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Barczewska M, Maksymowicz S, Zdolińska-Malinowska I, Siwek T, Grudniak M. Umbilical Cord Mesenchymal Stem Cells in Amyotrophic Lateral Sclerosis: an Original Study. Stem Cell Rev Rep 2020; 16:922-932. [PMID: 32725316 PMCID: PMC7456414 DOI: 10.1007/s12015-020-10016-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is still incurable. Although different therapies can affect the health and survival of patients. Our aim is to evaluate the effect of umbilical mesenchymal stem cells administrated intrathecally to patients with amyotrophic lateral sclerosis on disability development and survival. METHODS This case-control study involved 67 patients treated with Wharton's jelly mesenchymal stem cells (WJ-MSC). The treated patients were paired with 67 reference patients from the PRO-ACT database which contains patient records from 23 ALS clinical studies (phase 2/3). Patients in the treatment and reference groups were fully matched in terms of race, sex, onset of symptoms (bulbar/spinal), FT9 disease stage at the beginning of therapy and concomitant amyotrophic lateral sclerosis medications. Progression rates prior to treatment varied within a range of ± 0.5 points. All patients received three intrathecal injections of Wharton's jelly-derived mesenchymal stem cells every two months at a dose of 30 × 106 cells. Patients were assessed using the ALSFRS-R scale. Survival times were followed-up until March 2020. RESULTS Median survival time increased two-fold in all groups. In terms of progression, three response types measured in ALSFRS-R were observed: decreased progression rate (n = 21, 31.3%), no change in progression rate (n = 33, 49.3%) and increased progression rate (n = 13, 19.4%). Risk-benefit ratios were favorable in all groups. No serious adverse drug reactions were observed. INTERPRETATION Wharton's jelly-derived mesenchymal stem cells therapy is safe and effective in some ALS patients, regardless of the clinical features and demographic factors excluding sex. The female sex and a good therapeutic response to the first administration are significant predictors of efficacy following further administrations. Graphical Abstract Medical therapeutic experiment with retrospective case-control analyses.
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Affiliation(s)
- Monika Barczewska
- Department of Neurosurgery, University of Warmia and Mazury, Olsztyn, Poland
- Instytut Terapii Komórkowych S.A., FamiCord Group, Olsztyn, Poland
- University Clinical Hospital, Olsztyn, Poland
| | - Stanisław Maksymowicz
- Instytut Terapii Komórkowych S.A., FamiCord Group, Olsztyn, Poland.
- Department of Psychology and Sociology of Health and Public Health, Collegium Medicum, University of Warmia and Mazury, Warszawska 30, 10-082, Olsztyn, Poland.
| | | | - Tomasz Siwek
- Instytut Terapii Komórkowych S.A., FamiCord Group, Olsztyn, Poland
- University Clinical Hospital, Olsztyn, Poland
- Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
| | - Mariusz Grudniak
- Polski Bank Komórek Macierzystych S.A., FamiCord Group, Warsaw, Poland
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The Characteristics of Cognitive Impairment in ALS Patients Depend on the Lateralization of Motor Damage. Brain Sci 2020; 10:brainsci10090650. [PMID: 32961718 PMCID: PMC7563934 DOI: 10.3390/brainsci10090650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 01/30/2023] Open
Abstract
(1) Background: Cognitive features of patients with amyotrophic lateral sclerosis (ALS) have never been specifically analyzed according to the lateralization of motor impairment. In the present study we investigated the cognitive performances of ALS patients to describe the relationship between motor and cognitive dysfunction, according to site and side of disease onset. (2) Methods: Six-hundred and nine ALS patients underwent a comprehensive neuropsychological evaluation at diagnosis in Turin ALS Centre Tests included—mini-mental state examination (MMSE), frontal assessment battery (FAB), trail-making test A/B (TMT A-B), digit span forward and backward (digit span FW/digit span BW), letter fluency test (FAS), category fluency test (CAT), Rey auditory verbal learning test (RAVLT), Babcock story recall test (BSRT), Rey-Osterrieth complex figure test (ROCFT), Wisconsin card sorting test (WCST), Raven’s coloured progressive matrices (CPM47). Cognitive performances of patients, grouped by side and site of onset, were statistically compared using z-scores, as appropriate. (3) Results: Bulbar patients and bilateral spinal onset patients (Sbil) were generally characterized by lower cognitive performances in most neuropsychological tests, when compared to patients with lateralized onset (right-side spinal onset, Sri and left-side spinal onset, Sle). Digit span backward and visual memory task (ROCFT) median z-scores were significantly higher, reflecting a better cognitive performance, in Sri patients when compared to bulbar/Sbil patients, while verbal memory tasks (RAVLT and BRST) resulted in significantly higher scores in Sle patients. Our results are in keeping with hemispheric functional lateralization of language and visuospatial abilities. (4) Conclusions: In ALS patients, as in other neurodegenerative diseases, we found a direct relationship between lateralized motor and cognitive features.
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Tavazzi E, Daberdaku S, Vasta R, Calvo A, Chiò A, Di Camillo B. Exploiting mutual information for the imputation of static and dynamic mixed-type clinical data with an adaptive k-nearest neighbours approach. BMC Med Inform Decis Mak 2020; 20:174. [PMID: 32819346 PMCID: PMC7439551 DOI: 10.1186/s12911-020-01166-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/24/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clinical registers constitute an invaluable resource in the medical data-driven decision making context. Accurate machine learning and data mining approaches on these data can lead to faster diagnosis, definition of tailored interventions, and improved outcome prediction. A typical issue when implementing such approaches is the almost unavoidable presence of missing values in the collected data. In this work, we propose an imputation algorithm based on a mutual information-weighted k-nearest neighbours approach, able to handle the simultaneous presence of missing information in different types of variables. We developed and validated the method on a clinical register, constituted by the information collected over subsequent screening visits of a cohort of patients affected by amyotrophic lateral sclerosis. METHODS For each subject with missing data to be imputed, we create a feature vector constituted by the information collected over his/her first three months of visits. This vector is used as sample in a k-nearest neighbours procedure, in order to select, among the other patients, the ones with the most similar temporal evolution of the disease over time. An ad hoc similarity metric was implemented for the sample comparison, capable of handling the different nature of the data, the presence of multiple missing values and include the cross-information among features captured by the mutual information statistic. RESULTS We validated the proposed imputation method on an independent test set, comparing its performance with those of three state-of-the-art competitors, resulting in better performance. We further assessed the validity of our algorithm by comparing the performance of a survival classifier built on the data imputed with our method versus the one built on the data imputed with the best-performing competitor. CONCLUSIONS Imputation of missing data is a crucial -and often mandatory- step when working with real-world datasets. The algorithm proposed in this work could effectively impute an amyotrophic lateral sclerosis clinical dataset, by handling the temporal and the mixed-type nature of the data and by exploiting the cross-information among features. We also showed how the imputation quality can affect a machine learning task.
