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Ackrivo J, Hansen-Flaschen J, Jones BL, Wileyto EP, Schwab RJ, Elman L, Kawut SM. Classifying Patients with Amyotrophic Lateral Sclerosis by Changes in FVC. A Group-based Trajectory Analysis. Am J Respir Crit Care Med 2019; 200:1513-1521. [PMID: 31322417 PMCID: PMC6909832 DOI: 10.1164/rccm.201902-0344oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/18/2019] [Indexed: 11/16/2022] Open
Abstract
Rationale: A model for stratifying progression of respiratory muscle weakness in amyotrophic lateral sclerosis (ALS) would identify disease mechanisms and phenotypes suitable for future investigations. This study sought to categorize progression of FVC after presentation to an outpatient ALS clinic.Objectives: To identify clinical phenotypes of ALS respiratory progression based on FVC trajectories over time.Methods: We derived a group-based trajectory model from a single-center cohort of 837 patients with ALS who presented between 2006 and 2015. We applied our model to the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database with 7,461 patients with ALS. Baseline characteristics at first visit were used as predictors of trajectory group membership. The primary outcome was trajectory of FVC over time in months.Measurements and Main Results: We found three trajectories of FVC over time, termed "stable low," "rapid progressor," and "slow progressor." Compared with the slow progressors, the rapid progressors had shorter diagnosis delay, more bulbar-onset disease, and a lower ALS Functional Rating Scale-Revised (ALSFRS-R) total score at baseline. The stable low group had a shorter diagnosis delay, lower body mass index, more bulbar-onset disease, lower ALSFRS-R total score, and were more likely to have an ALSFRS-R orthopnea score lower than 4 compared with the slow progressors. We found that projected group membership predicted respiratory insufficiency in the PRO-ACT cohort (concordance statistic = 0.78, 95% CI, 0.76-0.79).Conclusions: We derived a group-based trajectory model for FVC progression in ALS, which validated against the outcome of respiratory insufficiency in an external cohort. Future studies may focus on patients predicted to be rapid progressors.
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Affiliation(s)
| | | | - Bobby L. Jones
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Lauren Elman
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Steven M. Kawut
- Department of Medicine
- Center for Clinical Epidemiology and Biostatistics, and
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Steinbach R, Batyrbekova M, Gaur N, Voss A, Stubendorff B, Mayer TE, Gaser C, Witte OW, Prell T, Grosskreutz J. Applying the D50 disease progression model to gray and white matter pathology in amyotrophic lateral sclerosis. NEUROIMAGE-CLINICAL 2019; 25:102094. [PMID: 31896467 PMCID: PMC6940701 DOI: 10.1016/j.nicl.2019.102094] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/07/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022]
Abstract
The D50 disease progression model well characterized a cross-sectional ALS cohort. VBM reveled ALS-related widespread gray and white matter density decreases. A spread of structural alterations occurs along with D50 model derived disease phases. White-matter alterations were associated with higher disease aggressiveness.
Therapeutic management and research in Amyotrophic Laterals Sclerosis (ALS) have been limited by the substantial heterogeneity in progression and anatomical spread that are endemic of the disease. Neuroimaging biomarkers represent powerful additions to the current monitoring repertoire but have yielded inconsistent associations with clinical scores like the ALS functional rating scale. The D50 disease progression model was developed to address limitations with clinical indices and the difficulty obtaining longitudinal data in ALS. It yields overall disease aggressiveness as time taken to reach halved functionality (D50); individual disease covered in distinct phases; and calculated functional state and calculated functional loss as acute descriptors of local disease activity. It greatly reduces the noise of the ALS functional rating scale and allows the comparison of highly heterogeneous disease and progression subtypes. In this study, we performed Voxel-Based Morphometry for 85 patients with ALS (60.1 ± 11.5 years, 36 female) and 62 healthy controls. Group-wise comparisons were performed separately for gray matter and white matter using ANCOVA testing with threshold-free cluster enhancement. ALS-related widespread gray and white matter density decreases were observed in the bilateral frontal and temporal lobes (p < 0.001, family-wise error corrected). We observed a progressive spread of structural alterations along the D50-derived phases, that were primarily located in frontal, temporal and occipital gray matter areas, as well as in supratentorial neuronal projections (p < 0.001 family-wise error corrected). ALS patients with higher overall disease aggressiveness (D50 < 30 months) showed a distinct pattern of supratentorial white matter density decreases relative to patients with lower aggressiveness; no significant differences were observed for gray matter density (p < 0.001 family-wise error corrected). The application of the D50 disease progression model separates measures of disease aggressiveness from disease accumulation. It revealed a strong correlation between disease phases and in-vivo measures of cerebral structural integrity. This study underscores the proposed corticofugal spread of cerebral pathology in ALS. We recommend application of the D50 model in studies linking clinical data with neuroimaging correlates.
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Affiliation(s)
- Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
| | - Meerim Batyrbekova
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Nayana Gaur
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Annika Voss
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Thomas E Mayer
- Department of Neuroradiology, Jena University Hospital, Jena, Germany
| | - Christian Gaser
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Tino Prell
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Healthy Ageing, Jena University Hospital, Jena, Germany
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Thouvenot E, Demattei C, Lehmann S, Maceski‐Maleska A, Hirtz C, Juntas‐Morales R, Pageot N, Esselin F, Alphandéry S, Vincent T, Camu W. Serum neurofilament light chain at time of diagnosis is an independent prognostic factor of survival in amyotrophic lateral sclerosis. Eur J Neurol 2019; 27:251-257. [DOI: 10.1111/ene.14063] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022]
Affiliation(s)
- E. Thouvenot
- Service de Neurologie CHU Nîmes CNRS INSERM Univ Montpellier Nîmes France
| | - C. Demattei
- Département d'Information Médicale CHU Nîmes Univ Montpellier Nîmes France
| | - S. Lehmann
- Laboratoire de Biochimie et Plateforme de Protéomique Clinique CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - A. Maceski‐Maleska
- Laboratoire de Biochimie et Plateforme de Protéomique Clinique CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - C. Hirtz
- Laboratoire de Biochimie et Plateforme de Protéomique Clinique CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - R. Juntas‐Morales
- Centre de référence SLA CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - N. Pageot
- Centre de référence SLA CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - F. Esselin
- Centre de référence SLA CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - S. Alphandéry
- Centre de référence SLA CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - T. Vincent
- Laboratoire d'Immunologie CHU Montpellier INSERM Univ Montpellier Montpellier France
| | - W. Camu
- Centre de référence SLA CHU Montpellier INSERM Univ Montpellier Montpellier France
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54
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Liu T, Shen D, Yang X, Cui B, Tai H, Wang Z, Liu S, Zhang K, Liu M, Cui L. Early onset but long survival and other prognostic factors in Chinese sporadic amyotrophic lateral sclerosis. J Clin Neurosci 2019; 69:74-80. [PMID: 31447367 DOI: 10.1016/j.jocn.2019.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To explore the cause of long survival but early onset and other prognostic factors among Chinese sporadic amyotrophic lateral sclerosis (ALS) patients. METHODS Patients with ALS were recruited and followed up from Jan 2013 to Jan 2017. Phenotype and survival were compared among different age-at-onset groups. Candidate prognostic factors were analyzed by Kaplan-Meier method, Cox regression and Royston Parmar (RP) model dealing with breaches of proportional hazard assumption. RESULTS In the cohort of 531 patients, mean age-at-onset was 53.68 years (SD:10.85) and overall estimated median survival time was 59 months (95% CI: 48.29-69.71). Pairwise comparison showed that patients above 65 years at onset were more frequently bulbar onset (adjusted residual: 3.0), less frequently lumbosacral onset (adjusted residual: -3.0), and had shorter survival compared with other age groups (p = 0.002). Cox and RP model demonstrated independent prognostic variables including age at onset, bulbar onset, diagnostic delay, MRC-score at first diagnosis and region of residence. CONCLUSIONS This clinic-based study suggested that Chinese sporadic ALS patients had relatively long survival probably due to young age and less bulbar onset cases. Short diagnostic delay, low MRC-score and northern residence were also predicative of short survival. Reallocation of resources is needed to optimize quality care and prolong survival time.
