Epidemiology of motor-neuron diseases

Amyotrophic lateral sclerosis in Finland. II: Clinical characteristics

The clinical characteristics of ALS in Finland were investigated. The study was based on the hospital records of 255 patients. No correlation was found between the disease and other previous illnesses. Muscular weakness was the most frequent complaint of the patients as their first symptom (149/255, i.e. 58 per cent). The duration of the disease was shortest (1.9 years) in male cases with the first symptoms in the bulbar area, and it was longest (3.4 years) in females with a spinal onset of the symptoms. The duration of the disease was in inverse relation to the age when it was contracted. Progressive muscular atrophy with fasciculations was considered the most important clinical sign of ALS. It was most frequently observed in the upper extremities including shoulders. Sensory disturbances were absent, sphincter abnormalities were reported in only three cases, bed sores did not exist, and there were no reports of impotence in the male patients. Two families with two familial cases in each were found, altogether two men and two women. Their disease did not differ from that of the rest of the series. The ALS patients soon became too disabled to work; 56 per cent bacame permanently disabled in less than 1 year's time, and only 9 per cent retained their working capacity for more than 2 years. The average length of stay at hospital was 32 days for ALS and 37 days for MS patients, but the later group was hospitalized 2-3 times more frequently than the former. Gastrostomy or tracheostomy and artificial respiration did not lenghten the lives of the patients.

Amyotrophic lateral sclerosis in Finland. I: An epidemiologic study

The prevalence of ALS and its distribution in Finland was investigated on the basis of prevalence numbers by counties. On the prevalence day, 1 January 1973, 168 ALS patients were found alive. They were collected from hospital records and the registers of the National Pension Institute. The prevalence was 3.56 cases per 100,000 populations, 4.25/100,000 for men and 1.92/100,000 for women, which gave a male to female prevalence ration 1.5 to 1. The distribution of the disease was uneven in the country being more frequent in the southeastern counties. The disease was contracted earlier (at 51.9 years of age) and its course was slower (3.7 years up to the prevalence day) in the prevalence material than in cases derived from the mortality statistics (58.0 years at the onset and duration of 2.6 years, respectively). This is explained by the dropping out of some of the younger and/or more benign cases from the mortality statistics. This seems to be true also in other countries.

Motor neurone disease with neurofibrillary tangles in a Brazilian woman

The occurrence of neurofibrillary tangles in both the cerebral cortex and brain stem is typically seen in the Guam type of amyotrophic lateral sclerosis, but is exceedingly rare in the classical form of the disease. Only 3 cases of sporadic amyotrophic lateral sclerosis with such histopathologic features have so far been reported, all in the United States. A 49-year-old Brazilian woman had an 18-month history of amyotrophic lateral sclerosis involving predominantly the left-sided extremities with prominent bulbar signs. Autopysi disclosed moderate to severe loss of motor neurones in the hypoglossal nuclei and anterior spinal horns, absence of pyramidal tract demyelination, depigmentation of the substantia nigra and numerous neurofibrillary tangles in the hypothalamic region, parahippocampal gyrus, reticular substance of the mesencephalon and pons and in some brain stem nuclei. The topographical distribution of these changes was closely similar to that of Guamanian amyotrophic lateral sclerosis.

Histocompatibility antigens associated with motor neurone disease

The distribution of histocompatibility antigens was studied in 44 patients with motor neurone disease (MND). An unusually high incidence of HLA antigens A2 and A28 was found, compared to a control population.

Plasma lactate in anterior horn cell disease

This communication reports biochemical findings in 7 patients with anterior horn cell disease. The diagnosis was confirmed by evidence of denervation in the EMG and mukle biopsy with normal motor conduction velocities. In 4 of these patients, upper extremities were involved in a symmetrical fashion. In 1, the upper and lower extremities were involved in a symmetrical fashion. In the other 2, one upper or lower extremity were respectively involved in isolation. Pyramidal tract signs were evident in 2 patients of this group. Seventh cranial nerve and 12th cranial nerve involvement were seen in 2 patients. None of the patients manifested 8th cranial nerve dysfunction. All of these 7 patients showed elevation of raised fasting plasma lactate, with normal plasma citrate and plasma pyruvate values. This is in contrast to the altered citrate and pyruvate levels described by other workers in other cases of anterior horn cell disease. The significant biochemical relationship are discussed.