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Affiliation(s)
- Erica Tavazzi
- Department of Information Engineering, University of Padua, Via Gradenigo 6/A, Padua, 35131 Italy
| | - Sebastian Daberdaku
- Department of Information Engineering, University of Padua, Via Gradenigo 6/A, Padua, 35131 Italy
| | - Rosario Vasta
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, Turin, 10124 Italy
| | - Andrea Calvo
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, Turin, 10124 Italy
| | - Adriano Chiò
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, Turin, 10124 Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padua, Via Gradenigo 6/A, Padua, 35131 Italy
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Acute, Hemorrhagic, Necrotizing Pancreatitis Associated With Riluzole Treatment in a Patient With Amyotrophic Lateral Sclerosis. Am J Ther 2020; 29:e265-e268. [PMID: 32769392 DOI: 10.1097/mjt.0000000000001217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vasta R, D'Ovidio F, Canosa A, Manera U, Torrieri MC, Grassano M, De Marchi F, Mazzini L, Moglia C, Calvo A, Chiò A. Plateaus in amyotrophic lateral sclerosis progression: results from a population‐based cohort. Eur J Neurol 2020; 27:1397-1404. [DOI: 10.1111/ene.14287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- R. Vasta
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - F. D'Ovidio
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - A. Canosa
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - U. Manera
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - M. C. Torrieri
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - M. Grassano
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - F. De Marchi
- Department of Neurology ALS Center Azienda Ospedaliero Universitaria Maggiore della Carità NovaraItaly
| | - L. Mazzini
- Department of Neurology ALS Center Azienda Ospedaliero Universitaria Maggiore della Carità NovaraItaly
| | - C. Moglia
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
- Neurology 1 Azienda Ospedaliero Universitaria Città della Salute e della Scienza Turin Italy
| | - A. Calvo
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
- Neurology 1 Azienda Ospedaliero Universitaria Città della Salute e della Scienza Turin Italy
| | - A. Chiò
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
- Neurology 1 Azienda Ospedaliero Universitaria Città della Salute e della Scienza Turin Italy
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Trojsi F, D’Alvano G, Bonavita S, Tedeschi G. Genetics and Sex in the Pathogenesis of Amyotrophic Lateral Sclerosis (ALS): Is There a Link? Int J Mol Sci 2020; 21:ijms21103647. [PMID: 32455692 PMCID: PMC7279172 DOI: 10.3390/ijms21103647] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with no known cure. Approximately 90% of ALS cases are sporadic, although multiple genetic risk factors have been recently revealed also in sporadic ALS (SALS). The pathological expansion of a hexanucleotide repeat in chromosome 9 open reading frame 72 (C9orf72) is the most common genetic mutation identified in familial ALS, detected also in 5–10% of SALS patients. C9orf72-related ALS phenotype appears to be dependent on several modifiers, including demographic factors. Sex has been reported as an independent factor influencing ALS development, with men found to be more susceptible than women. Exposure to both female and male sex hormones have been shown to influence disease risk or progression. Moreover, interplay between genetics and sex has been widely investigated in ALS preclinical models and in large populations of ALS patients carrying C9orf72 repeat expansion. In light of the current need for reclassifying ALS patients into pathologically homogenous subgroups potentially responsive to targeted personalized therapies, we aimed to review the recent literature on the role of genetics and sex as both independent and synergic factors, in the pathophysiology, clinical presentation, and prognosis of ALS. Sex-dependent outcomes may lead to optimizing clinical trials for developing patient-specific therapies for ALS.
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Pupillo E, Bianchi E, Vanacore N, Montalto C, Ricca G, Robustelli Della Cuna FS, Fumagalli F, Castellani M, Poli F, Romeo F, Tommasi D, Lazzaro P, Beghi E. Increased risk and early onset of ALS in professional players from Italian Soccer Teams. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:403-409. [PMID: 32321311 DOI: 10.1080/21678421.2020.1752250] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Since the observation of several deaths from amyotrophic lateral sclerosis (ALS) among Italian professional soccer players, an association between ALS and soccer has been postulated. The objective of the study is to investigate the association between professional soccer and the risk of ALS in a large cohort of former professional soccer players with prolonged follow-up. Methods: All professional soccer players practicing in the period 1959-2000 were identified through the archives of an Italian soccer cards publisher. For each player, date and place of birth, playing role, and team history were recorded. Each player was followed since 15 years of age. Incident ALS cases were all soccer players first diagnosed during the period 1959-2018. The expected incidence rate was the number of ALS cases/100,000 person-years expected in the cohort. SIR was the ratio between observed and expected incidence rate. Results: 34 ALS cases were detected. The number of expected cases was 17.8. The SIR was 1.91 (95% CI 1.32-2.67) in the entire sample and 4.66 (95% CI 2.66-7.57) in subjects aged less than 45 years. The mean age at diagnosis was 45.0 years. Compared to the mean age of onset of ALS in the general population (65.2 years), the disease in former soccer players occurred 20.2 years earlier. Conclusions: Professional soccer players are at higher risk of developing ALS than the general population. Soccer players with ALS develop the disease at a younger than expected age.
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Affiliation(s)
| | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nicola Vanacore
- Centro Nazionale Prevenzione delle Malattie e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Carla Montalto
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giuseppe Ricca
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | | | - Fabio Fumagalli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | | | - Fabio Poli
- Union of Professional Football Players in Italy, Vicenza, Italy
| | - Francesco Romeo
- Union of Professional Football Players in Italy, Vicenza, Italy
| | - Damiano Tommasi
- Union of Professional Football Players in Italy, Vicenza, Italy
| | - Pino Lazzaro
- Union of Professional Football Players in Italy, Vicenza, Italy
| | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Salamone P, Fuda G, Casale F, Marrali G, Lunetta C, Caponnetto C, Mazzini L, La Bella V, Mandrioli J, Simone IL, Moglia C, Calvo A, Tarella C, Chio A. G-CSF (filgrastim) treatment for amyotrophic lateral sclerosis: protocol for a phase II randomised, double-blind, placebo-controlled, parallel group, multicentre clinical study (STEMALS-II trial). BMJ Open 2020; 10:e034049. [PMID: 32209625 PMCID: PMC7202695 DOI: 10.1136/bmjopen-2019-034049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a fatal progressive neurological disorder characterised by a selective degeneration of motor neurons (MNs). Stem cell transplantation is considered as a promising strategy in neurological disorders therapy and the possibility of inducing bone marrow cells (BMCs) to circulate in the peripheral blood is suggested to investigate stem cells migration in degenerated ALS nerve tissues where potentially repair MN damage. Granulocyte-colony stimulating factor (G-CSF) is a growth factor which stimulates haematopoietic progenitor cells, mobilises BMCs into injured brain and it is itself a neurotrophic factor for MN. G-CSF safety in humans has been demonstrated and many observations suggest that it may affect neural cells. Therefore, we decided to use G-CSF to mobilise BMCs into the peripheral circulation in patients with ALS, planning a clinical trial to evaluate the effect of G-CSF administration in ALS patients compared with placebo. METHODS AND ANALYSIS STEMALS-II is a phase II multicentre, randomised double-blind, placebo-controlled, parallel group clinical trial on G-CSF (filgrastim) and mannitol in ALS patients. Specifically, we investigate safety, tolerability and efficacy of four repeated courses of intravenous G-CSF and mannitol administered in 76 ALS patients in comparison with placebo (indistinguishable glucose solution 5%). We determine increase of G-CSF levels in serum and cerebrospinal fluid as CD34+ cells and leucocyte count after treatment; reduction in ALS Functional Rating Scale-Revised Score, forced vital capacity, Scale for Testing Muscle Strength Score and quality of life; the adverse events/reactions during the treatment; changes in neuroinflammation biomarkers before and after treatment. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of Azienda Ospedaliera Universitaria 'Città della Salute e della Scienza', Torino, Italy. Results will be presented during scientific symposia or published in scientific journals. TRIAL REGISTRATION NUMBER Eudract 2014-002228-28.