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Affiliation(s)
- Tanxin Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xunzhe Yang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongfei Tai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhili Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuangwu Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Kang Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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55
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Boentert M. Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives. Nat Sci Sleep 2019; 11:97-111. [PMID: 31496852 PMCID: PMC6701267 DOI: 10.2147/nss.s183504] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/16/2019] [Indexed: 01/08/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease inevitably leading to generalized muscle weakness and premature death. Sleep disturbances are extremely common in patients with ALS and substantially add to the burden of disease for both patients and caregivers. Disruption of sleep can be caused by physical symptoms, such as muscle cramps, pain, reduced mobility, spasticity, mucus retention, and restless legs syndrome. In addition, depression and anxiety may lead to significant insomnia. In a small subset of patients, rapid eye movement (REM) sleep behavioral disorder may be present, reflecting neurodegeneration of central nervous system pathways which are involved in REM sleep regulation. With regard to overall prognosis, sleep-disordered breathing (SDB) and nocturnal hypoventilation (NH) are of utmost importance, particularly because NH precedes respiratory failure. Timely mechanical ventilation is one of the most significant therapeutic measures to prolong life span in ALS, and transcutaneous capnometry is superior to pulse oxymetry to detect NH early. In addition, it has been shown that in patients on home ventilatory support, survival time depends on whether normocapnia, normoxia, and elimination of apneic events during sleep can be reliably achieved. Several studies have investigated sleep patterns and clinical determinants of sleep disruption in ALS, but exact prevalence numbers are unknown. Thus, constant awareness for sleep-related symptoms is appropriate. Since no curative treatment can be offered to affected patients, sleep complaints should be thoroughly investigated in order to identify any treatable etiology and improve or stabilize quality of life as much as possible. The use of hypnotics should be confined to palliation during the terminal phase and refractory insomnia in earlier stages of the disease, taking into account that most compounds potentially aggravate SDB.
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Affiliation(s)
- Matthias Boentert
- Department of Neurology, University Hospital Muenster, Muenster, Germany
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56
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Marini C, Morbelli S, Cistaro A, Campi C, Caponnetto C, Bauckneht M, Bellini A, Buschiazzo A, Calamia I, Beltrametti MC, Margotti S, Fania P, Poggi I, Cabona C, Capitanio S, Piva R, Calvo A, Moglia C, Canosa A, Massone A, Nobili F, Mancardi G, Chiò A, Piana M, Sambuceti G. Interplay between spinal cord and cerebral cortex metabolism in amyotrophic lateral sclerosis. Brain 2019; 141:2272-2279. [PMID: 30730551 PMCID: PMC6061793 DOI: 10.1093/brain/awy152] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/10/2018] [Indexed: 11/15/2022] Open
Abstract
We recently reported the potential of Hough transform in delineating spinal cord metabolism by 18F-fluorodeoxyglucose PET/CT scanning in amyotrophic lateral sclerosis. The present study aimed to verify the relationship between spinal cord and brain metabolism in 44 prospectively recruited patients affected by amyotrophic lateral sclerosis submitted to 18F-fluorodeoxyglucose brain and whole-body PET/CT. Patients were studied to highlight the presence of brain hypo- or hypermetabolism with respect to healthy controls, and multiple regression analysis was performed to evaluate the correlation between spinal cord and brain metabolism. Our results confirmed higher 18F-fluorodeoxyglucose uptake in both cervical and dorsal spinal cord in patients with amyotrophic lateral sclerosis with respect to controls. This finding was paralleled by the opposite pattern in the brain cortex that showed a generalized reduction in tracer uptake. This hypometabolism was particularly evident in wide regions of the frontal-dorsolateral cortex while it did not involve the midbrain. Bulbar and spinal disease onset was associated with similar degree of metabolic activation in the spinal cord. However, among spinal onset patients, upper limb presentation was associated with a more pronounced metabolic activation of cervical segment. Obtained data suggest a differential neuro-pathological state or temporal sequence in disease progression.
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Affiliation(s)
- Cecilia Marini
- CNR Institute of Molecular Bioimaging and Physiology (IBFM), Milan, 20019, Italy.,Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy
| | - Silvia Morbelli
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy.,Department of Health Science, University of Genoa, Genoa, 16132, Italy
| | - Angelina Cistaro
- Positron Emission Tomography Centre IRMET S.p.A., Affidea, Turin, 10120, Italy
| | - Cristina Campi
- Department of Medicine-DIMED, Padova University Hospital, Via Giustiniani 2, 35128 Padua, Italy
| | - Claudia Caponnetto
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy.,DINOGMI University of Genoa, Genoa, 16132, Italy
| | - Matteo Bauckneht
- Department of Health Science, University of Genoa, Genoa, 16132, Italy
| | | | - Ambra Buschiazzo
- Department of Health Science, University of Genoa, Genoa, 16132, Italy
| | - Iolanda Calamia
- Department of Health Science, University of Genoa, Genoa, 16132, Italy
| | | | - Simone Margotti
- Positron Emission Tomography Centre IRMET S.p.A., Affidea, Turin, 10120, Italy
| | - Piercarlo Fania
- Positron Emission Tomography Centre IRMET S.p.A., Affidea, Turin, 10120, Italy
| | - Ilaria Poggi
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy.,DINOGMI University of Genoa, Genoa, 16132, Italy
| | - Corrado Cabona
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy.,DINOGMI University of Genoa, Genoa, 16132, Italy
| | - Selene Capitanio
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy
| | - Roberta Piva
- Department of Health Science, University of Genoa, Genoa, 16132, Italy
| | - Andrea Calvo
- ALS Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, 10120, Italy.,AUO Città della Salute e della Scienza, Turin, 10120, Italy
| | - Cristina Moglia
- ALS Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, 10120, Italy.,AUO Città della Salute e della Scienza, Turin, 10120, Italy
| | - Antonio Canosa
- ALS Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, 10120, Italy.,AUO Città della Salute e della Scienza, Turin, 10120, Italy
| | | | - Flavio Nobili
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy.,DINOGMI University of Genoa, Genoa, 16132, Italy
| | - Gianluigi Mancardi
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy.,DINOGMI University of Genoa, Genoa, 16132, Italy
| | - Adriano Chiò
- ALS Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, 10120, Italy.,AUO Città della Salute e della Scienza, Turin, 10120, Italy
| | - Michele Piana
- Department of Mathematics (DIMA), University of Genoa, Genoa, 16132, Italy.,SPIN Institute, CNR, Genoa, 16132, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, 16132, Italy.,Department of Health Science, University of Genoa, Genoa, 16132, Italy
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Moreno-Martinez L, Calvo AC, Muñoz MJ, Osta R. Are Circulating Cytokines Reliable Biomarkers for Amyotrophic Lateral Sclerosis? Int J Mol Sci 2019; 20:ijms20112759. [PMID: 31195629 PMCID: PMC6600567 DOI: 10.3390/ijms20112759] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that has no effective treatment. The lack of any specific biomarker that can help in the diagnosis or prognosis of ALS has made the identification of biomarkers an urgent challenge. Multiple panels have shown alterations in levels of numerous cytokines in ALS, supporting the contribution of neuroinflammation to the progressive motor neuron loss. However, none of them is fully sensitive and specific enough to become a universal biomarker for ALS. This review gathers the numerous circulating cytokines that have been found dysregulated in both ALS animal models and patients. Particularly, it highlights the opposing results found in the literature to date, and points out another potential application of inflammatory cytokines as therapeutic targets.
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Affiliation(s)
- Laura Moreno-Martinez
- Laboratory of Genetics and Biochemistry (LAGENBIO), Faculty of Veterinary-IIS Aragón, IA2-CITA, CIBERNED, University of Zaragoza, Miguel Servet 177, 50013 Zaragoza, Spain.
| | - Ana Cristina Calvo
- Laboratory of Genetics and Biochemistry (LAGENBIO), Faculty of Veterinary-IIS Aragón, IA2-CITA, CIBERNED, University of Zaragoza, Miguel Servet 177, 50013 Zaragoza, Spain.
| | - María Jesús Muñoz
- Laboratory of Genetics and Biochemistry (LAGENBIO), Faculty of Veterinary-IIS Aragón, IA2-CITA, CIBERNED, University of Zaragoza, Miguel Servet 177, 50013 Zaragoza, Spain.
| | - Rosario Osta
- Laboratory of Genetics and Biochemistry (LAGENBIO), Faculty of Veterinary-IIS Aragón, IA2-CITA, CIBERNED, University of Zaragoza, Miguel Servet 177, 50013 Zaragoza, Spain.
