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Wiesenfarth M, Forouhideh-Wiesenfarth Y, Elmas Z, Parlak Ö, Weiland U, Herrmann C, Schuster J, Freischmidt A, Müller K, Siebert R, Günther K, Fröhlich E, Knehr A, Simak T, Bachhuber F, Regensburger M, Petri S, Klopstock T, Reilich P, Schöberl F, Schumann P, Körtvélyessy P, Meyer T, Ruf WP, Witzel S, Tumani H, Brenner D, Dorst J, Ludolph AC. Clinical characterization of common pathogenic variants of SOD1-ALS in Germany. J Neurol 2024:10.1007/s00415-024-12564-1. [PMID: 39141064 DOI: 10.1007/s00415-024-12564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 08/15/2024]
Abstract
Pathogenic variants in the Cu/Zn superoxide dismutase (SOD1) gene can be detected in approximately 2% of sporadic and 11% of familial amyotrophic lateral sclerosis (ALS) patients in Europe. We analyzed the clinical phenotypes of 83 SOD1-ALS patients focusing on patients carrying the most frequent (likely) pathogenic variants (R116G, D91A, L145F) in Germany. Moreover, we describe the effect of tofersen treatment on ten patients carrying these variants. R116G patients showed the most aggressive course of disease with a median survival of 22.0 months compared to 198.0 months in D91A and 87.0 months in L145F patients (HR 7.71, 95% CI 2.89-20.58 vs. D91A; p < 0.001 and HR 4.25, 95% CI 1.55-11.67 vs. L145F; p = 0.02). Moreover, R116G patients had the fastest median ALSFRS-R progression rate with 0.12 (IQR 0.07-0.20) points lost per month. Median diagnostic delay was 10.0 months (IQR 5.5-11.5) and therefore shorter compared to 57.5 months (IQR 14.0-83.0) in D91A (p < 0.001) and 21.5 months (IQR 5.8-38.8) in L145F (p = 0.21) carriers. As opposed to D91A carriers (50.0%), 96.2% of R116G (p < 0.001) and 100.0% of L145F (p = 0.04) patients reported a positive family history. During tofersen treatment, all patients showed a reduction of neurofilament light chain (NfL) serum levels, independent of the SOD1 variant. Patients with SOD1-ALS carrying R116G, D91A, or L145F variants show commonalities, but also differences in their clinical phenotype, including a faster progression rate with shorter survival in R116G, and a comparatively benign disease course in D91A carriers.
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Affiliation(s)
| | | | - Zeynep Elmas
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Özlem Parlak
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ulrike Weiland
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Christine Herrmann
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Joachim Schuster
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
| | - Axel Freischmidt
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Kathrin Müller
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, 89081, Ulm, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, 89081, Ulm, Germany
| | - Kornelia Günther
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Elke Fröhlich
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Antje Knehr
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Tatiana Simak
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Franziska Bachhuber
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), University Hospital Erlangen, 91054, Erlangen, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Thomas Klopstock
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, 80336, Munich, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Munich, 81377, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377, Munich, Germany
| | - Peter Reilich
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, 80336, Munich, Germany
| | - Florian Schöberl
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, 80336, Munich, Germany
| | - Peggy Schumann
- Ambulanzpartner Soziotechnologie GmbH, 13353, Berlin, Germany
| | - Peter Körtvélyessy
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353, Berlin, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Magdeburg, 39120, Magdeburg, Germany
| | - Thomas Meyer
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353, Berlin, Germany
| | - Wolfgang P Ruf
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Simon Witzel
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
| | - David Brenner
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
| | - Johannes Dorst
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
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Vernikouskaya I, Müller HP, Ludolph AC, Kassubek J, Rasche V. AI-assisted automatic MRI-based tongue volume evaluation in motor neuron disease (MND). Int J Comput Assist Radiol Surg 2024; 19:1579-1587. [PMID: 38536565 PMCID: PMC11329588 DOI: 10.1007/s11548-024-03099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/04/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE Motor neuron disease (MND) causes damage to the upper and lower motor neurons including the motor cranial nerves, the latter resulting in bulbar involvement with atrophy of the tongue muscle. To measure tongue atrophy, an operator independent automatic segmentation of the tongue is crucial. The aim of this study was to apply convolutional neural network (CNN) to MRI data in order to determine the volume of the tongue. METHODS A single triplanar CNN of U-Net architecture trained on axial, coronal, and sagittal planes was used for the segmentation of the tongue in MRI scans of the head. The 3D volumes were processed slice-wise across the three orientations and the predictions were merged using different voting strategies. This approach was developed using MRI datasets from 20 patients with 'classical' spinal amyotrophic lateral sclerosis (ALS) and 20 healthy controls and, in a pilot study, applied to the tongue volume quantification to 19 controls and 19 ALS patients with the variant progressive bulbar palsy (PBP). RESULTS Consensus models with softmax averaging and majority voting achieved highest segmentation accuracy and outperformed predictions on single orientations and consensus models with union and unanimous voting. At the group level, reduction in tongue volume was not observed in classical spinal ALS, but was significant in the PBP group, as compared to controls. CONCLUSION Utilizing single U-Net trained on three orthogonal orientations with consequent merging of respective orientations in an optimized consensus model reduces the number of erroneous detections and improves the segmentation of the tongue. The CNN-based automatic segmentation allows for accurate quantification of the tongue volumes in all subjects. The application to the ALS variant PBP showed significant reduction of the tongue volume in these patients and opens the way for unbiased future longitudinal studies in diseases affecting tongue volume.