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Affiliation(s)
- Paolina Salamone
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Piemonte, Italy
| | - Giuseppe Fuda
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Piemonte, Italy
| | - Federico Casale
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Piemonte, Italy
| | - Giuseppe Marrali
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Piemonte, Italy
| | - Christian Lunetta
- NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Claudia Caponnetto
- Neurological Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Letizia Mazzini
- Department of Neurology, Maggiore della Carità Hospital, University of Piemonte Orientale, Novara, Italy
| | - Vincenzo La Bella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Sicilia, Italy
| | - Jessica Mandrioli
- Department of Neuroscience, Azienda Ospedaliera Universitaria Modena, St. Agostino-Estense Hospital, Modena, Italy
| | - Isabella Laura Simone
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Puglia, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Piemonte, Italy
- ALS Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Piemonte, Italy
- ALS Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Corrado Tarella
- Oncohematology Division, IEO European Institute of Oncology, IRCCS, University of Milan, Milano, Lombardia, Italy
| | - Adriano Chio
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Piemonte, Italy
- ALS Center, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
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Prognostic role of slow vital capacity in amyotrophic lateral sclerosis. J Neurol 2020; 267:1615-1621. [DOI: 10.1007/s00415-020-09751-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/11/2022]
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Filippini T, Fiore M, Tesauro M, Malagoli C, Consonni M, Violi F, Arcolin E, Iacuzio L, Oliveri Conti G, Cristaldi A, Zuccarello P, Zucchi E, Mazzini L, Pisano F, Gagliardi I, Patti F, Mandrioli J, Ferrante M, Vinceti M. Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030857. [PMID: 32019087 PMCID: PMC7037077 DOI: 10.3390/ijerph17030857] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/26/2022]
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease of the motor neurons. The etiology of ALS remains largely unknown, particularly with reference to the potential environmental determinants. Methods: We performed a population-based case-control study in four provinces from both Northern and Southern Italy in order to assess non-genetic ALS risk factors by collecting through tailored questionnaires information about clinical and lifestyle factors. We estimated ALS risk by calculating odds ratio (OR) with its 95% confidence interval (CI) using unconditional logistic regression models adjusted for sex, age and educational attainment. Results: We recruited 230 participants (95 cases and 135 controls). We found a possible positive association of ALS risk with trauma, particularly head trauma (OR = 2.61, 95% CI 1.19–5.72), electric shock (OR = 2.09, 95% CI 0.62–7.06), and some sports, although at a competitive level only. In addition, our results suggest an increased risk for subjects reporting use of private wells for drinking water (OR = 1.38, 95% CI 0.73–2.27) and for use of herbicides during gardening (OR = 1.95, 95% CI 0.88–2.27). Conversely, there was a suggestion of an inverse association with overall fish consumption (OR = 0.27, 95% CI 0.12–0.60), but with no dose-response relation. Consumption of some dietary supplements, namely those containing amino acids and, in the Southern Italy population, vitamins and minerals such as selenium, seemed associated with a statistically imprecise increased risk. Conclusions: Our results suggest a potential etiologic role a number of clinical and lifestyle factors with ALS risk. However, caution is needed due to some study limitations. These include the small sample size and the low number of exposed subjects, which affect statistical precision of risk estimates, the potential for exposure misclassification, and the uncertainties about mechanisms underpinning the possible association between these factors and disease risk.
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Affiliation(s)
- Tommaso Filippini
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Maria Fiore
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marina Tesauro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Carlotta Malagoli
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
| | - Michela Consonni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Federica Violi
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Elisa Arcolin
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
| | - Laura Iacuzio
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Department of Public Health, Local Health Unit, 41121 Modena, Italy
| | - Gea Oliveri Conti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Antonio Cristaldi
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Pietro Zuccarello
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Elisabetta Zucchi
- Neurology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Letizia Mazzini
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Fabrizio Pisano
- Neurological Rehabilitation Division, Policlinico San Marco di Zingonia, 24046 Zingonia (BG), Italy;
| | - Ileana Gagliardi
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marco Vinceti
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Correspondence:
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Chiò A, Moglia C, Canosa A, Manera U, D'Ovidio F, Vasta R, Grassano M, Brunetti M, Barberis M, Corrado L, D'Alfonso S, Iazzolino B, Peotta L, Sarnelli MF, Solara V, Zucchetti JP, De Marchi F, Mazzini L, Mora G, Calvo A. ALS phenotype is influenced by age, sex, and genetics: A population-based study. Neurology 2020; 94:e802-e810. [PMID: 31907290 DOI: 10.1212/wnl.0000000000008869] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the determinants of amyotrophic lateral sclerosis (ALS) phenotypes in a population-based cohort. METHODS The study population included 2,839 patients with ALS diagnosed in Piemonte, Italy (1995-2015). Patients were classified according to motor (classic, bulbar, flail arm, flail leg, predominantly upper motor neuron [PUMN], respiratory) and cognitive phenotypes (normal, ALS with cognitive impairment [ALSci], ALS with behavioral impairment [ALSbi], ALSci and ALSbi combined [ALScbi], ALS-frontotemporal dementia [FTD]). Binary logistic regression analysis was adjusted for sex, age, and genetics. RESULTS Bulbar phenotype correlated with older age (p < 0.0001), women were more affected than men at increasing age (p < 0.0001), classic with younger age (p = 0.029), men were more affected than women at increasing age (p < 0.0001), PUMN with younger age (p < 0.0001), flail arm with male sex (p < 0.0001) and younger age (p = 0.04), flail leg with male sex with increasing age (p = 0.008), and respiratory with male sex (p < 0.0001). C9orf72 expansions correlated with bulbar phenotype (p < 0.0001), and were less frequent in PUMN (p = 0.041); SOD1 mutations correlated with flail leg phenotype (p < 0.0001), and were less frequent in bulbar (p < 0.0001). ALS-FTD correlated with C9orf72 (p < 0.0001) and bulbar phenotype (p = 0.008), ALScbi with PUMN (p = 0.014), and ALSci with older age (p = 0.008). CONCLUSIONS Our data suggest that the spatial-temporal combination of motor and cognitive events leading to the onset and progression of ALS is characterized by a differential susceptibility to the pathologic process of motor and prefrontal cortices and lower motor neurons, and is influenced by age, sex, and gene variants. The identification of those factors that regulate ALS phenotype will allow us to reclassify patients into pathologically homogenous subgroups, responsive to targeted personalized therapies.
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Affiliation(s)
- Adriano Chiò
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy.
| | - Cristina Moglia
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Antonio Canosa
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Umberto Manera
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Fabrizio D'Ovidio
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Rosario Vasta
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Maurizio Grassano
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Maura Brunetti
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Marco Barberis
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Lucia Corrado
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Sandra D'Alfonso
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Barbara Iazzolino
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Laura Peotta
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Maria Francesca Sarnelli
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Valentina Solara
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Jean Pierre Zucchetti
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Fabiola De Marchi
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Letizia Mazzini
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Gabriele Mora
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Andrea Calvo
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., F.D., R.V., M.G., M. Brunetti, M. Barberis, B.I., L.P., J.P.Z., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont, Novara; ALS Center, Department of Neurology (M.F.S., V.S., F.D.M., L.M.), Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
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Global variation in prevalence and incidence of amyotrophic lateral sclerosis: a systematic review and meta-analysis. J Neurol 2019; 267:944-953. [PMID: 31797084 DOI: 10.1007/s00415-019-09652-y] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a global disease, which adversely affects the life quality of patients and significantly increases the burden of families and society. We aimed to assess the changing incidence, prevalence of ALS around the world. METHODS We searched Medline, Embase, Web of Science, and Cochrane library to identify articles published until September 9, 2018. Each included study was independently reviewed for methodological quality by two reviewers. We used a random-effects model to summarize individual studies and assessed heterogeneity (I2) with the χ2 test on Cochrane's Q statistic. RESULTS We identified 124 studies that were eligible for final inclusion, including 110 studies of incidence and 58 studies of prevalence. The overall crude worldwide ALS prevalence and incidence were 4.42 (95% CI 3.92-4.96) per 1,00,000 population and 1.59 (95% CI 1.39-1.81) per 1,00,000 person-years, respectively. ALS prevalence and incidence increased by age until the age of 70-79. Since 1957, incidence has been significantly rising year by year, and this upward trend was weakened after standardization. The longest survival time were in Asia (ranging from 3.74 years in South Asia to 9.23 years in West Asia). CONCLUSIONS With the aggravation of population aging and the rapid growth of economy, developing regions following the development pattern of the developed regions may suffer rising ALS prevalence and incidence which may increase their disease burden as well. These data highlight the need for research into underlying mechanism and innovations in health-care systems.