The epidemiology of amyotrophic lateral sclerosis in Finland. A study based on the death certificates of 421 patients

The mortality and prevalence of ALS in the various countries of Finland was studied. The work was based on death certificates derived from a 10-year period from 1963 to 1972, and altogether 421 cases were found. The mean duration of the disease was 2.7 years, and the mean age at death was 61.2 years. The average annual mortality rate was 0.91 per 100,000. The male to female ratio was 0.87 to 1, males outnumbered females only in age groups under 65. Some clustering of the cases seems to be taking place in the south-eastern part of the country. The rural to urban distribution of the patients' places of birth and domiciles did not differ markedly from that of thw whole population. After ALS itself pneumonia was the most common direct cause of death. Of other significant conditions coded in the death certificates schizophrenia and cancer did not occur more often than could be expected by chance. No evidence of inheritance of the disease was found.

Amyotrophic lateral sclerosis: a population study

A country-wide study of the frequency of amyotrophic lateral sclerosis (ALS) was undertaken in Israel for the period 1960-1970. Israel was chosen for this study because of its excellent medical facilities and detailed demographic information. Moreover, the population includes representative groups from all parts of the world for comparison of frequency. A wide variety of motor system disease was screened in all hospitals, clinics, and chronic care facilities in the country, death certificates were reviewed and physicians with a neurological practice were contacted to derive a tentative list of cases. Only those who fit strict clinical diagnostic criteria or had autopsy confirmation were included in estimates of prevalence and incidence. On January 1, 1965, the mid-point of the study, 62 patients with ALS were living in Israel. The age-adjusted prevalence of ALS on that date was 3 per 100,000 population. The average annual age-adjusted incidence for the period 1960-1970 was 0.78 per 100000 population )0.86 in males, 0.46 in females; ratio 1.9:1). There was no appreciable change in trend of incidence over the study interval. Age-specific incidence rates were similar in native-born inhabitants of Israel, immigrants from Europe and immigrants from Afro-Asian countries. The range in age-adjusted incidence among subgroups of immigrants to Israel from various countries was 0.25 to 1.20 per 100000 population but small numbers precluded testing the statistical significance of these rather narrow differences. Mean age at onset was 55.4 years for males and 52.4 years for females. The mean age at death was 60.2 for males and 58.0 for females. The average annual mortality from ALS was 0.58 per 100000 population. There were no familial aggregates of ALS in Israel and autopsy data showed no neurofibrillary changes, granulovacuolar or inclusion bodies. There are only a few other population studies of ALS in different regions of the world. The average annual incidence in these other studies ranged from 0.4 to 1.4 per 100000 population. Thus, the incidence in Israel falls within this narrow range. The present study lends further support to the impression that ALS has a remarkably uniform geographic distribution with Guam and the Kii peninsula of Japan being the only known areas with significantly high rates. If an environmental factor contributes to the pathogenesis of ALS, the factor must also have a uniform geographic distribution.

Familial amyotrophic lateral sclerosis with dementia: a second canadian family

A family with adult-onset amyotrophic lateral sclerosis (ALS) and dementia is described. The father presented with lower motor neurone disease affecting the legs. A son presented with bulbar paralysis. Neither developed dementia. A daughter presented with spastic right lower limb weakness. Two years later, she developed a rapidly progressive mental disorder. Her cortical pathology had a distinctive fronto-temporal distribution. The rarity of published reports on ALS with dementia in families outside the Western Pacific and the factor of parental consanguinity conspired to make genetic counseling for this family difficult.