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Affiliation(s)
- Ina Vernikouskaya
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | | | - Albert C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Volker Rasche
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
- Core Facility Small Animal MRI, University of Ulm, Ulm, Germany
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3
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Weishaupt JH, Körtvélyessy P, Schumann P, Valkadinov I, Weyen U, Hesebeck-Brinckmann J, Weishaupt K, Endres M, Andersen PM, Regensburger M, Dreger M, Koch JC, Conrad J, Meyer T. Tofersen decreases neurofilament levels supporting the pathogenesis of the SOD1 p.D91A variant in amyotrophic lateral sclerosis patients. COMMUNICATIONS MEDICINE 2024; 4:150. [PMID: 39054363 PMCID: PMC11272917 DOI: 10.1038/s43856-024-00573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Since the antisense oligonucleotide tofersen has recently become available for the treatment of amyotrophic lateral sclerosis (ALS) caused by mutations in SOD1, determining the causality of the over 230 SOD1 variants has become even more important. The most common SOD1 variant worldwide is p.D91A (c.272A > C), whose causality for ALS is contested when in a heterozygous state. The reason is the high allele frequency of SOD1D91A in Europe, exceeding 1% in Finno-Scandinavia. METHODS We present the clinical disease course and serum neurofilament light chain (NfL) results of treating 11 patients either homo- or heterozygous for the SOD1D91A allele for up to 16 months with tofersen. RESULTS Tofersen decreases serum neurofilament levels (sNFL), which are associated with the ALS progression rate, in the 6 ALS patients homozygous for SOD1D91A. We observe significantly lower sNfL levels in the 5 patients heterozygous for SOD1D91A. The results indicate that both mono- and bi-allelic SOD1D91A are causally relevant targets, with a possibly reduced effect size of SOD1D91Ahet. CONCLUSIONS The finding is relevant for decision making regarding tofersen treatment, patient counseling and inclusion of SOD1D91A patients in drug trials. As far as we are aware, the approach is conceptually new since it provides evidence for the causality of an ALS variant based on a biomarker response to gene-specific treatment.
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Affiliation(s)
- Jochen H Weishaupt
- Division of Neurodegenerative Disorders, Neurological University Clinic Mannheim, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany.
| | - Péter Körtvélyessy
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Center for ALS and other Motor Neuron Disorders, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Research Site Magdeburg, Magdeburg, Germany
| | - Peggy Schumann
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Ivan Valkadinov
- Division of Neurodegenerative Disorders, Neurological University Clinic Mannheim, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| | - Ute Weyen
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Department of Neurology, Center for ALS and other Motor Neuron Disorders, Bochum, Germany
| | - Jasper Hesebeck-Brinckmann
- Division of Neurodegenerative Disorders, Neurological University Clinic Mannheim, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| | - Kanchi Weishaupt
- Division of Neurodegenerative Disorders, Neurological University Clinic Mannheim, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Center for ALS and other Motor Neuron Disorders, Berlin, Germany
| | - Peter M Andersen
- Department of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), University Hospital Erlangen, Erlangen, Germany
| | - Marie Dreger
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Center for ALS and other Motor Neuron Disorders, Berlin, Germany
| | - Jan C Koch
- Clinic for Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Julian Conrad
- Division of Neurodegenerative Disorders, Neurological University Clinic Mannheim, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| | - Thomas Meyer
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Center for ALS and other Motor Neuron Disorders, Berlin, Germany.
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany.
