions and may be associated with neuronal loss. However, in some regions, there is no apparent neuronal loss while TDP-43 accumulation is evident; in contrast, in other regions, neuronal loss is apparent without any evidence of TDP-43 accumulation. Therefore, in addition to TDP-43 dysfunction, underlying region-specific cellular vulnerability may exist in the upper and lower motor neurons and frontotemporal system in patients with ALS. The microscopic discrepancy and selective vulnerability may be linked to the macroscopic propensities of the sites of onset, and may also determine the direction and rate of progression of the lesions. Thus, there may be multicentric sites of onset, region-oriented disease development, and different speeds of disease progression across patients with ALS. ALS lesions occur in motor-related areas but may spread to neighboring areas. However, since lesions may spread in a discontinuous manner, and the dynamics of disease propagation have not been able to be identified, it remains controversial whether the stepwise appearance of TDP-43-positive inclusions is based on direct cell-to-cell protein propagation. Further understanding of the phenotypic variability of ALS and its pathological basis may serve as a guide for investigating the underlying pathogenesis of ALS.
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Affiliation(s)
- Takahiro Takeda
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan.,Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kimihito Arai
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
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30
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McAlary L, Plotkin SS, Yerbury JJ, Cashman NR. Prion-Like Propagation of Protein Misfolding and Aggregation in Amyotrophic Lateral Sclerosis. Front Mol Neurosci 2019; 12:262. [PMID: 31736708 PMCID: PMC6838634 DOI: 10.3389/fnmol.2019.00262] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/14/2019] [Indexed: 01/26/2023] Open
Abstract
The discovery that prion protein can misfold into a pathological conformation that encodes structural information capable of both propagation and inducing severe neuropathology has revolutionized our understanding of neurodegenerative disease. Many neurodegenerative diseases with a protein misfolding component are now classified as “prion-like” owing to the propagation of both symptoms and protein aggregation pathology in affected individuals. The neuromuscular disorder amyotrophic lateral sclerosis (ALS) is characterized by protein inclusions formed by either TAR DNA-binding protein of 43 kDa (TDP-43), Cu/Zn superoxide dismutase (SOD1), or fused in sarcoma (FUS), in both upper and lower motor neurons. Evidence from in vitro, cell culture, and in vivo studies has provided strong evidence to support the involvement of a prion-like mechanism in ALS. In this article, we review the evidence suggesting that prion-like propagation of protein aggregation is a primary pathomechanism in ALS, focusing on the key proteins and genes involved in disease (TDP-43, SOD1, FUS, and C9orf72). In each case, we discuss the evidence ranging from biophysical studies to in vivo examinations of prion-like spreading. We suggest that the idiopathic nature of ALS may stem from its prion-like nature and that elucidation of the specific propagating protein assemblies is paramount to developing effective therapies.
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Affiliation(s)
- Luke McAlary
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Molecular Horizons and School of Chemistry and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Steven S Plotkin
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,Genome Sciences and Technology Program, University of British Columbia, Vancouver, BC, Canada
| | - Justin J Yerbury
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Molecular Horizons and School of Chemistry and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Neil R Cashman
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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31
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Dede HÖ, Şırın NG, Kocasoy-Orhan E, Idrısoğlu HA, Baslo MB. Electrophysiological Findings of Subclinical Lower Motor Neuron Involvement in Degenerative Upper Motor Neuron Diseases. ACTA ACUST UNITED AC 2019; 57:228-233. [PMID: 32952426 DOI: 10.29399/npa.23387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/26/2019] [Indexed: 12/11/2022]
Abstract
Introduction The present study is an examination of possible subclinical involvement of lower motor neuron (LMN) in patients with primary lateral sclerosis (PLS) and hereditary spastic paraparesis (HSP) electrophysiologically. Methods Nine PLS patients and 5 HSP patients were prospectively analyzed. Jitter measurement with concentric needle electrode (25 mm, 30 G) (CN-jitter) recorded from right extensor digitorum muscle during voluntary contraction with 1 kHz high-pass frequency filter set. European Myelopathy Score (EMS) was used to evaluate disability. The relationship between disability score and jitter values was investigated. Results HSP patients had suffered from the disease for longer period of time (p<0.001). Mean jitter values of patients with PLS and HSP were 26.5±12.1 µs and 30.8±34.8 µs, and the number of individual high jitters (>43 microseconds) observed in the PLS and HSP groups was 16/180 and 9/100, respectively without a significant intergroup difference. The ratio of patients with an abnormal jitter study were higher in HSP group (60%) compared to PLS (22%) (p<0.05). Potential pairs with blocking were present in HSP group (7 of 100 potential pairs) but not seen in PLS patients. EMS values were significantly lower in patients having potential pairs with high jitter and blocking compared to those without high jitter and blocking. Conclusion The present study has demonstrated that early signs of LMN dysfunction can be detected electrophysiologically by CN-jitter in patients with UMN involvement. These electrophysiological findings in these patients with longer disease duration and lower clinical scores may be explained by spreading of the disease to LMNs or transsynaptic degeneration and its contribution in disease progression.