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Sánchez-Martínez CM, Choreño-Parra JA, Nuñez-Orozco L, Placencia-Álvarez N, Alvis-Castaño LM, Guadarrama-Ortiz P. A retrospective study of the clinical phenotype and predictors of survival in non-Caucasian Hispanic patients with amyotrophic lateral sclerosis. BMC Neurol 2019; 19:261. [PMID: 31664949 PMCID: PMC6819359 DOI: 10.1186/s12883-019-1459-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/10/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the clinical phenotype of amyotrophic lateral sclerosis (ALS) in non-Caucasian populations. Here, we aimed to describe the clinical characteristics, prognostic factors and survival of Mexican patients with ALS. METHODS We conducted a retrospective study by reviewing the medical records of patients with ALS that attended and were regularly followed at a third level hospital in Mexico City from 2000 to 2015. We calculated absolute and relative frequencies of the clinical characteristics from all the participants. We also estimated correlation coefficients between clinical features and overall survival. Additionally, survival rates were compared for all participants grouped according to different clinical features using the Kaplan-Meier method and the log-rank test. RESULTS We enrolled 45 ALS patients, 53.33% had spinal-onset ALS and 46.66% presented bulbar ALS. The male/female ratio was 0.8. The mean age at onset of symptoms was 58.11 years. Mean survival time from onset was 64.73 ± 34.83 months. Cumulative survival rate after 5 years of disease onset was 44.44%. Age at onset and age at diagnosis inversely correlated with overall survival time. Also, we found that bulbar-onset, short diagnostic delay, percutaneous endoscopic gastrostomy, mechanical ventilation, and lower total cholesterol serum levels were associated with short survival. CONCLUSIONS The clinical characteristics of Mexican ALS patients differ from the disease phenotype observed in Caucasians. Nonetheless, the predictive value of certain well-recognized prognostic factors remains consistent in our population. The current study provides relevant information for a better understanding of prognostic factors in ALS patients from Mexico and other Latin American countries.
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Affiliation(s)
- Claudia Marisol Sánchez-Martínez
- Department of Neurology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Félix Cuevas, 540, Col del Valle Sur, 03100, Mexico City, Mexico.
| | - José Alberto Choreño-Parra
- Department of Research, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Mexico City, Mexico.,Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Lilia Nuñez-Orozco
- Department of Neurology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Félix Cuevas, 540, Col del Valle Sur, 03100, Mexico City, Mexico
| | - Noel Placencia-Álvarez
- Department of Neurology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Félix Cuevas, 540, Col del Valle Sur, 03100, Mexico City, Mexico
| | - Laura Marcela Alvis-Castaño
- Department of Neurology, Centro Médico Nacional 20 de Noviembre, ISSSTE, Félix Cuevas, 540, Col del Valle Sur, 03100, Mexico City, Mexico
| | - Parménides Guadarrama-Ortiz
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala & Manzanillo, Roma Sur, 06760, Mexico City, Mexico.
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Chiò A, Moglia C, Canosa A, Manera U, Vasta R, Brunetti M, Barberis M, Corrado L, D'Alfonso S, Bersano E, Sarnelli MF, Solara V, Zucchetti JP, Peotta L, Iazzolino B, Mazzini L, Mora G, Calvo A. Cognitive impairment across ALS clinical stages in a population-based cohort. Neurology 2019; 93:e984-e994. [PMID: 31409738 DOI: 10.1212/wnl.0000000000008063] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/09/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To assess the association of the degree of severity of motor impairment to that of cognitive impairment in a large cohort of patients with amyotrophic lateral sclerosis (ALS). METHODS This is a population-based cross-sectional study on patients with ALS incident in Piemonte, Italy, between 2007 and 2015. Cognitive status was classified according to the revised ALS-FTD Consensus Criteria. The King system and the Milano Torino Staging system (MiToS) were used for defining the severity of motor impairment. RESULTS Of the 797 patients included in the study, 163 (20.5%) had ALS-frontotemporal dementia (FTD), 38 (4.8%) cognitive and behavioral impairment (ALScbi), 132 (16.6%) cognitive impairment (ALSci), 63 (7.9%) behavioral impairment (ALSbi), 16 (2.0%) nonexecutive impairment, and 385 (48.2%) were cognitively normal. According to King staging, the frequency of cases with ALS-FTD progressively increased from 16.5% in stage 1-44.4% in stage 4; conversely, the frequency of ALSci, ALSbi, and ALScbi increased from King stage 1 to King stage 3 and decreased thereafter. A similar pattern was observed with the MiToS staging. ALS-FTD was more frequent in patients with bulbar involvement at time of cognitive testing. Patients with C9ORF72 expansion (n = 61) showed more severe cognitive impairment with increasing King and MiToS stages. CONCLUSION Our findings suggest that ALS motor and cognitive components may worsen in parallel, and that cognitive impairment becomes more pronounced when bulbar function is involved. Our data support the hypothesis that ALS pathology disseminates in a regional ordered sequence, through a cortico-efferent spreading model.
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Affiliation(s)
- Adriano Chiò
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy.
| | - Cristina Moglia
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Antonio Canosa
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Umberto Manera
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Rosario Vasta
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Maura Brunetti
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Marco Barberis
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Lucia Corrado
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Sandra D'Alfonso
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Enrica Bersano
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Maria Francesca Sarnelli
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Valentina Solara
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Jean Pierre Zucchetti
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Laura Peotta
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Barbara Iazzolino
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Letizia Mazzini
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Gabriele Mora
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
| | - Andrea Calvo
- From the ALS Center (A. Chiò, C.M., A. Canosa, U.M., R.V., M. Brunetti, M. Barberis, J.P.Z., L.P., B.I., A. Calvo), "Rita Levi Montalcini" Department of Neuroscience, University of Torino; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino (A. Chiò, C.M., A. Calvo), Turin; Institute of Cognitive Sciences and Technologies (A. Chiò), National Research Council, Rome; Department of Health Sciences Interdisciplinary Research Center of Autoimmune Diseases (L.C., S.D.), "Amedeo Avogadro" University of Eastern Piedmont; ALS Center (E.B., M.F.S., V.S., L.M.), Department of Neurology, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara; and Istituti Clinici Scientifici Maugeri (G.M.), IRCCS Milano, Milan, Italy
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65
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Iazzolino B, Pain D, Peotta L, Calvo A, Moglia C, Canosa A, Manera U, Ilardi A, Bombaci A, Zucchetti JP, Mora G, Chio A. Validation of the revised classification of cognitive and behavioural impairment in ALS. J Neurol Neurosurg Psychiatry 2019; 90:734-739. [PMID: 30733331 DOI: 10.1136/jnnp-2018-319696] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In 2017, the diagnostic criteria for cognitive and behavioural impairment in amyotrophic lateral sclerosis (ALS) with frontotemporal dementia (ALSFTD-1) have been modified (ALSFTD-2) with the inclusion of a novel category (ALS with combined cognitive and behavioural impairment, ALScbi) and with changes of operational criteria of the other categories (ALS with cognitive impairment (ALSci), ALS with behavioural impairment (ALSbi) and ALS with frontotemporal dementia (ALS-FTD)). We compared the two sets of criteria to assess the effect of the revised criteria on the cognitive classification of patients with ALS. METHODS Two cohorts of patients with ALS were included in this study: a population-based cohort including patients identified through the Piemonte/Valle d'Aosta register for ALS in the 2014-2017 period (n=321), and a referral cohort recruited at the Turin ALS centre and at the ALS centre of the Maugeri Institute in Milan in the same period (n=205). Cognitive function was classified in blind by two neuropsychologists expert in ALS. RESULTS ALSFTD-2 criteria determined a shift of about 15% of patients from their original category to a new one. In both cohorts, about 9% of patients were reclassified to the novel category ALScbi. Among patients previously classified as cognitively normal, 14 (4.3%, population-based cohort) and 19 (9.3%, referral cohort) were reclassified as ALSbi or ALSci. The median survival of the different categories was significantly different with both with sets of criteria. CONCLUSIONS The new ALSFTD-2 criteria, compared with the old ones, have positive effects on the clinical practice being more sensitive to the early cognitive impairment and having a better prognostic yield.