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Linse K, Weber C, Reilich P, Schöberl F, Boentert M, Petri S, Rödiger A, Posa A, Otto M, Wolf J, Zeller D, Brunkhorst R, Koch J, Hermann A, Großkreutz J, Schröter C, Groß M, Lingor P, Machetanz G, Semmler L, Dorst J, Lulé D, Ludolph A, Meyer T, Maier A, Metelmann M, Regensburger M, Winkler J, Schrank B, Kohl Z, Hagenacker T, Brakemeier S, Weyen U, Weiler M, Lorenzl S, Bublitz S, Weydt P, Grehl T, Kotterba S, Lapp HS, Freigang M, Vidovic M, Aust E, Günther R. Patients' and caregivers' perception of multidimensional and palliative care in amyotrophic lateral sclerosis - protocol of a German multicentre study. Neurol Res Pract 2024; 6:34. [PMID: 38961496 PMCID: PMC11223310 DOI: 10.1186/s42466-024-00328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/22/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is an inevitably fatal condition that leads to a progressive loss of physical functioning, which results in a high psychosocial burden and organizational challenges related to medical care. Multidimensional and multiprofessional care is advised to meet the complex needs of patients and their families. Many healthcare systems, including Germany, may not be able to meet these needs because non-medical services such as psychological support or social counselling are not regularly included in the care of patients with ALS (pwALS). Specialised neuropalliative care is not routinely implemented nor widely available. Caregivers of pwALS are also highly burdened, but there is still a lack of support services for them. METHODS This project aims to assess the perceptions and satisfaction with ALS care in Germany in pwALS and their caregivers. This will be achieved by means of a cross-sectional, multicentre survey. The examination will assess, to which extend the patients' needs in the six domains of physical, psychological, social, spiritual, practical and informational are being met by current care structures. This assessment will be linked to mental well-being, subjective quality of life, attitudes toward life-sustaining measures and physician-assisted suicide, and caregiver burden. The study aims to recruit 500 participants from nationwide ALS centres in order to draw comprehensive conclusions for Germany. A total of 29 centres, mostly acquired via the clinical and scientific German Network for Motor Neuron Diseases (MND-NET), will take part in the project, 25 of which have already started recruitment. PERSPECTIVE It is intended to provide data-based starting points on how current practice of care in Germany is perceived pwALS and their caregivers and how it can be improved according to their needs. Planning and initiation of the study has been completed. TRIAL REGISTRATION The study is registered at ClinicalTrails.gov; NCT06418646.
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Affiliation(s)
- Katharina Linse
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
- German Center for Neurodegenerative Diseases Dresden, Tatzberg 41, 01307, Dresden, Germany.
| | - Constanze Weber
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Peter Reilich
- Department of Neurology with Friedrich-Baur-Institute, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, München, Germany
| | - Florian Schöberl
- Department of Neurology with Friedrich-Baur-Institute, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, München, Germany
| | - Matthias Boentert
- University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- Department of Medicine, UKM-Marienhospital Steinfurt, Mauritiusstr. 5, 48565, Steinfurt, Germany
| | - Susanne Petri
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | | | - Andreas Posa
- University Hospital Halle, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Markus Otto
- University Hospital Halle, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Joachim Wolf
- Deaconess Hospital Mannheim, Speyerer Strasse 91-93, 68163, Mannheim, Germany
| | - Daniel Zeller
- University Hospital Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany
| | - Robert Brunkhorst
- University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Jan Koch
- University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Andreas Hermann
- University Medical Center Rostock, Translational Neurodegeneration Section "Albrecht Kossel", Gehlsheimer Strasse 20, 18147, Rostock, Germany
- German Center for Neurodegenerative Diseases Rostock/Greifswald, Gehlsheimer Strasse 20, 18147, Rostock, Germany
| | | | - Carsten Schröter
- Hospital Hoher Meißner, Hardtstrasse 36, 37242, Bad Sooden-Allendorf, Germany
| | - Martin Groß
- Evangelic Hospital Oldenburg, Steinweg 13-17, 26122, Oldenburg, Germany
| | - Paul Lingor
- Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- German Center for Neurodegenerative Diseases Munich, Feodor-Lynen-Strasse 17, 81377, Munich, Germany
| | - Gerrit Machetanz
- Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Luisa Semmler
- Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Johannes Dorst
- University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Dorothée Lulé
- University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert Ludolph
- University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Thomas Meyer
- Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - André Maier
- Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Metelmann
- University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | | | - Jürgen Winkler
- University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Berthold Schrank
- DKD Helios Clinic Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany
| | - Zacharias Kohl
- University Hospital Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Tim Hagenacker
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Svenja Brakemeier
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ute Weyen
- BG University Hospital Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Lorenzl
- Hospital Agatharied, Norbert-Kerkel-Platz, 83734, Hausham, Germany
- Institute of Palliative Care and Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, München, Germany
| | - Sarah Bublitz
- Hospital Agatharied, Norbert-Kerkel-Platz, 83734, Hausham, Germany
- Institute of Palliative Care and Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
| | - Patrick Weydt
- University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Torsten Grehl
- Alfried-Krupp-Hospital Essen, Alfried-Krupp-Strasse 21, 45131, Essen, Germany
| | | | - Hanna-Sophie Lapp
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Maren Freigang
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Maximilian Vidovic
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Elisa Aust
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - René Günther
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
- German Center for Neurodegenerative Diseases Dresden, Tatzberg 41, 01307, Dresden, Germany.