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Affiliation(s)
- Hava Özlem Dede
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Nermin Görkem Şırın
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Elif Kocasoy-Orhan
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Halil Atilla Idrısoğlu
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Barış Baslo
- Department of Clinic Neurophysiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
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Abstract
PURPOSE OF REVIEW Hereditary myelopathies are very diverse genetic disorders, and many of them represent a widespread neurodegenerative process rather than isolated spinal cord dysfunction. This article reviews various types of inherited myelopathies, with emphasis on hereditary spastic paraplegias and spastic ataxias. RECENT FINDINGS The ever-growing number of myelopathy-causing genes and broadening of phenotype-genotype correlations makes the molecular diagnosis of inherited myelopathies a daunting task. This article emphasizes the main phenotypic clusters among inherited myelopathies that can facilitate the diagnostic process. This article focuses on newly identified genetic causes and the most important identifying clinical features that can aid the diagnosis, including the presence of a characteristic age of onset and additional neurologic signs such as leukodystrophy, thin corpus callosum, or amyotrophy. SUMMARY The exclusion of potentially treatable causes of myelopathy remains the most important diagnostic step. Syndromic diagnosis can be supported by molecular diagnosis, but the genetic diagnosis at present does not change the management. Moreover, a negative genetic test does not exclude the diagnosis of a hereditary myelopathy because comprehensive molecular testing is not yet available, and many disease-causing genes remain unknown.
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Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the death of both upper and lower motor neurons (MNs) in the brain, brainstem and spinal cord. The neurodegenerative mechanisms leading to MN loss in ALS are not fully understood. Importantly, the reasons why MNs are specifically targeted in this disorder are unclear, when the proteins associated genetically or pathologically with ALS are expressed ubiquitously. Furthermore, MNs themselves are not affected equally; specific MNs subpopulations are more susceptible than others in both animal models and human patients. Corticospinal MNs and lower somatic MNs, which innervate voluntary muscles, degenerate more readily than specific subgroups of lower MNs, which remain resistant to degeneration, reflecting the clinical manifestations of ALS. In this review, we discuss the possible factors intrinsic to MNs that render them uniquely susceptible to neurodegeneration in ALS. We also speculate why some MN subpopulations are more vulnerable than others, focusing on both their molecular and physiological properties. Finally, we review the anatomical network and neuronal microenvironment as determinants of MN subtype vulnerability and hence the progression of ALS.
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Affiliation(s)
- Audrey M G Ragagnin
- Centre for Motor Neuron Disease Research, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sina Shadfar
- Centre for Motor Neuron Disease Research, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Marta Vidal
- Centre for Motor Neuron Disease Research, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Md Shafi Jamali
- Centre for Motor Neuron Disease Research, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Julie D Atkin
- Centre for Motor Neuron Disease Research, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia
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Gowland A, Opie-Martin S, Scott KM, Jones AR, Mehta PR, Batts CJ, Ellis CM, Leigh PN, Shaw CE, Sreedharan J, Al-Chalabi A. Predicting the future of ALS: the impact of demographic change and potential new treatments on the prevalence of ALS in the United Kingdom, 2020-2116. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:264-274. [PMID: 30961394 PMCID: PMC6567553 DOI: 10.1080/21678421.2019.1587629] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: To model the effects of demographic change under various scenarios of possible future treatment developments in ALS. Methods: Patients diagnosed with ALS at the King’s College Hospital Motor Nerve Clinic between 2004 and 2017, and living within the London boroughs of Lambeth, Southwark, and Lewisham (LSL), were included as incident cases. We also ascertained incident cases from the Canterbury region over the same period. Future incidence of ALS was estimated by applying the calculated age- and sex-specific incidence rates to the UK population projections from 2020 to 2116. The number of prevalent cases for each future year was estimated based on an established method. Assuming constant incidence, we modelled four possible future prevalence scenarios by altering the median disease duration for varying subsets of the population, to represent the impact of new treatments. Results: The total number of people newly diagnosed with ALS per year in the UK is projected to rise from a baseline of 1415 UK cases in 2010 to 1701 in 2020 and 2635 in 2116. Overall prevalence of ALS was predicted to increase from 8.58 per 100,000 persons in 2020 to 9.67 per 100,000 persons in 2116. Halting disease progression in patients with C9orf72 mutations would yield the greatest impact of the modelled treatment scenarios, increasing prevalence in the year 2066 from a baseline of 9.50 per 100,000 persons to 15.68 per 100,000 persons. Conclusions: Future developments in treatment would combine with the effects of demographic change to result in more people living longer with ALS.