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Affiliation(s)
- Barbara Iazzolino
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy
| | - Debora Pain
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Laura Peotta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy
| | - Andrea Calvo
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy.,Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Cristina Moglia
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy.,Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Antonio Canosa
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy
| | - Umberto Manera
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy
| | - Antonio Ilardi
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy
| | - Alessandro Bombaci
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy
| | - Jean Pierre Zucchetti
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy
| | - Gabriele Mora
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Adriano Chio
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Torino, Italy .,ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy.,Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy
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66
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Trojsi F, Siciliano M, Femiano C, Santangelo G, Lunetta C, Calvo A, Moglia C, Marinou K, Ticozzi N, Ferro C, Scialò C, Sorarù G, Conte A, Falzone YM, Tortelli R, Russo M, Sansone VA, Chiò A, Mora G, Silani V, Volanti P, Caponnetto C, Querin G, Sabatelli M, Riva N, Logroscino G, Messina S, Fasano A, Monsurrò MR, Tedeschi G, Mandrioli J. Comparative Analysis of C9orf72 and Sporadic Disease in a Large Multicenter ALS Population: The Effect of Male Sex on Survival of C9orf72 Positive Patients. Front Neurosci 2019; 13:485. [PMID: 31156370 PMCID: PMC6534038 DOI: 10.3389/fnins.2019.00485] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/29/2019] [Indexed: 12/30/2022] Open
Abstract
We investigated whether the C9orf72 repeat expansion is associated with specific clinical features, comorbidities, and prognosis in patients with amyotrophic lateral sclerosis (ALS). A cohort of 1417 ALS patients, diagnosed between January 1, 2009 and December 31, 2013 by 13 Italian ALS Referral Centers, was screened for the C9orf72 repeat expansion, and the analyses were performed comparing patients carrying this expansion (ALS-C9Pos) to those negative for this and other explored ALS-related mutations (ALS without genetic mutations, ALSwoGM). Compared to the ALSwoGM group, ALS-C9Pos patients (n = 84) were younger at disease onset, at the first clinical observation and at diagnosis (p < 0.001). After correcting for these differences, we found that ALS-C9Pos patients had higher odds of bulbar onset, diagnosis of frontotemporal dementia (FTD) and family history of ALS, FTD, and Alzheimer's disease and had lower odds of spinal onset, non-invasive ventilation, hypertension and psychiatric diseases than ALSwoGM patients. Among these variables, those related to shorter survival time were: bulbar onset, presence of FTD, hypertension, psychiatric disease, and family history of ALS (p < 0.05). Cox proportional hazards regression multivariate analysis suggested that carrying the C9orf72 repeat expansion was an independent factor negatively impacting on survival time in men (HR 1.58, 95% CI 1.07–2.33, p = 0.021), but not in women (p > 0.05) as well as in the whole sample (p > 0.05). When compared to ALSwoGM, ALS-C9Pos showed an earlier disease onset, no significant diagnostic delay and a higher odds of bulbar onset, FTD and family history of ALS and dementia. Moreover, male sex drove the negative effect of expanded variant on survival, confirming the hypothesis that sex is likely to be a crucial factor in the biology of C9orf72-related disease.
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Affiliation(s)
- Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Psychology, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Cinzia Femiano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Christian Lunetta
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Milan, Italy.,NEMO Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina, Italy
| | - Andrea Calvo
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Turin, Italy
| | - Cristina Moglia
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Turin, Italy
| | - Kalliopi Marinou
- Department of Neurorehabilitation-ALS Center, IRCCS Scientific Clinical Institute Maugeri, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Milan, Italy
| | - Christian Ferro
- Neurorehabilitation Unit/ALS Center, Scientific Clinical Institutes (ICS) Maugeri, IRCCS, Messina, Italy
| | - Carlo Scialò
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padua, Italy
| | - Amelia Conte
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation-Pol. A. Gemelli Foundation, Rome, Italy
| | - Yuri M Falzone
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Rosanna Tortelli
- Department of Clinical Research in Neurology, University of Bari "A. Moro", at Pia Fondazione "Card. G. Panico", Lecce, Italy
| | - Massimo Russo
- NEMO Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Valeria Ada Sansone
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Adriano Chiò
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Turin, Italy
| | - Gabriele Mora
- Department of Neurorehabilitation-ALS Center, IRCCS Scientific Clinical Institute Maugeri, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Milan, Italy
| | - Paolo Volanti
- Neurorehabilitation Unit/ALS Center, Scientific Clinical Institutes (ICS) Maugeri, IRCCS, Messina, Italy
| | - Claudia Caponnetto
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova, Italy
| | - Giorgia Querin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padua, Italy
| | - Mario Sabatelli
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation-Pol. A. Gemelli Foundation, Rome, Italy.,Department of Geriatrics, Neurosciences and Orthopedics, Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Nilo Riva
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, University of Bari "A. Moro", at Pia Fondazione "Card. G. Panico", Lecce, Italy
| | - Sonia Messina
- NEMO Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Fasano
- Department of Neuroscience, S. Agostino-Estense Hospital and University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Rosaria Monsurrò
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Jessica Mandrioli
- Department of Neuroscience, S. Agostino-Estense Hospital and University of Modena and Reggio Emilia, Modena, Italy
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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: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [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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68
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Jun KY, Park J, Oh KW, Kim EM, Bae JS, Kim I, Kim SH. Epidemiology of ALS in Korea using nationwide big data. J Neurol Neurosurg Psychiatry 2019; 90:395-403. [PMID: 30409890 PMCID: PMC6581156 DOI: 10.1136/jnnp-2018-318974] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to determine the incidence, prevalence and survival time of Korean patients with amyotrophic lateral sclerosis (ALS) using National Health Insurance Service (NHIS) data. METHODS Using NHIS data, the Korean nationwide health dataset, we identified patients with motor neuron diseases who were first diagnosed with a KCD-6 code (G12.20-G12.28; modified from ICD-10 codes) between 2011 and 2015. ALS (G12.21 code) epidemiological characteristics, including annual incidence, prevalence, mortality rates and survival time, were analysed and compared with sociodemographic variables. RESULTS New patients with ALS (n=3049) were enrolled over 5 years. The mean annual incidence was 1.20/100 000, and the sex ratio was 1.60 (male:female). The mean age at the time of diagnosis was 61.4 years. The prevalence rate was 3.43/100 000 in 2015. In this period, riluzole was prescribed to 53.6% of patients with ALS. Furthermore, 20.3% of patients with ALS underwent tracheostomy. When analysed for age and socioeconomic status, ALS prevalence rate was 10.71 in the aged group (≥60) in 2015 and was lowest in the middle-income group compared with that in the high-income and low-income groups. The estimated mean survival time in this population was 50.0 months, and the 3-year and 5-year mortality rates were 52.1% and 63.7%, respectively. CONCLUSIONS This study is the first nationwide survey for epidemiological characteristics of ALS in Korea using national data. The use of these data substantially advances the understanding of Korean and Asian ALS epidemiology and its relationship with socioeconomic status, age and sex.
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Affiliation(s)
- Kyo Yeon Jun
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea.,Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
| | - Eun Mi Kim
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Inah Kim
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea .,Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea .,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
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69
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Leighton DJ, Newton J, Stephenson LJ, Colville S, Davenport R, Gorrie G, Morrison I, Swingler R, Chandran S, Pal S. Changing epidemiology of motor neurone disease in Scotland. J Neurol 2019; 266:817-825. [PMID: 30805795 DOI: 10.1007/s00415-019-09190-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Scotland benefits from an integrated national healthcare team for motor neurone disease (MND) and a tradition of rich clinical data capture using the Scottish MND Register (launched in 1989; one of the first national registers). The Scottish register was re-launched in 2015 as Clinical Audit Research and Evaluation of MND (CARE-MND), an electronic platform for prospective, population-based research. We aimed to determine if incidence of MND is changing over time. METHODS Capture-recapture methods determined the incidence of MND in 2015-2016. Incidence rates for 2015-2016 and 1989-1998 were direct age and sex standardised to allow time-period comparison. Phenotypic characteristics and socioeconomic status of the cohort are described. RESULTS Coverage of the CARE-MND platform was 99%. Crude incidence in the 2015-2017 period was 3.83/100,000 person-years (95% CI 3.53-4.14). Direct age-standardised incidence in 2015 was 3.42/100,000 (95% CI 2.99-3.91); in 2016, it was 2.89/100,000 (95% CI 2.50-3.34). The 1989-1998 direct standardised annual incidence estimate was 2.32/100,000 (95% CI 2.26-2.37). 2015-2016 standardised incidence was 66.9% higher than Northern European estimates. Socioeconomic status was not associated with MND. CONCLUSIONS Our data show a changing landscape of MND in Scotland, with a rise in incidence by 36.0% over a 25-year period. This is likely attributable to ascertainment in the context of improved neurological services in Scotland. Our data suggest that CARE-MND is a reliable national resource and findings can be extrapolated to the other Northern European populations.