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5
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Imrell S, Fang F, Ingre C, Sennfält S. Increased incidence of motor neuron disease in Sweden: a population-based study during 2002-2021. J Neurol 2024; 271:2730-2735. [PMID: 38386047 PMCID: PMC11055737 DOI: 10.1007/s00415-024-12219-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Motor neuron diseases (MND), with amyotrophic lateral sclerosis constituting most cases, are rare conditions of unknown etiology. There have been reports of an increase in incidence during the latter half of the twentieth century in various Western countries, including Sweden. This study provides updated data on the incidence of MND in Sweden during the last 20 years. METHODS Data was obtained from the Swedish National Patient Register on individuals diagnosed with MND from 2002 to 2021 and analysed in relation to group level data for the entire Swedish population. Incidence rates were calculated and presented in relation to year, age, sex, and region. RESULTS In the early 2000s, there was a crude incidence rate of 3.5-3.7 per 100,000 person-years, which then increased to 4.0-4.6 from 2008 onward. Age standardization to the starting year (2002) partially mitigated this increase. The incidence rate was greater among men compared to women and was highest within the age range of 70 to 84 years. There were indications of a higher incidence rate in the northernmost parts of the country, although the difference was not statistically significant. CONCLUSIONS The incidence rate of MND in Sweden now seems to have surpassed 4 cases per 100,000 person-years. This is higher when compared to both other European countries and previous Swedish studies. It remains to be determined if this increase reflects an actual increasing incidence of MND in Sweden or is due to other factors such as better registry coverage.
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Affiliation(s)
- Sofia Imrell
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Caroline Ingre
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Sennfält
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Gebrehiwet P, Brekke J, Rudnicki SA, Mellor J, Wright J, Earl L, Ball N, Iqbal H, Thomas O, Castellano G. Time from amyotrophic lateral sclerosis symptom onset to key disease milestones: analysis of data from a multinational cross-sectional survey. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:345-357. [PMID: 38156828 DOI: 10.1080/21678421.2023.2297795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To determine the average time from Amyotrophic Lateral Sclerosis (ALS) symptom onset to 11 pre-defined milestones, overall and according to ALS progression rate and geographic location. METHODS Data were drawn from the Adelphi Real World ALS Disease-Specific ProgrammeTM, a point-in-time survey of neurologists caring for people living with ALS (pALS) conducted in France, Germany, Italy, Spain, the United Kingdom and the United States from 2020-2021. ALS progression rate was calculated using time since symptom onset and ALS Functional Rating Scale Revised score. RESULTS Survey results were available for N = 1003 pALS (progression rate for N = 867). Mean time from symptom onset was 3.8 months to first consultation, 8.0 months to diagnosis, 16.2 months to employment change (part-time/sick leave/retirement/unemployment), 17.5 months to use of a walking aid, 18.5 months to first occurrence of caregiver support, 22.8 months to use of a wheelchair, 24.6 months to use of a communication aid, 27.3 months to use of a respiratory aid, 28.6 months to use of gastrostomy feeding, 29.7 months to use of eye gaze technology and 30.3 months to entering a care facility. Multivariate analysis indicated significant effects of fast (versus slow) progression rate on time to reach all 11 milestones, as well as US (versus European) location, age, body mass index and bulbar onset (versus other) on time to reach milestones. CONCLUSIONS pALS rapidly reached clinical and disease-related milestones within 30 months from symptom onset. Milestones were reached significantly faster by pALS with fast versus slow progression. Geographic differences were observed.