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Affiliation(s)
- Alison Gowland
- a Department of Basic and Clinical Neuroscience , King's College London, Maurice Wohl Clinical Neuroscience Institute , London , UK
| | - Sarah Opie-Martin
- a Department of Basic and Clinical Neuroscience , King's College London, Maurice Wohl Clinical Neuroscience Institute , London , UK
| | - Kirsten M Scott
- b Department of Clinical Neuroscience , University of Cambridge , Cambridge , UK
| | - Ashley R Jones
- a Department of Basic and Clinical Neuroscience , King's College London, Maurice Wohl Clinical Neuroscience Institute , London , UK
| | - Puja R Mehta
- a Department of Basic and Clinical Neuroscience , King's College London, Maurice Wohl Clinical Neuroscience Institute , London , UK.,c King's College Hospital , London , UK
| | - Christine J Batts
- d Kent and Canterbury Hospital , East Kent Hospital NHS University Foundation Trust , Canterbury , UK
| | | | - P Nigel Leigh
- e Department of Neuroscience, Brighton and Sussex Medical School , Trafford Centre for Biomedical Research, University of Sussex , Brighton , UK , and
| | - Christopher E Shaw
- f United Kingdom Dementia Research Institute, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK
| | - Jemeen Sreedharan
- a Department of Basic and Clinical Neuroscience , King's College London, Maurice Wohl Clinical Neuroscience Institute , London , UK
| | - Ammar Al-Chalabi
- a Department of Basic and Clinical Neuroscience , King's College London, Maurice Wohl Clinical Neuroscience Institute , London , UK.,c King's College Hospital , London , UK
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Pinto WBVR, Debona R, Nunes PP, Assis ACD, Lopes CG, Bortholin T, Dias RB, Naylor FGM, Chieia MAT, Souza PVS, Oliveira ASB. Atypical Motor Neuron Disease variants: Still a diagnostic challenge in Neurology. Rev Neurol (Paris) 2019; 175:221-232. [PMID: 30846210 DOI: 10.1016/j.neurol.2018.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 11/20/2022]
Abstract
Motor neuron disease (MND) represents a wide and heterogeneous expanding group of disorders involving the upper or lower motor neurons, mainly represented by amyotrophic lateral sclerosis (ALS), primary lateral sclerosis, progressive muscular atrophy and progressive bulbar palsy. Primary motor neuronopathies are characterized by progressive degenerative loss of anterior horn cell motoneurons (lower motor neurons) or loss of giant pyramidal Betz cells (upper motor neurons). Despite its well-known natural history, pathophysiological and clinical characteristics for the most common MND, atypical clinical presentation and neurodegenerative mechanisms are commonly observed in rare clinical entities, so-called atypical variants of MND-ALS, including flail-leg syndrome, flail-arm syndrome, facial-onset sensory and motor neuronopathy (FOSMN), finger extension weakness and downbeat nystagmus (FEWDON-MND) and long-lasting and juvenile MND-ALS. Herein, we provide a review article presenting clinical, genetic, pathophysiological and neuroimaging findings of atypical variants of MND-ALS in clinical practice.