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58
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Ngo ST, van Eijk RPA, Chachay V, van den Berg LH, McCombe PA, Henderson RD, Steyn FJ. Loss of appetite is associated with a loss of weight and fat mass in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:497-505. [PMID: 31144522 DOI: 10.1080/21678421.2019.1621346] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Weight loss in amyotrophic lateral sclerosis (ALS) is associated with faster disease progression and shorter survival. It has different possible causes, including loss of appetite. Our objective is to determine the prevalence and impact of loss of appetite on change in body weight and composition in patients with ALS. Methods: We conducted a prospective case-control study, comparing demographic, clinical, appetite and prognostic features between 62 patients with ALS and 45 healthy non-neurodegenerative disease (NND) controls. To determine the impact of loss of appetite on weight throughout disease course, we conducted serial assessments at ∼three to four-month intervals. Results: Loss of appetite is more prevalent in patients with ALS than NND controls (29 vs. 11.1%, odds ratio = 3.27 (1.1-9.6); p < 0.01). In patients with ALS, loss of appetite is associated with greater weight loss and greater loss of fat mass. Appetite scores in patients with ALS worsens as disease progresses and are correlated with worsening ALS Functional Rating Scale-Revised scores. Conclusion: We confirm that loss of appetite is prevalent in patients with ALS and is significantly associated with weight loss and loss of fat mass. Appetite worsens with disease progression. Identification and early interventions to address loss of appetite in patients with ALS may prevent or slow weight loss; this could improve disease outcome.
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Affiliation(s)
- Shyuan T Ngo
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland , Brisbane , Australia.,Queensland Brain Institute, The University of Queensland , Brisbane , Australia.,Centre for Clinical Research, The University of Queensland , Brisbane , Australia.,Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia.,Wesley Medical Research, The Wesley Hospital , Brisbane , Australia
| | - Ruben P A van Eijk
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands.,Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , The Netherlands , and
| | - V Chachay
- School of Human Movement and Nutrition Sciences, The University of Queensland , Brisbane , Australia
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Pamela A McCombe
- Centre for Clinical Research, The University of Queensland , Brisbane , Australia.,Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia.,Wesley Medical Research, The Wesley Hospital , Brisbane , Australia
| | - Robert D Henderson
- Queensland Brain Institute, The University of Queensland , Brisbane , Australia.,Centre for Clinical Research, The University of Queensland , Brisbane , Australia.,Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia.,Wesley Medical Research, The Wesley Hospital , Brisbane , Australia
| | - Frederik J Steyn
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland , Brisbane , Australia.,Centre for Clinical Research, The University of Queensland , Brisbane , Australia.,Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane , Australia.,Wesley Medical Research, The Wesley Hospital , Brisbane , Australia
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59
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Mandrioli J, Crippa V, Cereda C, Bonetto V, Zucchi E, Gessani A, Ceroni M, Chio A, D’Amico R, Monsurrò MR, Riva N, Sabatelli M, Silani V, Simone IL, Sorarù G, Provenzani A, D’Agostino VG, Carra S, Poletti A. Proteostasis and ALS: protocol for a phase II, randomised, double-blind, placebo-controlled, multicentre clinical trial for colchicine in ALS (Co-ALS). BMJ Open 2019; 9:e028486. [PMID: 31152038 PMCID: PMC6549675 DOI: 10.1136/bmjopen-2018-028486] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Disruptions of proteasome and autophagy systems are central events in amyotrophic lateral sclerosis (ALS) and support the urgent need to find therapeutic compounds targeting these processes. The heat shock protein B8 (HSPB8) recognises and promotes the autophagy-mediated removal of misfolded mutant SOD1 and TDP-43 fragments from ALS motor neurons (MNs), as well as aggregating species of dipeptides produced in C9ORF72-related diseases. In ALS-SOD1 mice and in human ALS autopsy specimens, HSPB8 is highly expressed in spinal cord MNs that survive at the end stage of disease. Moreover, the HSPB8-BAG3-HSP70 complex maintains granulostasis, which avoids conversion of dynamic stress granules (SGs) into aggregation-prone assemblies. We will perform a randomised clinical trial (RCT) with colchicine, which enhances the expression of HSPB8 and of several autophagy players, blocking TDP-43 accumulation and exerting crucial activities for MNs function. METHODS AND ANALYSIS Colchicine in amyotrophic lateral sclerosis (Co-ALS) is a double-blind, placebo-controlled, multicentre, phase II RCT. ALS patients will be enrolled in three groups (placebo, colchicine 0.01 mg/day and colchicine 0.005 mg/day) of 18 subjects treated with riluzole; treatment will last 30 weeks, and follow-up will last 24 weeks. The primary aim is to assess whether colchicine decreases disease progression as measured by ALS Functional Rating Scale - Revised (ALSFRS-R) at baseline and at treatment end. Secondary aims include assessment of (1) safety and tolerability of Colchicine in patiets with ALS; (2) changes in cellular activity (autophagy, protein aggregation, and SG and exosome secretion) and in biomarkers of disease progression (neurofilaments); (3) survival and respiratory function and (4) quality of life. Preclinical studies with a full assessment of autophagy and neuroinflammation biomarkers in fibroblasts, peripheral blood mononuclear cells and lymphoblasts will be conducted in parallel with clinic assessment to optimise time and resources. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of Area Vasta Emilia Nord and by Agenzia Italiana del Farmaco (EUDRACT N.2017-004459-21) based on the Declaration of Helsinki. This research protocol was written without patient involvement. Patients' association will be involved in disseminating the study design and results. Results will be presented during scientific symposia or published in scientific journals. TRIAL REGISTRATION NUMBER EUDRACT 2017-004459-21; NCT03693781; Pre-results.
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Affiliation(s)
- Jessica Mandrioli
- Department of Neurosciences, St. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Valeria Crippa
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Centro di Eccellenza sulle Malattie Neurodegenerative, Università degli Studi di Milano, Milano, Italy
| | - Cristina Cereda
- Genomics and Post-Genomics Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina Bonetto
- Laboratory of Translational Biomarkers, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Elisabetta Zucchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Gessani
- Department of Neurosciences, St. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Mauro Ceroni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of General Neurology, Rare Diseases Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Adriano Chio
- “Rita Levi Montalcini” Departmentof Neurosciences, ALS Centre, University of Turin and Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Roberto D’Amico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Rosaria Monsurrò
- Dipartimento ad attività integratedi Medicina Interna e Specialistica, Azienda Ospedaliero Universitaria “L. Vanvitelli”, Napoli, Italy
| | - Nilo Riva
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Sabatelli
- Neuromuscular Omni Centre (NEMO), Fondazione Serena Onlus, Policlinico A. Gemelli IRCCS, Roma, Italy
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italy
- UOC di Neurologia, Dipartimento di Scienze dell’invecchiamento, Neurologiche, ortopediche e della testa collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Vincenzo Silani
- Department of Neurology-Stroke Unitand Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Isabella Laura Simone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Gianni Sorarù
- Department of Neurosciences, University of Padua, Padua, Italy
| | | | | | - Serena Carra
- Centre for Neuroscience and Nanotechnology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Angelo Poletti
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Centro di Eccellenza sulle Malattie Neurodegenerative, Università degli Studi di Milano, Milano, Italy
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60
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Zeng P, Yu X, Xu H. Association Between Premorbid Body Mass Index and Amyotrophic Lateral Sclerosis: Causal Inference Through Genetic Approaches. Front Neurol 2019; 10:543. [PMID: 31178821 PMCID: PMC6543002 DOI: 10.3389/fneur.2019.00543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose: Inverse association between premorbid body mass index (BMI) and amyotrophic lateral sclerosis (ALS) was implied in observational studies; however, whether this association is causal remains largely unknown. Materials and Methods: We first conducted a meta-analysis to investigate whether there exits an association between premorbid BMI and ALS. We then employed a two-sample Mendelian randomization approach to evaluate the causal relationship of genetically increased BMI with the risk of ALS. The Mendelian randomization analysis was implemented using summary statistics for independent instruments obtained from large-scale genome-wide association studies of BMI (up to ~770,000 individuals) and ALS (up to ~81,000 individuals). The causal effect of BMI on ALS was estimated using inverse-variance weighted methods and was further validated through extensive complementary and sensitivity analyses. Results: The meta-analysis showed that a unit increase of premorbid BMI can result in about 3.0% (95% CI 2.1-4.5%) risk reduction of ALS. Using 1,031 instruments that were strongly related to BMI, the causal effect of per one standard deviation increase of BMI was estimated to be 1.04 (95% CI 0.97-1.11, p = 0.275) in the European population. This null association between BMI and ALS also held in the East Asian population and was robust against various modeling assumptions and outlier biases. Additionally, the Egger-regression and MR-PRESSO ruled out the possibility of horizontal pleiotropic effects of instruments. Conclusion: Our results do not support the causal role of genetically increased or decreased BMI on the risk of ALS.