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Affiliation(s)
- Danielle J Leighton
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Judith Newton
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Laura J Stephenson
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Richard Davenport
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - George Gorrie
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Institute of Neurosciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Ian Morrison
- Department of Neurology, NHS Tayside, Dundee, UK
| | - Robert Swingler
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK. .,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK. .,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK. .,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.
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De Marchi F, Tondo G, Sarnelli MF, Corrado L, Solara V, D'Alfonso S, Cantello R, Mazzini L. A case of progressive non-fluent aphasia as onset of amyotrophic lateral sclerosis with frontotemporal dementia. Int J Neurosci 2019; 129:719-721. [PMID: 30146930 DOI: 10.1080/00207454.2018.1516657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The association between Amyotrophic Lateral Sclerosis (ASL) and FrontoTemporal Dementia (FTD) is well known. Most of reports describing ASL-FTD cases show a strong association between ALS and the behavioural form of FTD. Conversely, the association between ALS and pure Semantic Dementia or Progressive Non-Fluent Aphasia (PNFA) is extremely rare, ranging from 1 to 3%. A clinical phenotype characterized by a rapidly progressive aphasic dementia and motoneuron disease (MND) has been described in few case reports; since the updating of PNFA diagnostic criteria in 2011, no clinical report has been related. We want to describe a case of patient presented, at the onset, as PNFA who developed, one year later, ALS with bulbar onset. The patient was screened for the main genes causing or associated with MND and/or dementia but no variants with a pathogenetic effect were observed.
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Affiliation(s)
- F De Marchi
- a Department of Neurology , Eastern Piedmont University, "Maggiore della Carità" University Hospital , Novara , Italy
| | - G Tondo
- a Department of Neurology , Eastern Piedmont University, "Maggiore della Carità" University Hospital , Novara , Italy
| | - M F Sarnelli
- b ALS Center, Department of Neurology , "Maggiore della Carità" University Hospital , Novara , Italy
| | - L Corrado
- c Interdisciplinary Research Center of Autoimmune Disease (IRCAD), Eastern Piedmont University , Novara , Italy
| | - V Solara
- b ALS Center, Department of Neurology , "Maggiore della Carità" University Hospital , Novara , Italy
| | - S D'Alfonso
- c Interdisciplinary Research Center of Autoimmune Disease (IRCAD), Eastern Piedmont University , Novara , Italy
| | - R Cantello
- a Department of Neurology , Eastern Piedmont University, "Maggiore della Carità" University Hospital , Novara , Italy
| | - L Mazzini
- b ALS Center, Department of Neurology , "Maggiore della Carità" University Hospital , Novara , Italy
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Elamin EM, Wilson CS, Sriaroon C, Crudup B, Pothen S, Kang YC, White KT, Anderson WM. Effects of early introduction of non-invasive positive pressure ventilation based on forced vital capacity rate of change: Variation across amyotrophic lateral sclerosis clinical phenotypes. Int J Clin Pract 2019; 73:e13257. [PMID: 30230161 DOI: 10.1111/ijcp.13257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 08/10/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease associated with high morbidity and mortality. We evaluated the ability of pulmonary function tests to predict disease progression by ALS clinical phenotypes, and the timing of the introduction of non-invasive positive pressure ventilation (NIPPV). MATERIALS AND METHODS A cohort study was performed in all adult patients who fulfilled El Escorial criteria at a tertiary-care academic medical centre for veterans in the USA from 1 January 2010 to 31 December 2014. Eligible patients underwent sitting and supine forced vital capacity (FVC) and the FVC rate of change (RoC) per month was calculated. ALS Functional Rating Scale-Revised (ALSFRS-R) scores were collected. RESULTS A total of 137 patients were included in our analysis. The average survival from ALS onset was 31.40 (±40.04) months. The general cohort median (IQR) RoC was -0.87 (-2.55 to 0.34)/-0.65 (-2.55 to 0.70) % per month (P = 0.81) of the sitting/supine FVC, respectively. However, mean monthly RoC varied among the ALS phenotypes, with higher variation among global ALS, where greater decline in RoC was noted. The average time from ALS onset to tracheostomy was 27.88 (±22.21) months. The average sitting/supine FVC RoC for subjects requiring tracheostomy was -2.86 (±3.77)/-3.63 (±3.75) at the time of tracheostomy, compared to -1.190 (±2.38)/-1.07 (±3.78) for those who did not require the procedure. Although NIPPV use did not result in statistically significant improvements in either the sitting or supine FVC %, it did slow the RoC decline of patients with global ALS phenotypes. CONCLUSIONS Initiation of NIPPV based on decline in RoC rather than the absolute value of either sitting or supine FVC may result in early stabilisation of ALS patients' pulmonary deterioration for the global clinical phenotype, and thus may have the potential for prolonging survival until tracheostomy or death.
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Affiliation(s)
- Elamin M Elamin
- Division of Pulmonary, Critical Care Medicine and Sleep, James A. Haley Veterans' Hospital, Tampa, Florida
- Division of Pulmonary, Critical Care Medicine, and Sleep, University of South Florida, Tampa, Florida
| | - Catherine S Wilson
- Mental Health and Behavioral Science Services, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Chakrapol Sriaroon
- Division of Pulmonary, Critical Care Medicine, and Sleep, University of South Florida, Tampa, Florida
| | - Bianca Crudup
- Mental Health and Behavioral Science Services, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Sophia Pothen
- College of Osteopathic Medicine, Liberty University, Lynchburg, Virginia
| | - Younghee C Kang
- Division of Pulmonary, Critical Care Medicine and Sleep, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Kevin T White
- Division of Pulmonary, Critical Care Medicine and Sleep, James A. Haley Veterans' Hospital, Tampa, Florida
| | - William M Anderson
- Division of Pulmonary, Critical Care Medicine and Sleep, James A. Haley Veterans' Hospital, Tampa, Florida
- Division of Pulmonary, Critical Care Medicine, and Sleep, University of South Florida, Tampa, Florida
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Turgut N, Varol SaraÇoglu G, Kat S, Balci K, GÜldiken B, Birgili O, Kabayel L. An epidemiologic investigation of amyotrophic lateral sclerosis in Thrace, Turkey, 2006-2010. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:100-106. [PMID: 30468083 DOI: 10.1080/21678421.2018.1525403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in Thrace, Turkey in a five-year time period (2006-2010). METHODS Study population included residents of three provinces (Edirne, Tekirdag, Kırklareli) in the Thrace region. Cases were ascertained from all of the neurologic centers and hospitals of these provinces. Demographic and clinical information was collected for each patient. Newly diagnosed ALS patients who are fulfilling the El Escorial revised diagnostic criteria were enrolled into the study. RESULTS We identified a total of 145 patients (93 males, 52 females). The mean age at diagnosis was 57.0 ± 13.6. According to El Escorial criteria, 60.0% of the cases were definite ALS, 24.8% were probable, and 15.2% were possible ALS. Thirty-two cases were bulbar (22.1%), 113 cases (77.9%) were spinal onset. Mean time delay from onset to diagnosis was 12.0 ± 11.2 months. Age-gender standardized incidence rates with reference to Turkey, USA 2008 census were 1.9 (95% confidence interval (CI), 1.8-2.1), 1.9 (95%CI, 1.8-2.2) for overall. There were 112 living ALS patients at the end of the study. Crude point prevalence was calculated as 7.3 per 100,000 population (95%CI, 5.9-8.7). CONCLUSIONS This is the first study to provide fundamental data about demographic and clinical characteristics about ALS in Thrace region of Turkey. Incidence and prevalence of ALS in Thrace region of Turkey appear to be comparable with European countries.