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Affiliation(s)
- W B V R Pinto
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - R Debona
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - P P Nunes
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - A C D Assis
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - C G Lopes
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - T Bortholin
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - R B Dias
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - F G M Naylor
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - M A T Chieia
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
| | - P V S Souza
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil.
| | - A S B Oliveira
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 899, 04022-002 Vila Clementino, São Paulo SP, Brazil
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de Visser M. Evidence for treatment of spasticity in motor neuron disease. Lancet Neurol 2019; 18:130-131. [DOI: 10.1016/s1474-4422(18)30493-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
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Finegan E, Chipika RH, Shing SLH, Hardiman O, Bede P. Primary lateral sclerosis: a distinct entity or part of the ALS spectrum? Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:133-145. [PMID: 30654671 DOI: 10.1080/21678421.2018.1550518] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Primary lateral sclerosis (PLS) has been traditionally viewed as a distinct upper motor neuron condition (UMN) but is increasingly regarded as a sub-phenotype within the amyotrophic lateral sclerosis (ALS) spectrum. Despite established diagnostic criteria, formal diagnosis can be challenging and the protracted diagnostic journey and uncertainty about longer-term prognosis cause considerable distress to patients and caregivers. PLS patients are invariably excluded from ALS clinical trials, while PLS pharmacological trials are lacking. There remains an unmet need for diagnostic biomarkers for upper motor neuron predominant conditions and prognostic indicators regarding prognosis, survival, and risk of conversion to ALS. Validated biomarkers will not only have implications for individualized patient care but also serve as outcome measures in pharmaceutical trials. Given the paucity of post-mortem studies in PLS, novel pathological insights are generally inferred from state-of-the-art imaging studies. Computational neuroimaging has already contributed significantly to the characterization of PLS-associated pathology in vivo and has underscored the role of neuro-inflammation, the presence of extra-motor changes, and confirmed pathological patterns similar to ALS. This systematic review assesses the current state of PLS research across clinical, neuroimaging and neuropathological domains from a combined clinical and academic perspective. We discuss patterns of pathological overlap with other ALS phenotypes, examine if the biological processes of PLS warrant therapeutic strategies distinct from ALS, and evaluate the evidence that classes PLS as a distinct clinico-pathological entity.
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Affiliation(s)
- Eoin Finegan
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Rangariroyashe H Chipika
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Stacey Li Hi Shing
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Orla Hardiman
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
| | - Peter Bede
- a Computational Neuroimaging Group, Academic Unit of Neurology , Biomedical Sciences Institute, Trinity College , Dublin , Ireland
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Riva N, Mora G, Sorarù G, Lunetta C, Ferraro OE, Falzone Y, Leocani L, Fazio R, Comola M, Comi G. Safety and efficacy of nabiximols on spasticity symptoms in patients with motor neuron disease (CANALS): a multicentre, double-blind, randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2018; 18:155-164. [PMID: 30554828 DOI: 10.1016/s1474-4422(18)30406-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/10/2018] [Accepted: 10/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spasticity is a major determinant of disability and decline in quality of life in patients with motor neuron disease. Cannabinoids have been approved for symptomatic treatment of spasticity in multiple sclerosis. We investigated whether cannabinoids might also reduce spasticity in patients with motor neuron disease. METHODS We did an investigator-initiated, randomised, double-blind, placebo-controlled, phase 2 clinical trial at four tertiary motor neuron disease centres in Italy. Eligible patients were aged 18-80 years; had possible, laboratory-supported probable, probable, or definite amyotrophic lateral sclerosis as defined by revised El Escorial criteria, or primary lateral sclerosis according to Pringle's criteria; had spasticity symptoms due to motor neuron disease for at least 3 months; had spasticity scores of 1 or greater in at least two muscle groups on the Modified Ashworth Scale; and were taking an antispasticity regimen that was maintained at a stable dose for 30 days before enrolment. Participants were assigned (1:1) by an independent statistician via a computer-generated randomisation sequence to a standardised oromucosal spray (nabiximols) containing a defined combination of delta-9-tetrahydrocannabinol and cannabidiol (each 100 μL actuation contained 2·7 mg delta-9-tetrahydrocannabinol and 2·5 mg cannabidiol) or to placebo for 6 weeks. Participants self-titrated during the first 14 treatment days according to a predefined escalation scheme (maximum 12 actuations per 24 h), then maintained that dose for 4 weeks. The primary endpoint was the change in the score on the Modified Ashworth Scale, which was assessed at baseline and after 6 weeks. Safety and tolerability were also monitored. Participants, investigators, site personnel, and the study statistician were masked to treatment allocation. All randomised participants who received at least one dose of study drug were included in the analysis. This trial is registered with ClinicalTrials.gov, number NCT01776970. The trial is closed to new participants with follow-up completed. FINDINGS Between Jan 19, 2013, and Dec 15, 2014, 60 participants were randomly assigned, and 59 participants were included in the final analysis (29 in the nabiximols group and 30 in the placebo group). Modified Ashworth Scale scores improved by a mean of 0·11 (SD 0·48) in the nabiximols group and deteriorated by a mean of 0·16 (0·47) in the placebo group (adjusted effect estimate -0·32 [95% CI -0·57 to -0·069]; p=0·013). Nabiximols was well tolerated, and no participants withdrew from the double-blind phase of the study. No serious adverse effects occurred. INTERPRETATION In this proof-of-concept trial, nabiximols had a positive effect on spasticity symptoms in patients with motor neuron disease and had an acceptable safety and tolerability profile. These findings should be investigated further in larger clinical trials. FUNDING Italian Research Foundation for Amyotrophic Lateral Sclerosis.