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Affiliation(s)
- Ping Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
- Center for Medical Statistics and Data Analysis, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xinghao Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Haibo Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
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61
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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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62
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Agosta F, Spinelli EG, Riva N, Fontana A, Basaia S, Canu E, Castelnovo V, Falzone Y, Carrera P, Comi G, Filippi M. Survival prediction models in motor neuron disease. Eur J Neurol 2019; 26:1143-1152. [PMID: 30920076 DOI: 10.1111/ene.13957] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to assess the predictive value of multimodal brain magnetic resonance imaging (MRI) on survival in a large cohort of patients with motor neuron disease (MND), in combination with clinical and cognitive features. METHODS Two hundred MND patients were followed up prospectively for a median of 4.13 years. At baseline, subjects underwent neurological examination, cognitive assessment and brain MRI. Grey matter volumes of cortical and subcortical structures and diffusion tensor MRI metrics of white matter tracts were obtained. A multivariable Royston-Parmar survival model was created using clinical and cognitive variables. The increase of survival prediction accuracy provided by MRI variables was assessed. RESULTS The multivariable clinical model included predominant upper or lower motor neuron presentations and diagnostic delay as significant prognostic predictors, reaching an area under the receiver operating characteristic curve (AUC) of a 4-year survival prediction of 0.79. The combined clinical and MRI model including selected grey matter fronto-temporal volumes and diffusion tensor MRI metrics of the corticospinal and extra-motor tracts reached an AUC of 0.89. Considering amyotrophic lateral sclerosis patients only, the clinical model including diagnostic delay and semantic fluency scores provided an AUC of 0.62, whereas the combined clinical and MRI model reached an AUC of 0.77. CONCLUSION Our study demonstrated that brain MRI measures of motor and extra-motor structural damage, when combined with clinical and cognitive features, are useful predictors of survival in patients with MND, particularly when a diagnosis of amyotrophic lateral sclerosis is made.
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Affiliation(s)
- F Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - E G Spinelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - N Riva
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - A Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - S Basaia
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - E Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - V Castelnovo
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Y Falzone
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - P Carrera
- Unit of Genomics for Human Disease Diagnosis, Division of Genetics and Cell Biology, Clinical Molecular Biology Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - G Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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63
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Doughty CT, Guidon AC, Paganoni S, Hedley-Whyte ET. Case 12-2019: A 60-Year-Old Man with Weakness and Difficulty Chewing. N Engl J Med 2019; 380:1566-1574. [PMID: 30995378 DOI: 10.1056/nejmcpc1900141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christopher T Doughty
- From the Department of Neurology, Brigham and Women's Hospital (C.T.D.), the Departments of Neurology (A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, Spaulding Rehabilitation Hospital (S.P.), and the Departments of Neurology (C.T.D., A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Harvard Medical School - all in Boston
| | - Amanda C Guidon
- From the Department of Neurology, Brigham and Women's Hospital (C.T.D.), the Departments of Neurology (A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, Spaulding Rehabilitation Hospital (S.P.), and the Departments of Neurology (C.T.D., A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Harvard Medical School - all in Boston
| | - Sabrina Paganoni
- From the Department of Neurology, Brigham and Women's Hospital (C.T.D.), the Departments of Neurology (A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, Spaulding Rehabilitation Hospital (S.P.), and the Departments of Neurology (C.T.D., A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Harvard Medical School - all in Boston
| | - E Tessa Hedley-Whyte
- From the Department of Neurology, Brigham and Women's Hospital (C.T.D.), the Departments of Neurology (A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, Spaulding Rehabilitation Hospital (S.P.), and the Departments of Neurology (C.T.D., A.C.G.), Physical Medicine and Rehabilitation (S.P.), and Pathology (E.T.H.-W.), Harvard Medical School - all in Boston
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64
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Sproviero D, La Salvia S, Colombo F, Zucca S, Pansarasa O, Diamanti L, Costa A, Lova L, Giannini M, Gagliardi S, Lauranzano E, Matteoli M, Ceroni M, Malaspina A, Cereda C. Leukocyte Derived Microvesicles as Disease Progression Biomarkers in Slow Progressing Amyotrophic Lateral Sclerosis Patients. Front Neurosci 2019; 13:344. [PMID: 31037054 PMCID: PMC6476347 DOI: 10.3389/fnins.2019.00344] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/25/2019] [Indexed: 12/16/2022] Open
Abstract
The lack of biomarkers in Amyotrophic Lateral Sclerosis (ALS) makes it difficult to determine the stage of the disease in patients and, therefore, it delays therapeutic trials. Microvesicles (MVs) are possible biomarkers implicated in physiological and pathological functions, however, their role in ALS remains unclear. We investigated whether plasma derived microvesicles could be overrepresented in a group of 40 patients affected by ALS compared to 28 Alzheimer’s Disease (AD) patients and 36 healthy volunteers. Leukocyte derived MVs (LMVs) compared to endothelial, platelet, erythrocyte derived MVs, were mostly present in ALS patients compared to AD patients and healthy donors. Correlation analysis corrected for the presence of confounding variables (riluzole, age at onset, site of onset, gender) was tested between PRL (Progression Rate at the Last visit) and LMVs, and a statistically significant value was found (Pearson partial correlation r = 0.407, p = 0.006). We also investigated SOD1, TDP-43 intravesicular protein level in LMVs. Misfolded SOD1 was selectively transported by LMVs and its protein level was associated with the percentage of LMVs in slow progressing patients (r = 0.545, p = 0.033). Our preliminary findings suggest that LMVs are upregulated in ALS patients and they can be considered possible markers of disease progression.
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Affiliation(s)
- Daisy Sproviero
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Sabrina La Salvia
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Federico Colombo
- Flow Cytometry and Cell Sorting Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Susanna Zucca
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Orietta Pansarasa
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Diamanti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Division of General Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Division of General Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Lova
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Becton Dickinson Italia S.p.A., Milan, Italy
| | - Marta Giannini
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stella Gagliardi
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Eliana Lauranzano
- Laboratory of Pharmacology and Brain Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Michela Matteoli
- Laboratory of Pharmacology and Brain Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,IN-CNR, Milan, Italy
| | - Mauro Ceroni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Division of General Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Malaspina
- Neurodegeneration Group, Centre for Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Cristina Cereda
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
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Ning P, Yang B, Li S, Mu X, Shen Q, Hu F, Tang Y, Yang X, Xu Y. Systematic review of the prognostic role of body mass index in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:356-367. [PMID: 30931632 DOI: 10.1080/21678421.2019.1587631] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Pingping Ning
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Baiyuan Yang
- Department of Neurology, Seventh People’s Hospital of Chengdu, Chengdu, Sichuan Province, P.R. China,
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Xin Mu
- Department of Neurology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, P.R. China and
| | - Qiuyan Shen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Fayun Hu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Yao Tang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
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Chipika RH, Finegan E, Li Hi Shing S, Hardiman O, Bede P. Tracking a Fast-Moving Disease: Longitudinal Markers, Monitoring, and Clinical Trial Endpoints in ALS. Front Neurol 2019; 10:229. [PMID: 30941088 PMCID: PMC6433752 DOI: 10.3389/fneur.2019.00229] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) encompasses a heterogeneous group of phenotypes with different progression rates, varying degree of extra-motor involvement and divergent progression patterns. The natural history of ALS is increasingly evaluated by large, multi-time point longitudinal studies, many of which now incorporate presymptomatic and post-mortem assessments. These studies not only have the potential to characterize patterns of anatomical propagation, molecular mechanisms of disease spread, but also to identify pragmatic monitoring markers. Sensitive markers of progressive neurodegenerative change are indispensable for clinical trials and individualized patient care. Biofluid markers, neuroimaging indices, electrophysiological markers, rating scales, questionnaires, and other disease-specific instruments have divergent sensitivity profiles. The discussion of candidate monitoring markers in ALS has a dual academic and clinical relevance, and is particularly timely given the increasing number of pharmacological trials. The objective of this paper is to provide a comprehensive and critical review of longitudinal studies in ALS, focusing on the sensitivity profile of established and emerging monitoring markers.