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Affiliation(s)
- Nilda Turgut
- a Neurology Department , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Gamze Varol SaraÇoglu
- b Public Health Department , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Selahattin Kat
- c Neurology Department , Edirne State Hospital , Edirne , Turkey
| | - Kemal Balci
- d Neurology Department , Ondokuz Mayıs University School of Medicine , Samsun , Turkey
| | - BabÜrhan GÜldiken
- e Neurology Department , Trakya University School of Medicine , Edirne , Turkey
| | - Ozlem Birgili
- b Public Health Department , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Levent Kabayel
- f Neurology Department , Ekol Hospital , Edirne , Turkey
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Theme 12 Respiratory and nutritional management. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:325-352. [DOI: 10.1080/21678421.2018.1510582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Palese F, Sartori A, Verriello L, Ros S, Passadore P, Manganotti P, Barbone F, Pisa FE. Epidemiology of amyotrophic lateral sclerosis in Friuli-Venezia Giulia, North-Eastern Italy, 2002-2014: a retrospective population-based study. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:90-99. [PMID: 30430867 DOI: 10.1080/21678421.2018.1511732] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the epidemiology of Amyotrophic Lateral Sclerosis (ALS) in Friuli-Venezia Giulia (FVG) region, Italy, over a 13-year period (2002-2014), estimating ALS (a) incidence, prevalence, and clinical features; (b) mortality, also comparing Udine municipality to the rest of FVG. METHODS We conducted a retrospective population-based study. ALS incident cases were ascertained using multiple sources and validated through expert review. We calculated crude and standardized incidence rate (IR), point prevalence and mortality rate (MR), each with 95% confidence interval. Standardized incidence (SIR) and mortality (SMR) ratio were calculated to compare Udine to FVG. RESULTS Among 444 incident cases (50.0% men, median age 68.5 years), onset was bulbar in 30.2%, spinal in 59.9%, mixed in 9.9%; 3.6% had familial ALS. Crude and 2000 European population standardized IR was respectively 2.81 (2.56-3.09) and 2.09 (1.89-2.29) per 100,000 person-years. Standardized male-to-female incidence ratio was 1.05. IR peaked at age 65-74 years (men: 9.93, 8.04-12.32; women: 7.74, 6.18-9.67) and decreased thereafter. Prevalence was 8.36 (6.74-9.97) cases per 100,000 inhabitants on 30 June 2009 and 7.98 (6.40-9.56) on 30 June 2014. SIR was 1.20 and SMR 1.11. CONCLUSIONS When assessed over a long period, incidence of ALS was in the range of Italian and European population-based registries and showed a consistent pattern by age and sex. IR and MR were only slightly higher in Udine vs. FVG.
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Affiliation(s)
| | - Arianna Sartori
- b Neurologic Clinic, Department of Medical, Surgical and Health Sciences , Azienda Sanitaria Universitaria Integrata di Trieste, University Hospital of Trieste , Trieste , Italy
| | - Lorenzo Verriello
- c Neurologic Clinic, Department of Neurological Sciences , Azienda Sanitaria Universitaria Integrata di Udine , Udine , Italy
| | - Silvia Ros
- d Neurologic Clinic , Hospital of Gorizia , Gorizia , Italy
| | - Paolo Passadore
- e Neurologic Clinic , Hospital of Pordenone , Pordenone , Italy
| | - Paolo Manganotti
- b Neurologic Clinic, Department of Medical, Surgical and Health Sciences , Azienda Sanitaria Universitaria Integrata di Trieste, University Hospital of Trieste , Trieste , Italy
| | - Fabio Barbone
- a Medical Area Department , University of Udine , Udine , Italy
| | - Federica Edith Pisa
- a Medical Area Department , University of Udine , Udine , Italy.,f Leibniz Institute for Prevention Research and Epidemiology - BIPS , Bremen , Germany.,g Institute of Hygiene and Clinical Epidemiology , University Hospital of Udine , Udine , Italy
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75
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Kim JM, Park JH, Kim HS, Lee JW, Lim HS, Choi WA, Kang SW. Epidemiology and diagnostic process of amyotrophic lateral sclerosis as distinct from myelopathy: 5-year cohort study of whole-population in South Korea. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:547-554. [PMID: 30421999 DOI: 10.1080/21678421.2018.1491600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the incidence, prevalence, and demographic factors of all amyotrophic lateral sclerosis (ALS) patients diagnosed in South Korea from 2011 to 2015, and to analyze cases misdiagnosed as myelopathy. METHODS The whole population registered under the Korean National Health Insurance Service (KNHIS) was applied. All 4551 patients who were registered as having ALS code from 2011 to 2015 were included. For all ALS patients, the incidence, prevalence, and demographic factors were assessed. Trends of diagnosis for myelopathy, and surgery prior to confirmation of ALS diagnosis were identified. RESULTS When the whole 48,135,715 KNHIS population enrolled in 2015, the incidence of ALS in 2015 was estimated to be 1.68 per 100,000 person-years, and the prevalence was 6.49 per 100,000 persons. Life expectancy of ALS can be calculated as 3.9 years after the diagnosis, and the mean age of diagnosis was 59.5 ± 13.1. A total of 1902 patients diagnosed with myelopathy before a diagnosis of ALS accounted for 0.13% of all myelopathy patients, and 41.8% of all ALS patients. It took an average of 471.7 d to confirm a diagnosis of ALS after the myelopathy diagnosis. Among the patients finally diagnosed with ALS, more patients underwent surgery for myelopathy (n = 263, 13.8%) than among patients who were diagnosed with myelopathy alone, and underwent surgery (n = 141,148, 9.8%). CONCLUSIONS This whole-population nationwide demographic study confirmed the data from previous studies. Clinicians should consider the possibility of ALS when making a myelopathy diagnosis, especially if the symptoms are sufficiently severe to require surgery.
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Affiliation(s)
- Jong Moon Kim
- a Department of Rehabilitation Medicine , CHA Bundang Medical Center, CHA University , Gyeonggi-do , Republic of Korea
| | - Jung Hyun Park
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
| | - Hyung Seop Kim
- c Departments of Physical Medicine and Rehabilitation , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea and
| | - Jang Woo Lee
- c Departments of Physical Medicine and Rehabilitation , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea and
| | - Hyun Sun Lim
- d Research and Analysis Team , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea
| | - Won Ah Choi
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
| | - Seong-Woong Kang
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
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Dardiotis E, Siokas V, Sokratous M, Tsouris Z, Aloizou AM, Florou D, Dastamani M, Mentis AFA, Brotis AG. Body mass index and survival from amyotrophic lateral sclerosis: A meta-analysis. Neurol Clin Pract 2018; 8:437-444. [PMID: 30564498 DOI: 10.1212/cpj.0000000000000521] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/25/2018] [Indexed: 12/12/2022]
Abstract
Background Several studies have examined the relationship between body mass index (BMI) and survival from amyotrophic lateral sclerosis (ALS). Many indicate that low BMI at diagnosis or during follow-up may be associated with accelerated progression and shortened survival. This study systematically evaluated the relationship between BMI and survival in patients with ALS. Methods The PubMed database was searched to identify all available studies reporting time-to-event data. Eight studies with 6,098 patients fulfilled the eligibility criteria. BMI was considered a continuous and ordered variable. Interstudy heterogeneity was assessed by the Cochran Q test and quantified by the I2 metric. Fixed- or random-effects odds ratios summarized pooled effects after taking interstudy variability into account. Significance was set at p < 0.05. Results The ALS survival hazard ratio (HR) decreased approximately by 3% (95% confidence interval [CI]: 2%-5%) for each additional BMI unit when BMI was considered a continuous variable. When BMI was considered a categorical variable, the HRs for "normal" BMI vs "overweight" BMI and "obese" BMI were estimated to be as high as 0.91 (95% CI: 0.79-1.04) and 0.78 (95% CI: 0.60-1.01), respectively. The HR for the comparison of the "normal" BMI vs "underweight" BMI was estimated to be as high as 1.94 (95% CI: 1.42-2.65). Conclusions BMI is significantly and inversely associated with ALS survival.