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Affiliation(s)
- Nilo Riva
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Mora
- Department of Neurorehabilitation, Amyotrophic Lateral Sclerosis Centre, Istituti Clinici Scientifici Maugeri, IRCCS, Milan, Italy
| | - Gianni Sorarù
- Department of Neurosciences, Neuromuscular Centre, University of Padova, Padua, Italy
| | | | - Ottavia E Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Yuri Falzone
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Letizia Leocani
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaella Fazio
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Comola
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
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Yedavalli VS, Patil A, Shah P. Amyotrophic Lateral Sclerosis and its Mimics/Variants: A Comprehensive Review. J Clin Imaging Sci 2018; 8:53. [PMID: 30652056 PMCID: PMC6302559 DOI: 10.4103/jcis.jcis_40_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/12/2018] [Indexed: 12/16/2022] Open
Abstract
Motor neuron diseases (MNDs) are a debilitating subset of diseases, which result in progressive neuronal destruction and eventual loss of voluntary muscular function. These entities are often challenging to distinguish and accurately diagnose given overlapping clinical pictures and overall rarity. This group of diseases has a high morbidity and mortality rate overall and delineating each type of disease can help guide appropriate clinical management and improve quality of life for patients. Of all MNDs, amyotrophic lateral sclerosis (ALS) is by far the most common comprising 80%–90% of cases. However, other mimics and variants of ALS can appear similar both clinically and radiographically. In this review, we delve into the epidemiological, physiological, neuroimaging, and prognostic characteristics and management of ALS and its most common MND mimics/variants. In doing so, we hope to improve accuracy in diagnosis and potential management for this rare group of diseases.
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Affiliation(s)
- Vivek S Yedavalli
- Department of Neuroradiology and Neurointervention, Stanford University, Palo Alto, California, USA
| | - Abhijit Patil
- Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Parinda Shah
- Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
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Abstract
ALS is a neurodegenerative disease in which the primary symptoms result in progressive neuromuscular weakness. Recent studies have highlighted that there is significant heterogeneity with regard to anatomical and temporal disease progression. Importantly, more recent advances in genetics have revealed new causative genes to the disease. New efforts have focused on the development of biomarkers that could aid in diagnosis, prognosis, and serve as pharmacodynamics markers. Although traditional pharmaceuticals continue to undergo trials for ALS, new therapeutic strategies including stem cell transplantation studies, gene therapies, and antisense therapies targeting some of the familial forms of ALS are gaining momentum.
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Clark MG, Smallwood Shoukry R, Huang CJ, Danielian LE, Bageac D, Floeter MK. Loss of functional connectivity is an early imaging marker in primary lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:562-569. [PMID: 30299161 DOI: 10.1080/21678421.2018.1517180] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The clinical diagnosis of primary lateral sclerosis can only be made after upper motor neuron symptoms have progressed for several years without developing lower motor neuron signs. The goal of the study was to identify neuroimaging changes that occur early in primary lateral sclerosis, prior to clinical diagnosis. METHODS MRI scans were obtained on 13 patients with adult-onset progressive spasticity for five years or less who were followed longitudinally to confirm a clinical diagnosis of primary lateral sclerosis. Resting state functional MRI, diffusion tensor imaging, and anatomical images were obtained. These "pre-PLS" patients were compared to 18 patients with longstanding, established primary lateral sclerosis and 28 controls. RESULTS Pre-PLS patients had a marked reduction in seed-based resting-state motor network connectivity compared to the controls and patients with longstanding disease. White matter regions with reduced fractional anisotropy were similar in the two patient groups compared to the controls. Patients with longstanding disease had cortical thinning of the precentral gyrus. A slight thinning of the right precentral gyrus was detected in initial pre-PLS patients' scans. Follow-up scans in eight pre-PLS patients 1-2 years later showed increasing motor connectivity, thinning of the precentral gyrus, and no change in diffusion measures of the corticospinal tract or callosal motor region. CONCLUSIONS Loss of motor functional connectivity is an early imaging marker in primary lateral sclerosis. This differs from literature descriptions of amyotrophic lateral sclerosis, warranting further studies to test whether resting-state functional MRI can differentiate between amyotrophic lateral sclerosis and primary lateral sclerosis at early disease stages.