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Affiliation(s)
| | - Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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67
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Tan GP, Soon LHY, Ni B, Cheng H, Tan AKH, Kor AC, Chan Y. The pattern of use and survival outcomes of a dedicated adult Home Ventilation and Respiratory Support Service in Singapore: a 7-year retrospective observational cohort study. J Thorac Dis 2019; 11:795-804. [PMID: 31019767 DOI: 10.21037/jtd.2019.02.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background In Singapore, a dedicated adult multidisciplinary Home Ventilation and Respiratory Support Service (HVRSS) was set-up to assist individuals with chronic ventilatory failure. We aimed to study the use, survival outcomes and identify factors influencing survival in our cohort of ventilator-assisted individuals (VAIs). Methods We retrospectively reviewed all referrals to HVRSS from 2009 to 2015. All VAIs were included and divided into 4 categories: (I) amyotrophic lateral sclerosis (ALS); (II) other neuromuscular and chest wall disease (NMCW); (III) spinal cord injury (SCI); and (IV) complex intensive care unit (ICU) groups for comparison of baseline characteristics, co-morbidities, therapy details and survival outcomes. Cox proportional analysis was used to identify important factors influencing survival for ALS and non-ALS VAIs. Results There were 112 VAIs; most were male (63%) and ethnic Chinese (83%). At baseline, median [interquartile range (IQR)] age was 61 [46-69] years, body mass index was 20.2 (17.1-23.8) kg/m2 and forced vital capacity was 38 [24-65] %predicted. The three most common diseases were ALS (43%), SCI (13%) and congenital muscular dystrophies (6%). Seventy-four (66%) VAIs received non-invasive ventilation (NIV). Median survival for ALS, Complex ICU, SCI and NMCW VAIs were 1.8, 2.6, 4.2 and 6.7 years respectively. In ALS, NIV conversion to invasive mechanical ventilation (IMV) was associated with longer survival [hazard ratio (HR) 0.24]. In non-ALS VAIs, older age (HR 1.40) and cardiovascular comorbidities (HR 2.61) were poor prognostic factors. Conclusions The HVRSS managed a heterogenous group of VAIs in Singapore and survival is comparable to published cohorts. ALS had the worst survival whereas NMCW had the best survival with Complex ICU and SCI groups in between. Transition from NIV to IMV, age and cardiovascular disease were important prognostic factors.
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Affiliation(s)
- Geak Poh Tan
- Department of Respiratory and Critical Care Medicine, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lydia Hse Yin Soon
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Nursing Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bin Ni
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Nursing Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hong Cheng
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Nursing Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Adrian Kok Heng Tan
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Continuing and Community Care, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ai Ching Kor
- Department of Respiratory and Critical Care Medicine, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yeow Chan
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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68
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Matsuda C, Shimizu T, Nakayama Y, Haraguchi M. Cough peak flow decline rate predicts survival in patients with amyotrophic lateral sclerosis. Muscle Nerve 2018; 59:168-173. [DOI: 10.1002/mus.26320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Chiharu Matsuda
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science; 2-1-6 Kamikitazawa, Setagaya-ku Tokyo 156-8506 Japan
| | - Toshio Shimizu
- Department of Neurology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
- Department of Neurology; Tokyo Metropolitan Tama Medical Center; Tokyo Japan
| | - Yuki Nakayama
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science; 2-1-6 Kamikitazawa, Setagaya-ku Tokyo 156-8506 Japan
| | - Michiko Haraguchi
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science; 2-1-6 Kamikitazawa, Setagaya-ku Tokyo 156-8506 Japan
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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: 29] [Impact Index Per Article: 4.8] [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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70
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Tortelli R, Arcuti S, Copetti M, Barone R, Zecca C, Capozzo R, Barulli MR, Simone IL, Logroscino G. Pseudobulbar affect as a negative prognostic indicator in amyotrophic lateral sclerosis. Acta Neurol Scand 2018. [PMID: 29527672 DOI: 10.1111/ane.12918] [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: 12/11/2022]
Abstract
OBJECTIVE To evaluate whether the presence of pseudobulbar affect (PBA) in an early stage of the disease influences survival in a population-based incident cohort of amyotrophic lateral sclerosis (ALS). METHODS Incident ALS cases, diagnosed according to El Escorial criteria, were enrolled from a prospective population-based registry in Puglia, Southern Italy. The Center for Neurologic Study-Lability Scale (CNS-LS), a self-administered questionnaire, was used to evaluate PBA. Total scores range from 7 to 35. A score ≥13 was used to identify PBA. Cox proportional hazard models were used for survival analysis. The modified C-statistic for censored survival data was used for models' discrimination. RECursive Partitioning and AMalgamation (RECPAM) analysis was used to identify subgroups of patients with different patterns of risk, depending on baseline characteristics. RESULTS We enrolled 94 sporadic ALS, median age of 64 years (range: 26-80). At the censoring date, 65 of 94 (69.2%), 39 of 60 (65.0%), and 26 of 34 (76.5%) patients reached the outcome (tracheotomy/death), in the whole, non-PBA and in the PBA groups, respectively. Kaplan-Meier survival curves for the two subgroups were not significantly different (log-rank test: 1.3, P = .25). The discrimination ability of a multivariable model with demographic and clinical variables of interest was not improved by adding PBA. In the RECPAM analysis, ALSFRSr and the total score of CNS-LS scale (</≥10) were the most important variables for differentiating all risk categories. CONCLUSIONS These preliminary results underlie that the presence of PBA at entry negatively influences survival in a specific subgroup of patients with ALS characterized by less functional impairment.