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Affiliation(s)
- Efthimios Dardiotis
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Maria Sokratous
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Desponia Florou
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Metaxia Dastamani
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Alexios-Fotios A Mentis
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Alexandros G Brotis
- Department of Neurology (ED, VS, MS, ZT, A-MA, DF, MD), Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece; Department of Microbiology (A-FAM), University of Thessaly, University Hospital of Larissa, Larissa, Greece; Public Health Laboratories (A-FAM), Hellenic Pasteur Institute, Athens, Greece; and Department of Neurosurgery (AGB), University of Thessaly, University Hospital of Larissa, Larissa, Greece
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Ahmadzai P, Kab S, Vlaar T, Artaud F, Carcaillon-Bentata L, Canonico M, Moisan F, Elbaz A. Age-dependent sex ratios of motor neuron disease: French nationwide study and meta-analysis. Neurology 2018; 90:e1588-e1595. [PMID: 29602909 DOI: 10.1212/wnl.0000000000005459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/02/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine the relation of age with male-to-female (M/F) ratios and incidence rates of motor neuron disease (MND) in a French nationwide study and meta-analysis of incidence studies. METHODS We used data from the French National Health Insurance databases. Patients with incident MND (2010-2014) were identified based on drug claims (riluzole), hospitalization records, death records, and long-term chronic disease benefits. We estimated age-specific M/F incidence ratios using Poisson regression. Poisson, Gompertz, and multistep models were used to model the relation between age and incidence. We performed a meta-analysis (n = 28 studies) and used meta-regression to examine the relation of age with incidence rates and ratios. RESULTS In France, we identified 10,848 patients with incident MND (6,021 men, 4,827 women). Incidence was higher in men than in women in all age groups. M/F ratios were significantly different across age groups and followed a quadratic trend (p < 0.001). Between 20 and 49 years, the average M/F ratio was 2.26 (95% confidence interval [CI] = 1.96-2.62); it was 1.41 (95% CI = 1.35-1.47) between 50 and 84 years, and 1.88 (95% CI = 1.64-2.17) after 85 years. Incidence was lower in women than men at younger ages, but increased more steeply in women than men. Similar patterns were observed in the meta-analysis of incidence studies, especially in 19 higher-quality studies. CONCLUSION The relation between age and M/F incidence ratios of MND follows a quadratic U-shaped pattern with an abrupt drop after the fifth decade. The change in M/F ratios before and after menopause suggests that reproductive/hormonal protective factors have a role in women and should prompt further studies to explore this hypothesis.
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Affiliation(s)
- Pasarlai Ahmadzai
- From the Université Paris-Saclay (P.A., S.K., T.V., F.A., M.C., A.E.), Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif; and Santé publique France (S.K., T.V., L.C.-B., F.M., A.E.), Saint-Maurice, France
| | - Sofiane Kab
- From the Université Paris-Saclay (P.A., S.K., T.V., F.A., M.C., A.E.), Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif; and Santé publique France (S.K., T.V., L.C.-B., F.M., A.E.), Saint-Maurice, France
| | - Tim Vlaar
- From the Université Paris-Saclay (P.A., S.K., T.V., F.A., M.C., A.E.), Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif; and Santé publique France (S.K., T.V., L.C.-B., F.M., A.E.), Saint-Maurice, France
| | - Fanny Artaud
- From the Université Paris-Saclay (P.A., S.K., T.V., F.A., M.C., A.E.), Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif; and Santé publique France (S.K., T.V., L.C.-B., F.M., A.E.), Saint-Maurice, France
| | - Laure Carcaillon-Bentata
- From the Université Paris-Saclay (P.A., S.K., T.V., F.A., M.C., A.E.), Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif; and Santé publique France (S.K., T.V., L.C.-B., F.M., A.E.), Saint-Maurice, France
| | - Marianne Canonico
- From the Université Paris-Saclay (P.A., S.K., T.V., F.A., M.C., A.E.), Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif; and Santé publique France (S.K., T.V., L.C.-B., F.M., A.E.), Saint-Maurice, France
| | - Frédéric Moisan
- From the Université Paris-Saclay (P.A., S.K., T.V., F.A., M.C., A.E.), Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif; and Santé publique France (S.K., T.V., L.C.-B., F.M., A.E.), Saint-Maurice, France
| | - Alexis Elbaz
- From the Université Paris-Saclay (P.A., S.K., T.V., F.A., M.C., A.E.), Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif; and Santé publique France (S.K., T.V., L.C.-B., F.M., A.E.), Saint-Maurice, France.
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78
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Vieira VM, Hansen J, Gredal O, Weisskopf MG. Spatial analyses of ALS incidence in Denmark over three decades. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:275-284. [PMID: 29383960 DOI: 10.1080/21678421.2018.1432658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the motor neuron with very few known risk factors. We conducted a spatial epidemiologic analysis of ALS incidence in Denmark to assess the contribution of sociodemographic determinants to geographic variation. METHODS We analyzed 4249 ALS cases (1982-2013), each with 100 controls matched on sex and birth year. Odds ratio and 95% confidence bands at birth and diagnosis/index locations were calculated using generalized additive models. We included a bivariate spatial smooth for location in our conditional logistic regression adjusted for socioeconomic status and marital status. We also conducted analyses adjusted for both birth and diagnosis addresses to separate location effects. RESULTS We observed significantly elevated ALS odds near Copenhagen for both the birth and diagnosis period analyses. Sociodemographic factors did not explain the observed patterns. When we further adjusted our spatial analyses by including both birth and diagnosis addresses, the significant area of elevated male ALS odds by birth address shifted to northwest Denmark away from Copenhagen, and there was little evidence of variation among women. Geographic variation at diagnosis differed between male and females, suggesting that patterns are not just due to regional variation in case ascertainment. CONCLUSION ALS incidence in Denmark is associated with both location at birth and diagnosis, suggesting that geographic variation may be due to exposures occurring at birth or closer to diagnosis, although the latter could relate to case ascertainment issues.
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Affiliation(s)
- Verónica M Vieira
- a Program in Public Health, Susan and Henry Samueli College of Health Sciences , University of California , Irvine , CA , USA
| | - Johnni Hansen
- b Danish Cancer Society Research Center , Copenhagen , Denmark
| | - Ole Gredal
- c National Rehabilitation Center for Neuromuscular Disorders , Copenhagen , Denmark , and
| | - Marc G Weisskopf
- d Departments of Environmental Health and Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
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79
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Vasta R, Calvo A, Moglia C, Cammarosano S, Manera U, Canosa A, D'Ovidio F, Mazzini L, Chiò A. Spatial epidemiology of amyotrophic lateral sclerosis in Piedmont and Aosta Valley, Italy: a population-based cluster analysis. Eur J Neurol 2018; 25:756-761. [PMID: 29377594 DOI: 10.1111/ene.13586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/19/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The analysis of the spatial distribution of cases could give important cues on putative environmental causes of a disease. Our aim was to perform a spatial analysis of an amyotrophic lateral sclerosis (ALS) cohort from the Piedmont and Aosta Valley ALS register (PARALS) over a 20-year period. METHODS The address at the moment of diagnosis was considered for each ALS case. Municipalities' and census divisions' resident populations during the 1995-2014 period were obtained. A cluster analysis was performed adopting both Moran's index and the Kulldorff spatial scan statistic. RESULTS A total of 2702 ALS patients were identified. An address was retrieved for 2671 (99%) patients. Moran's index was -0.01 (P value 0.83), thus revealing no clusters. SaTScan identified no statistically significant clusters. When census divisions were considered, Moran's index was 0.13 (P value 0.45); SaTScan revealed one statistically significant small cluster in the province of Alessandria. Here, 0.0099 cases were expected and three cases were observed (relative risk 304.60; 95% confidence interval 109.83-845.88, P value 0.03). DISCUSSION Our study showed a substantial homogeneous distribution of ALS cases in Piedmont and Aosta Valley. The population-based setting and the adoption of proper statistical analyses strengthen the validity of our results. Such a finding further suggests the involvement of multiple environmental and genetic factors in ALS pathogenesis.
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Affiliation(s)
- R Vasta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - A Calvo
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - C Moglia
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - S Cammarosano
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - U Manera
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - A Canosa
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - F D'Ovidio
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - L Mazzini
- ALS Center, Department of Neurology, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - A Chiò
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
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