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Affiliation(s)
- Michael G Clark
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Rachel Smallwood Shoukry
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Caleb J Huang
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Laura E Danielian
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Devin Bageac
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
| | - Mary Kay Floeter
- a National Institute of Neurological Disorders and Stroke , National Institutes of Health , Bethesda , MD , USA
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Ramanathan RS, Rana S. Demographics and clinical characteristics of primary lateral sclerosis: case series and a review of literature. Neurodegener Dis Manag 2018; 8:17-23. [PMID: 29316850 DOI: 10.2217/nmt-2017-0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Primary lateral sclerosis (PLS) is a form of motor neuron disease involving only upper motor neurons. In some patients presenting as PLS, the disease progresses to involve lower motor neurons and thereby converting to amyotrophic lateral sclerosis (ALS). However, pure forms of PLS do exist. Our aim was to study epidemiological and clinical characteristics of pure PLS patients treated at our neuromuscular clinic. METHODS We retrospectively reviewed 15 patients from July 2011 to October 2014 with PLS treated at the neuromuscular disorder clinic at our hospital. Data collection included patient demographics, age and site of onset, duration of symptoms and duration of follow-up. We also studied clinical features such as bulbar involvement; pseudobulbar affect; depression; spasms/pain; bladder involvement; diagnostic work up, in other words, MRI; brain/electromyography findings; clinical course, namely years to wheelchair; and need for gastrostomy tube requirement baclofen pump placement. We also tried to find a correlation between PLS and environmental factors such as urban/suburban/rural living, consumption of well water, socioeconomic status/occupation and history of trauma. RESULTS Male-to-female ratio was 1:2, mean age at onset of symptoms was 58.6 years, with the oldest patient being an 84-year-old female at the time of onset of symptoms. Mean duration of follow-up was 51 months. Mean duration of symptoms was 77.4 months. About eight (53%) patients presented with bulbar symptoms in the form of spastic speech and dysphagia, pseudobulbar affect, developed depression and had bladder involvement. Seven (47%) patients presented with symmetric spasticity in the extremities. A third of the patients required baclofen for spasticity and a third required gastrostomy tube placement for dysphagia. None of them had abnormal neuroimaging or electrodiagnostic testing. Only one patient had history of trauma. About half of the patients were from lower socioeconomic status as well as middle class. One of the patients had consumed well water during younger years and three (20%) patients lived in the rural area. CONCLUSION Though on review of literature there is no clear consensus about the existence of PLS as a distinct disease entity, we believe that there are rare cases of motor neuron disease with progressive upper motor neuron symptoms that throughout their course never convert to ALS. Our series highlights the demographic and clinical features of these patients and underscores the longer survival of these patients when compared with ALS.
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Affiliation(s)
| | - Sandeep Rana
- Temple University School of Medicine, Neurology Residency Program Director, Neuromuscular Department Director, Allegheny Health Network, 420 E North Ave, Suite 206, Pittsburgh, PA 15212, USA
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Turner M, Cosgrove J, Jamieson S, Chowdhury FU. Teaching Neuroimages: Hypometabolism of the primary motor cortex in primary lateral sclerosis: The stripe sign. Neurology 2017; 86:1464. [PMID: 27163663 DOI: 10.1212/wnl.0000000000002600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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 eventual paralysis. Until recently, ALS was classified primarily within the neuromuscular domain, although new imaging and neuropathological data have indicated the involvement of the non-motor neuraxis in disease pathology. In most patients, the mechanisms underlying the development of ALS are poorly understood, although a subset of patients have familial disease and harbour mutations in genes that have various roles in neuronal function. Two possible disease-modifying therapies that can slow disease progression are available for ALS, but patient management is largely mediated by symptomatic therapies, such as the use of muscle relaxants for spasticity and speech therapy for dysarthria.