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Affiliation(s)
- R. Tortelli
- Unit of Neurodegenerative Diseases; Department of Clinical Research in Neurology; University of Bari “A. Moro” at Pia Fondazione Card. G. Panico; Tricase Lecce Italy
| | - S. Arcuti
- Unit of Biostatistics; IRCCS “Casa Sollievo della Sofferenza”; San Giovanni Rotondo Foggia Italy
| | - M. Copetti
- Unit of Biostatistics; IRCCS “Casa Sollievo della Sofferenza”; San Giovanni Rotondo Foggia Italy
| | - R. Barone
- Unit of Neurodegenerative Diseases; Department of Clinical Research in Neurology; University of Bari “A. Moro” at Pia Fondazione Card. G. Panico; Tricase Lecce Italy
| | - C. Zecca
- Unit of Neurodegenerative Diseases; Department of Clinical Research in Neurology; University of Bari “A. Moro” at Pia Fondazione Card. G. Panico; Tricase Lecce Italy
| | - R. Capozzo
- Unit of Neurodegenerative Diseases; Department of Clinical Research in Neurology; University of Bari “A. Moro” at Pia Fondazione Card. G. Panico; Tricase Lecce Italy
| | - M. R. Barulli
- Unit of Neurodegenerative Diseases; Department of Clinical Research in Neurology; University of Bari “A. Moro” at Pia Fondazione Card. G. Panico; Tricase Lecce Italy
| | - I. L. Simone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs; University of Bari “A. Moro”; Bari Italy
| | - G. Logroscino
- Unit of Neurodegenerative Diseases; Department of Clinical Research in Neurology; University of Bari “A. Moro” at Pia Fondazione Card. G. Panico; Tricase Lecce Italy
- Department of Basic Medical Sciences, Neurosciences and Sense Organs; University of Bari “A. Moro”; Bari Italy
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71
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Chen X, Wei QQ, Chen Y, Cao B, Ou R, Hou Y, Yuan X, Zhang L, Liu H, Shang H. Clinical Staging of Amyotrophic Lateral Sclerosis in Chinese Patients. Front Neurol 2018; 9:442. [PMID: 29971035 PMCID: PMC6018204 DOI: 10.3389/fneur.2018.00442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/25/2018] [Indexed: 02/05/2023] Open
Abstract
Objective: It is important to explore the utility of clinical staging systems in the management of amyotrophic lateral sclerosis (ALS). Our aim was to assess the validity of King's College in a Chinese ALS cohort, by evaluating the duration and informativeness of each stage and examining the association between stage and prognosis. Methods: From May 2008 to December 2016, patients with a likely diagnosis of ALS were registered. We prospectively assessed the progression of the patients through the stages and calculated the duration of each stage. Results: The median duration in Stage 1 was 12.00 months, Stage 2 7.50 months, Stage 3 6.50 months, and Stage 4 4.10 months. Subset analysis revealed that the spinal-onset and early-onset patients had a longer median time in Stage 1 compared to bulbar-onset and late-onset patients, respectively. Riluzole treatment extended the durations of Stages 1 and 2, and the effect was maintained in patients with long-term use of riluzole (>6 months). Patients who initiated long-term riluzole therapy early, in Stage 1 or 2, had a longer Stage 2. Patients who received percutaneous gastrostomy endoscopy (PEG) or non-invasive positive-pressure ventilation (NIPPV) showed longer durations of Stage 4. The differences in survival time measured from each stage to death or censor date were significant. Conclusions: We validated the King's College staging system in a Chinese population, and showed this system to be useful in clinical practice. Patients with bulbar-onset or an age of onset>45 years tended to have rapidly progressing ALS. Riluzole may be more effective when initiated in an early disease stage and continued long-term. PEG and NIPPV treatments can extend disease duration of Stage 4.
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Affiliation(s)
- Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian-Qian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - RuWei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoqin Yuan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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72
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Revisiting the concept of amyotrophic lateral sclerosis as a multisystems disorder of limited phenotypic expression. Curr Opin Neurol 2018; 30:599-607. [PMID: 28914734 DOI: 10.1097/wco.0000000000000488] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The current review will examine the contemporary evidence that amyotrophic lateral sclerosis (ALS) is a syndrome in which the unifying feature is a progressive loss of upper and lower motor neuron function. RECENT FINDINGS Although ALS is traditionally viewed as a neurodegenerative disorder affecting the motor neurons, there is considerable phenotypic heterogeneity and widespread involvement of the central nervous system. A broad range of both causative and disease modifying genetic variants are associated with both sporadic and familial forms of ALS. A significant proportion of ALS patients have an associated frontotemporal dysfunction which can be a harbinger of a significantly shorter survival and for which there is increasing evidence of a fundamental disruption of tau metabolism in those affected individuals. Although the traditional neuropathology of the degenerating motor neurons in ALS is that of neuronal cytoplasmic inclusions composed neuronal intermediate filaments, the presence of neuronal cytoplasmic inclusions composed of RNA binding proteins suggests a key role for RNA dysmetabolism in the pathogenesis of ALS. SUMMARY ALS is a complex multisystem neurodegenerative syndrome with marked heterogeneity at not only the level of clinical expression, but also etiologically.
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73
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Mandrioli J, Ferri L, Fasano A, Zucchi E, Fini N, Moglia C, Lunetta C, Marinou K, Ticozzi N, Drago Ferrante G, Scialo C, Sorarù G, Trojsi F, Conte A, Falzone YM, Tortelli R, Russo M, Sansone VA, Mora G, Silani V, Volanti P, Caponnetto C, Querin G, Monsurrò MR, Sabatelli M, Chiò A, Riva N, Logroscino G, Messina S, Calvo A. Cardiovascular diseases may play a negative role in the prognosis of amyotrophic lateral sclerosis. Eur J Neurol 2018. [PMID: 29512869 DOI: 10.1111/ene.13620] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Only a few studies have considered the role of comorbidities in the prognosis of amyotrophic lateral sclerosis (ALS) and have provided conflicting results. METHODS Our multicentre, retrospective study included patients diagnosed from 1 January 2009 to 31 December 2013 in 13 referral centres for ALS located in 10 Italian regions. Neurologists at these centres collected a detailed phenotypic profile and follow-up data until death in an electronic database. Comorbidities at diagnosis were recorded by main categories and single medical diagnosis, with the aim of investigating their role in ALS prognosis. RESULTS A total of 2354 incident cases were collected, with a median survival time from onset to death/tracheostomy of 43 months. According to univariate analysis, together with well-known clinical prognostic factors (age at onset, diagnostic delay, site of onset, phenotype, Revised El Escorial Criteria and body mass index at diagnosis), the presence of dementia, hypertension, heart disease, chronic obstructive pulmonary disease, haematological and psychiatric diseases was associated with worse survival. In multivariate analysis, age at onset, diagnostic delay, phenotypes, body mass index at diagnosis, Revised El Escorial Criteria, dementia, hypertension, heart diseases (atrial fibrillation and heart failure) and haematological diseases (disorders of thrombosis and haemostasis) were independent prognostic factors of survival in ALS. CONCLUSIONS Our large, multicentre study demonstrated that, together with the known clinical factors that are known to be prognostic for ALS survival, hypertension and heart diseases (i.e. atrial fibrillation and heart failure) as well as haematological diseases are independently associated with a shorter survival. Our findings suggest some mechanisms that are possibly involved in disease progression, giving new interesting clues that may be of value for clinical practice and ALS comorbidity management.
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Affiliation(s)
- J Mandrioli
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - L Ferri
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - A Fasano
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - E Zucchi
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - N Fini
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - C Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Torino
| | - C Lunetta
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Milano.,NEuroMuscular Omnicentre (NEMO) Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina
| | - K Marinou
- Department of Neurorehabilitation-ALS Center, Scientific Institute of Milan, Salvatore Maugeri Foundation IRCCS, Milan
| | - N Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan.,Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, University of Milan, Milan
| | - G Drago Ferrante
- Neurorehabilitation Unit/ALS Center, Salvatore Maugeri Foundation, IRCCS, Mistretta, Messina
| | - C Scialo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, IRCCS AOU San Martino-IST, Genova
| | - G Sorarù
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padua
| | - F Trojsi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples
| | - A Conte
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation-Pol. A. Gemelli Foundation, Rome
| | - Y M Falzone
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan
| | - R Tortelli
- Department of Clinical Research in Neurology, University of Bari at Pia Fondazione 'Card. G. Panico', Tricase, Lecce
| | - M Russo
- Department of Clinical and Experimental Medicine, University of Messina and Nemo Sud Clinical Center for Neuromuscular Diseases, Aurora Foundation, Messina
| | - V A Sansone
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Milano.,Department of Biomedical Sciences for Health, University of Milan, Milan
| | - G Mora
- Department of Neurorehabilitation-ALS Center, Scientific Institute of Milan, Salvatore Maugeri Foundation IRCCS, Milan
| | - V Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan.,Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, University of Milan, Milan
| | - P Volanti
- Neurorehabilitation Unit/ALS Center, Salvatore Maugeri Foundation, IRCCS, Mistretta, Messina
| | - C Caponnetto
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, IRCCS AOU San Martino-IST, Genova
| | - G Querin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padua
| | - M R Monsurrò
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples
| | - M Sabatelli
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation-Pol. A. Gemelli Foundation, Rome.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - A Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Torino
| | - N Riva
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan
| | - G Logroscino
- Department of Clinical Research in Neurology, University of Bari at Pia Fondazione 'Card. G. Panico', Tricase, Lecce
| | - S Messina
- NEuroMuscular Omnicentre (NEMO) Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina.,Department of Clinical and Experimental Medicine, University of Messina and Nemo Sud Clinical Center for Neuromuscular Diseases, Aurora Foundation, Messina
| | - A Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Torino
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Tan GP, McArdle N, Dhaliwal SS, Douglas J, Rea CS, Singh B. Patterns of use, survival and prognostic factors in patients receiving home mechanical ventilation in Western Australia: A single centre historical cohort study. Chron Respir Dis 2018; 15:356-364. [PMID: 29415556 PMCID: PMC6234575 DOI: 10.1177/1479972318755723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Home mechanical ventilation (HMV) is used in a wide range of disorders associated with chronic hypoventilation. We describe the patterns of use, survival and predictors of death in Western Australia. We identified 240 consecutive patients (60% male; mean age 58 years and body mass index 31 kg m-2) referred for HMV between 2005 and 2010. The patients were grouped into four categories: motor neurone disorders (MND; 39%), pulmonary disease (PULM; 25%, mainly chronic obstructive pulmonary disease), non-MND neuromuscular and chest wall disorders (NMCW; 21%) and the obesity hypoventilation syndrome (OHS; 15%). On average, the patients had moderate ventilatory impairment (forced vital capacity: 51%predicted), sleep apnoea (apnoea-hypopnea index: 25 events h-1), sleep-related hypoventilation (transcutaneous carbon dioxide rise of 20 mmHg) and daytime hypercarbia (PCO2: 54 mmHg). Median durations of survival from HMV initiation were 1.0, 4.2, 9.9 and >11.5 years for MND, PULM, NMCW and OHS, respectively. Independent predictors of death varied between primary indications for HMV; the predictors included (a) age in all groups except for MND (hazard ratios (HRs) 1.03-1.10); (b) cardiovascular disease (HR: 2.35, 95% confidence interval (CI): 1.08-5.10) in MND; (c) obesity (HR: 0.28, 95% CI: 0.13-0.62) and oxygen therapy (HR: 0.33, 95% CI: 0.14-0.79) in PULM; and (d) forced expiratory volume in 1 s (%predicted; HR: 0.93, 95% CI: 0.88-1.00) in OHS.