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Affiliation(s)
- Orla Hardiman
- Academic Unit of Neurology, Room 5.41 Trinity Biomedical Science Institute, Trinity College Dublin, Pearse Street, Dublin 2, Ireland
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adriano Chio
- Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy
| | - Emma M Corr
- Academic Unit of Neurology, Room 5.41 Trinity Biomedical Science Institute, Trinity College Dublin, Pearse Street, Dublin 2, Ireland
| | | | - Wim Robberecht
- KU Leuven-University of Leuven, University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Zachary Simmons
- Department of Neurology, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, USA
| | - Leonard H van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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Wais V, Rosenbohm A, Petri S, Kollewe K, Hermann A, Storch A, Hanisch F, Zierz S, Nagel G, Kassubek J, Weydt P, Brettschneider J, Weishaupt JH, Ludolph AC, Dorst J. The concept and diagnostic criteria of primary lateral sclerosis. Acta Neurol Scand 2017; 136:204-211. [PMID: 27858953 DOI: 10.1111/ane.12713] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Primary lateral sclerosis (PLS) is commonly considered as a motor neuron disease (MND) variant which almost exclusively affects upper motor neurons (UMN). There is still no consensus whether PLS should be regarded as an independent disease entity separate from amyotrophic lateral sclerosis (ALS) or as a comparatively slowly progressive variant of ALS. Given these different views, clinical diagnosis of PLS is a challenge. In this multicenter study, we analyzed clinical features of patients diagnosed with PLS in four specialized MND centers. MATERIAL AND METHODS We retrospectively analyzed clinical, laboratory, imaging, and electrophysiological data of 76 patients with PLS diagnosed in four specialized ALS centers. We analyzed the concept of the disease based on our findings and an extensive review of the literature. RESULTS We found that 79% of patients showed asymmetrical symptoms, 60% showed clinical or electrophysiological signs of lower motor neuron (LMN) involvement after a mean of 8.4 ± 5.0 years, and extrapyramidal and/or non-motoric symptoms were frequently observed. Interestingly, none of the patients diagnosed with PLS fulfilled the diagnostic criteria proposed by Pringle et al. in 1992. CONCLUSIONS Our data show that PLS as a disease entity is still not well enough defined and that there are different concepts about its clinical presentation. We believe that further prospective longitudinal studies are needed in order to refine diagnostic criteria to reflect current clinical practice. Furthermore, neuropathological and neuroimaging approaches might help to arrange PLS in the MND spectrum and its classification.
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Affiliation(s)
- Verena Wais
- Department of Neurology; University of Ulm; Ulm Germany
| | | | - Susanne Petri
- Department of Neurology; University of Hannover; Hannover Germany
| | - Katja Kollewe
- Department of Neurology; University of Hannover; Hannover Germany
| | - Andreas Hermann
- Department of Neurology; Division for Neurodegenerative Diseases; Dresden University of Technology; Dresden Germany
- German Center for Neurodegenerative Diseases (DZNE); Dresden Germany
| | - Alexander Storch
- Department of Neurology; Division for Neurodegenerative Diseases; Dresden University of Technology; Dresden Germany
- German Center for Neurodegenerative Diseases (DZNE); Dresden Germany
- Department of Neurology; University Medical Center Rostock; Rostock Germany
| | - Frank Hanisch
- Department of Neurology; Evangelisches Krankenhaus Königin Elisabeth Herzberge; Berlin Germany
| | - Stephan Zierz
- Department of Neurology; University of Halle; Halle Germany
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry; University of Ulm; Ulm Germany
| | - Jan Kassubek
- Department of Neurology; University of Ulm; Ulm Germany
| | - Patrick Weydt
- Department of Neurology; University of Ulm; Ulm Germany
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Abstract
Amyotrophic lateral sclerosis (ALS) is primarily characterized by progressive loss of motor neurons, although there is marked phenotypic heterogeneity between cases. Typical, or "classical," ALS is associated with simultaneous upper motor neuron (UMN) and lower motor neuron (LMN) involvement at disease onset, whereas atypical forms, such as primary lateral sclerosis and progressive muscular atrophy, have early and predominant involvement in the UMN and LMN, respectively. The varying phenotypes can be so distinctive that they would seem to have differing biology. Because the same phenotypes can have multiple causes, including different gene mutations, there may be multiple molecular mechanisms causing ALS, implying that the disease is a syndrome. Conversely, multiple phenotypes can be caused by a single gene mutation; thus, a single molecular mechanism could be compatible with clinical heterogeneity. The pathogenic mechanism(s) in ALS remain unknown, but active propagation of the pathology neuroanatomically is likely a primary component.
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Affiliation(s)
- Leslie I Grad
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montréal H3A 2B4, Canada
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093
| | - Neil R Cashman
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
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de Vries BS, Rustemeijer LM, van der Kooi AJ, Raaphorst J, Schröder CD, Nijboer TC, Hendrikse J, Veldink JH, van den Berg LH, van Es MA. A case series of PLS patients with frontotemporal dementia and overview of the literature. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:534-548. [DOI: 10.1080/21678421.2017.1354996] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Bálint S. de Vries
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Laura M.M. Rustemeijer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Anneke J. van der Kooi
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,
| | - Joost Raaphorst
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands,
| | - Carin D. Schröder
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands,
| | - Tanja C.W. Nijboer
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands,
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands, and
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan H. Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Leonard H. van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Michael A. van Es
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,
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Al-Chalabi A, Hardiman O, Kiernan MC, Chiò A, Rix-Brooks B, van den Berg LH. Amyotrophic lateral sclerosis: moving towards a new classification system. Lancet Neurol 2017; 15:1182-94. [PMID: 27647646 DOI: 10.1016/s1474-4422(16)30199-5] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 12/18/2022]
Abstract
Amyotrophic lateral sclerosis is a progressive adult-onset neurodegenerative disease that primarily affects upper and lower motor neurons, but also frontotemporal and other regions of the brain. The extent to which each neuronal population is affected varies between individuals. The subsequent patterns of disease progression form the basis of diagnostic criteria and phenotypic classification systems, with considerable overlap in the clinical terms used. This overlap can lead to confusion between diagnosis and phenotype. Formal classification systems such as the El Escorial criteria and the International Classification of Diseases are systematic approaches but they omit features that are important in clinical management, such as rate of progression, genetic basis, or functional effect. Therefore, many neurologists use informal classification approaches that might not be systematic, and could include, for example, anatomical descriptions such as flail-arm syndrome. A new strategy is needed to combine the benefits of a systematic approach to classification with the rich and varied phenotypic descriptions used in clinical practice.
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Affiliation(s)
- Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK.
| | - Orla Hardiman
- Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adriano Chiò
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Benjamin Rix-Brooks
- Carolinas Neuromuscular/ALS-MDA Center, Department of Neurology, Carolinas Medical Center, Carolinas Healthcare System Neurosciences Institute, Charlotte, NC, USA; University of North Carolina School of Medicine-Charlotte Campus, Charlotte, NC, USA
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Netherlands
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Tard C, Defebvre L, Moreau C, Devos D, Danel-Brunaud V. Clinical features of amyotrophic lateral sclerosis and their prognostic value. Rev Neurol (Paris) 2017; 173:263-272. [DOI: 10.1016/j.neurol.2017.03.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/27/2017] [Indexed: 12/29/2022]
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Fournier CN, Murphy A, Loci L, Mitsumoto H, Lomen-Hoerth C, Kisanuki Y, Simmons Z, Maragakis NJ, McVey AL, Al-Lahham T, Heiman-Patterson TD, Andrews J, McDonnell E, Cudkowicz M, Atassi N. Primary Lateral Sclerosis and Early Upper Motor Neuron Disease: Characteristics of a Cross-Sectional Population. J Clin Neuromuscul Dis 2016; 17:99-105. [PMID: 26905909 DOI: 10.1097/CND.0000000000000102] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goals of this study were to characterize clinical and electrophysiologic findings of subjects with upper motor neuron disease and to explore feasibility of clinical trials in this population. METHODS Twenty northeast amyotrophic lateral sclerosis consortium (northeast amyotrophic lateral sclerosis) sites performed chart reviews to identify active clinical pure upper motor neuron disease patients. Patients with hereditary spastic paraplegia or meeting revised El Escorial electrodiagnostic criteria for amyotrophic lateral sclerosis were excluded. Patients were classified into 2 groups according to the presence or absence of minor electromyography (EMG) abnormalities. RESULTS Two hundred thirty-three subjects with upper motor neuron disease were identified; 217 had available EMG data. Normal EMGs were seen in 140 subjects, and 77 had minor denervation. Mean disease duration was 84 (±80) months for the entire cohort with no difference seen between the 2 groups. No difference was seen in clinical symptoms, disability, or outcome measures between the 2 groups after correcting for multiple comparisons. CONCLUSIONS Minor EMG abnormalities were not associated with phenotypic differences in a clinical upper motor neuron disease population. These findings suggest that subtle EMG abnormalities can not necessarily be used as a prognostic tool in patients with clinical upper motor neuron disease. This study also demonstrates the availability of a large number of patients with upper motor neuron diseases within the northeast amyotrophic lateral sclerosis network and suggests feasibility for conducting clinical trials in this population.
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