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Affiliation(s)
- Geak Poh Tan
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia.,3 Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Nigel McArdle
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia.,4 University of Western Australia, Nedlands, Western Australia
| | | | - Jane Douglas
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Clare Siobhan Rea
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Bhajan Singh
- 1 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,2 West Australian Sleep Disorders Research Institute, Nedlands, Western Australia.,4 University of Western Australia, Nedlands, Western Australia
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75
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Riluzole and other prognostic factors in ALS: a population-based registry study in Italy. J Neurol 2018; 265:817-827. [PMID: 29404735 DOI: 10.1007/s00415-018-8778-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE In this prospective population-based registry study on ALS survival, we investigated the role of riluzole treatment, together with other clinical factors, on the prognosis in incident ALS cases in Emilia Romagna Region (ERR), Italy. METHODS A registry for ALS has been collecting all incident cases in ERR since 2009. Detailed clinical data from all patients diagnosed with ALS between 1.1.2009 and 31.12.2014 have been analyzed for this study, with last follow up date set at 31.12.2015. RESULTS During the 6 years of the study, there were 681 incident cases with a median tracheostomy-free survival of 40 months (95% CI 36-44) from onset and of 26 months (95% CI 24-30) from diagnosis; 573 patients (84.14%) were treated with riluzole, 207 (30.39%) patients underwent gastrostomy, 246 (36.12%) non invasive ventilation, and 103 (15.15%) invasive ventilation. Patients who took treatment for ≥ 75% of disease duration from diagnosis had a median survival of 29 months compared to 18 months in patients with < 75% treatment duration. In multivariable analysis, factors independently influencing survival were age at onset (HR 1.04, 95% CI 1.02-1.05, p < 0.001), dementia (HR 1.56, 95% CI 1.05-2.32, p = 0.027), degree of diagnostic certainty (HR 0.88, 95% CI 0.78-0.98, p = 0.021), gastrostomy (HR 1.46, 95% CI 1.14-1.88, p = 0.003), NIV (HR 1.43, 95% CI 1.12-1.82, p = 0.004), and weight loss at diagnosis (HR 1.05, 95% CI 1.03-1.07, p < 0.001), diagnostic delay (HR 0.98, 95% CI 0.97-0.99, p = 0.004), and % treatment duration (HR 0.98, 95% CI 0.98-0.99, p < 0.001). CONCLUSIONS Independently from other prognostic factors, patients who received riluzole for a longer period of time survived longer, but further population based studies are needed to verify if long-tem use of riluzole prolongs survival.
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76
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Spataro R, Volanti P, Lo Coco D, La Bella V. Marital status is a prognostic factor in amyotrophic lateral sclerosis. Acta Neurol Scand 2017; 136:624-630. [PMID: 28470818 DOI: 10.1111/ane.12771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Several variables have been linked to a shorter survival in patients with amyotrophic lateral sclerosis (ALS), for example, female sex, older age, site of disease onset, rapid disease progression, and a relatively short diagnostic delay. With regard to marital status, previous studies suggested that living with a partner might be associated to a longer survival and a higher likelihood to proceed to tracheostomy. Therefore, to further strengthen this hypothesis, we investigated the role of marital status as a prognostic variable in a cohort of ALS patients. METHODS We performed a retrospective analysis on 501 consecutive ALS patients for which a complete disease's natural history and clinical/demographic data were available. At diagnosis, 409 patients (81.6%) were married or lived with a stable partner, whereas 92 patients (18.4%) were single/widowed/divorced. RESULTS In our ALS cohort, being married was associated with a median longer survival (married, 35 months [24-50] vs unmarried, 27 months [18-42]; P<.004). Moreover, married and unmarried patients were significantly different in many clinical and demographic variables, including age at disease onset, gender, body mass index, and number of children. Cox regression analysis showed that age at onset, diagnostic delay, and marital status were independent predictors of survival. In unmarried patients, female sex was also significantly associated with shorter survival. CONCLUSIONS Marital status is a prognostic factor in ALS, and it significantly affects survival.
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Affiliation(s)
- R. Spataro
- Department of Experimental BioMedicine and Clinical Neurosciences; ALS Clinical Research Center; University of Palermo; Palermo Italy
| | - P. Volanti
- Neurorehabilitation Unit; ALS Center; Istituti Clinici Scientifici Maugeri; Mistretta Italy
| | - D. Lo Coco
- Department of Experimental BioMedicine and Clinical Neurosciences; ALS Clinical Research Center; University of Palermo; Palermo Italy
- Neurology Unit; Department of Internal Medicine; Ospedale Civico - ARNAS; Palermo Italy
| | - V. La Bella
- Department of Experimental BioMedicine and Clinical Neurosciences; ALS Clinical Research Center; University of Palermo; Palermo Italy
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77
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Changes in routine laboratory tests and survival in amyotrophic lateral sclerosis. Neurol Sci 2017; 38:2177-2182. [DOI: 10.1007/s10072-017-3138-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/26/2017] [Indexed: 12/22/2022]
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78
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Peter RS, Rosenbohm A, Dupuis L, Brehme T, Kassubek J, Rothenbacher D, Nagel G, Ludolph AC. Life course body mass index and risk and prognosis of amyotrophic lateral sclerosis: results from the ALS registry Swabia. Eur J Epidemiol 2017; 32:901-908. [PMID: 28975435 DOI: 10.1007/s10654-017-0318-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/23/2017] [Indexed: 12/12/2022]
Abstract
Weight loss appears as a strong predictor of survival of patients with amyotrophic lateral sclerosis, yet no data are currently available to describe the life course history of pre-diagnostic body mass index (BMI) in these patients. 393 ALS cases (mean age: 65.8 years, 57.3% men) and 791 controls matched by age and sex from a population-based case-control study of the ALS Registry Swabia were analyzed. Differences of BMI change in cases and controls over time were modeled using a multilevel additive model. In addition, survival in ALS cases by BMI change was modeled using an accelerated failure time model adjusted for prognostic factors. In ALS cases, BMI was consistently higher than in controls in the 20-70 years before the interview. Conditional logistic regression revealed an odds ratio of 1.05 (95% confidence interval (CI) 1.00-1.11, p = 0.041) per 1 kg/m2 higher BMI 35-45 years before interview. However, a sharp decrease was evident in the BMI of ALS cases about 10 years before disease onset. Moreover, weight loss was strongly associated with shorter survival in ALS patients. Illustrating this, patients with stable weight showed a median survival time of 22.1 (95%-CI 19.2-25.0) months, as compared to 13.4 (95%-CI 10.5-16.3) months for patients with weight loss of 2.5 kg/m2 over the last 3 months before the interview. Thus, alterations in body weight are present in ALS patients already decades before clinical manifestation of ALS, while weight loss precedes motor symptoms of several years and is associated with poor prognosis.
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Affiliation(s)
- Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | | | - Luc Dupuis
- INSERM U1118, Université de Strasbourg, Strasbourg, France
| | - Torben Brehme
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, Ulm University, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
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Comorbidity of dementia with amyotrophic lateral sclerosis (ALS): insights from a large multicenter Italian cohort. J Neurol 2017; 264:2224-2231. [PMID: 28914354 DOI: 10.1007/s00415-017-8619-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
To assess the association, at diagnosis, between amyotrophic lateral sclerosis (ALS) and dementia in a large cohort of well-characterized Italian patients. We investigated the phenotypic profile of 1638 incident patients with definite, probable or laboratory-supported probable ALS, diagnosed from January 2009 to December 2013 in 13 Italian Referral Centers, located in 10 Italian Regions, and classified in two independent subsamples accounting for presence or not of dementia. The collected ALS features, including survival and other follow-up data, were compared between the two subgroups using a one-way analysis of variance and Chi-square test, as appropriate, logistic regression models and Kaplan-Meier survival analysis. Between-subgroup comparisons showed an older age at clinical observation (p = .006), at onset and at diagnosis (p = .002) in demented versus non demented ALS patients. After adjustment for these variables, diagnosis of dementia was significantly associated with higher odds of family history of ALS (p = .001) and frontotemporal dementia (p = .003) and of bulbar onset (p = .004), and lower odds of flail leg phenotype (p = .019) and spinal onset (p = .008). The median survival time was shorter in demented versus non-demented patients, especially in case of classical, bulbar and flail limb phenotypes and both bulbar and spinal onset. Our multicenter study emphasized the importance of an early diagnosis of comorbid dementia in ALS patients, which may have clinical impact and prognostic relevance. Moreover, our results may give further inputs to validation of ALS-specific tools for the screening of cognitive impairment in clinical practice.
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80
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Hardiman O, Al-Chalabi A, Brayne C, Beghi E, van den Berg LH, Chio A, Martin S, Logroscino G, Rooney J. The changing picture of amyotrophic lateral sclerosis: lessons from European registers. J Neurol Neurosurg Psychiatry 2017; 88:557-563. [PMID: 28285264 DOI: 10.1136/jnnp-2016-314495] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 12/12/2022]
Abstract
Prospective population based-registers of amyotrophic lateral sclerosis (ALS) have operated in Europe for over two decades, and have provided important insights into our understanding of ALS. Here, we review the benefits that population registers have brought to the understanding of the incidence, prevalence, phenotype and genetics of ALS and outline the core operating principles that underlie these registers and facilitate international collaboration. Going forward, we offer lessons learned from our collective experience of operating population-based ALS registers in Europe for over two decades, focusing on register design, maintenance, identification and management of bias and the value of cross-national harmonisation and integration.
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Affiliation(s)
- Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Beaumont, Ireland
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Ettore Beghi
- Neurological Diseases Laboratory, Department of Neurosciences, IRCCS Mario Negri, Milano, Italy
| | - Leonard H van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriano Chio
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Sarah Martin
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - James Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
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81
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Filareti M, Luotti S, Pasetto L, Pignataro M, Paolella K, Messina P, Pupillo E, Filosto M, Lunetta C, Mandrioli J, Fuda G, Calvo A, Chiò A, Corbo M, Bendotti C, Beghi E, Bonetto V. Decreased Levels of Foldase and Chaperone Proteins Are Associated with an Early-Onset Amyotrophic Lateral Sclerosis. Front Mol Neurosci 2017; 10:99. [PMID: 28428745 PMCID: PMC5382314 DOI: 10.3389/fnmol.2017.00099] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/23/2017] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by a progressive upper and lower motor neuron degeneration. One of the peculiar clinical characteristics of ALS is the wide distribution in age of onset, which is probably caused by different combinations of intrinsic and exogenous factors. We investigated whether these modifying factors are converging into common pathogenic pathways leading either to an early or a late disease onset. This would imply the identification of phenotypic biomarkers, that can distinguish the two populations of ALS patients, and of relevant pathways to consider in a therapeutic intervention. Toward this aim a differential proteomic analysis was performed in peripheral blood mononuclear cells (PBMC) from a group of 16 ALS patients with an age of onset ≤55 years and a group of 16 ALS patients with an age of onset ≥75 years, and matched healthy controls. We identified 43 differentially expressed proteins in the two groups of patients. Gene ontology analysis revealed that there was a significant enrichment in annotations associated with protein folding and response to stress. We next validated a selected number of proteins belonging to this functional group in 85 patients and 83 age- and sex-matched healthy controls using immunoassays. The results of the validation study confirmed that there was a decreased level of peptidyl-prolyl cis-trans isomerase A (also known as cyclophilin A), heat shock protein HSP 90-alpha, 78 kDa glucose-regulated protein (also known as BiP) and protein deglycase DJ-1 in PBMC of ALS patients with an early onset. Similar results were obtained in PBMC and spinal cord from two SOD1G93A mouse models with an early and late disease onset. This study suggests that a different ability to upregulate proteins involved in proteostasis, such as foldase and chaperone proteins, may be at the basis of a different susceptibility to ALS, putting forward the development of therapeutic approaches aiming at boosting the protein quality control system.
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Affiliation(s)
- Melania Filareti
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy.,Department of Neurorehabilitation Sciences, Casa Cura PoliclinicoMilan, Italy
| | - Silvia Luotti
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
| | - Laura Pasetto
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
| | - Mauro Pignataro
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
| | - Katia Paolella
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
| | - Paolo Messina
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
| | - Elisabetta Pupillo
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
| | - Massimiliano Filosto
- Center for Neuromuscular Diseases and Neuropathies, Unit of Neurology, ASST Spedali Civili and University of BresciaBrescia, Italy
| | | | - Jessica Mandrioli
- Department of Neuroscience, Azienda Ospedaliero Universitaria di Modena, Ospedale Civile S. Agostino-EstenseModena, Italy
| | - Giuseppe Fuda
- ALS Center, Department of Neuroscience Rita Levi Montalcini, University of TorinoTorino, Italy
| | - Andrea Calvo
- ALS Center, Department of Neuroscience Rita Levi Montalcini, University of TorinoTorino, Italy
| | - Adriano Chiò
- ALS Center, Department of Neuroscience Rita Levi Montalcini, University of TorinoTorino, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa Cura PoliclinicoMilan, Italy
| | - Caterina Bendotti
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
| | - Ettore Beghi
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
| | - Valentina Bonetto
- Istituto Di Ricerche Farmacologiche Mario Negri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)Milan, Italy
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82
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Abstract
Amyotrophic lateral sclerosis is a neurodegenerative disease predominantly affecting upper and lower motor neurons, resulting in progressive paralysis and death from respiratory failure within 2 to 3 years. The peak age of onset is 55 to 70 years, with a male predominance. The causes of amyotrophic lateral sclerosis are only partly known, but they include some environmental risk factors as well as several genes that have been identified as harbouring disease-associated variation. Here we review the nature, epidemiology, genetic associations, and environmental exposures associated with amyotrophic lateral sclerosis.
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Affiliation(s)
- Sarah Martin
- Maurice Wohl Clinical Neuroscience Institute, King’s College, London, UK
| | - Ahmad Al Khleifat
- Maurice Wohl Clinical Neuroscience Institute, King’s College, London, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King’s College, London, UK
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83
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Skillbäck T, Mattsson N, Blennow K, Zetterberg H. Cerebrospinal fluid neurofilament light concentration in motor neuron disease and frontotemporal dementia predicts survival. Amyotroph Lateral Scler Frontotemporal Degener 2017. [DOI: 10.1080/21678421.2017.1281962] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tobias Skillbäck
- Institute of Neuroscience and Physiology, Department of Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden,
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden,
| | - Niklas Mattsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden,
- Department of Neurology, Skåne University Hospital, Lund, Sweden, and
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden,
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden,
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden,
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden,
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
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