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Affiliation(s)
- Paulos Gebrehiwet
- Health Economics and Outcomes Research, Cytokinetics, Incorporated ,South San Francisco, CA, USA
| | - Johan Brekke
- Medical Affairs, Cytokinetics, Incorporated, South San Francisco, CA, USA
| | - Stacy A Rudnicki
- Clinical Research, Cytokinetics, Incorporated, South San Francisco, CA, USA and
| | | | - Jack Wright
- Real World Evidence, Adelphi Real World, Bollington, UK
| | - Lucy Earl
- Real World Evidence, Adelphi Real World, Bollington, UK
| | - Nathan Ball
- Real World Evidence, Adelphi Real World, Bollington, UK
| | - Halima Iqbal
- Real World Evidence, Adelphi Real World, Bollington, UK
| | - Owen Thomas
- Real World Evidence, Adelphi Real World, Bollington, UK
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7
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Finsel J, Rosenbohm A, Peter RS, Bäzner H, Börtlein A, Dempewolf S, Schabet M, Hecht M, Kohler A, Opherk C, Nägele A, Sommer N, Lindner A, Rothenbacher D, Ludolph AC, Nagel G, Lulé DE. Coping as a resource to allow for psychosocial adjustment in fatal disease: results from patients with amyotrophic lateral sclerosis. Front Psychol 2024; 15:1361767. [PMID: 38638511 PMCID: PMC11024296 DOI: 10.3389/fpsyg.2024.1361767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal disorder, which imposes a severe emotional burden on patients. Appropriate coping mechanisms may alleviate this burden and facilitate wellbeing, with social support known to be a successful coping strategy. This observational study aimed to determine the interplay of general coping traits of hope for success and fear of failure, coping behavior of social activity, and patients' wellbeing. Methods In this cross-sectional study, patients with ALS from a clinical-epidemiological registry in Southwestern Germany were interviewed regarding coping traits (achievement-motivated behavior: hope for success and fear of failure), coping behavior of social activity, and psychosocial adjustment, determined using measures of depressiveness, anxiety [both measured by Hospital Anxiety and Depression Scale (HADS)], and quality of life [Anamnestic Comparative Self-Assessment (ACSA)]. Demographics, clinical [ALS Functional Rating Scale revised version (ALSFRS-R)], and survival data were recorded. Results A total of 868 patients [60.70% male patients, mean age: 64.70 (±10.83) years, mean ALSFRS-R: 37.36 ± 7.07] were interviewed. Anxiety in patients was found to be associated with a high fear of failure. In contrast, a generally positive attitude in patients exemplified in high hopes for success was associated with better wellbeing. Finally, coping behavior of social activity explained up to 65% of the variance of depressiveness among the patients with ALS. Conclusion In this study, we present evidence that the wellbeing of patients with ALS is not an immediate fatalistic consequence of physical degradation but rather determined by coping traits and behavior, which may be trained to substantially increase the wellbeing of patients with ALS.
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Affiliation(s)
- Julia Finsel
- Department of Neurology, Ulm University, Ulm, Germany
| | | | - Raphael S. Peter
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Hansjörg Bäzner
- Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Axel Börtlein
- Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Silke Dempewolf
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Schabet
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Hecht
- Department of Neurology, Klinikum Kaufbeuren, Kliniken Oberallgäu-Kaufbeuren, Kaufbeuren, Germany
| | - Andreas Kohler
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Christian Opherk
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Andrea Nägele
- Department of Neurology, Christophsbad Göppingen, Göppingen, Germany
| | - Norbert Sommer
- Department of Neurology, Christophsbad Göppingen, Göppingen, Germany
| | - Alfred Lindner
- Department of Neurology, Marienhospital Stuttgart, Stuttgart, Germany
| | | | - Albert C. Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm Site, Ulm, Germany
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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8
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Reilich P. [Multidimensional care for people with ALS and their families]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:70-71. [PMID: 38490215 DOI: 10.1055/a-2240-8802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Liebe Leserin, lieber Leser,wie Sie vermutlich im klinischen Alltag immer wieder erleben, stellt die Amyotrophe
Lateralsklerose (ALS) besondere Anforderungen an eine optimale Versorgung der
Betroffenen. Das Informationslevel der Hilfesuchenden ist meist hoch, ebenso die
Erwartungen an ein neues „Wundermedikament“, das in Meldungen der Medien immer
wieder in Aussicht gestellt wird.
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9
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Wiesenfarth M, Dorst J, Brenner D, Elmas Z, Parlak Ö, Uzelac Z, Kandler K, Mayer K, Weiland U, Herrmann C, Schuster J, Freischmidt A, Müller K, Siebert R, Bachhuber F, Simak T, Günther K, Fröhlich E, Knehr A, Regensburger M, German A, Petri S, Grosskreutz J, Klopstock T, Reilich P, Schöberl F, Hagenacker T, Weyen U, Günther R, Vidovic M, Jentsch M, Haarmeier T, Weydt P, Valkadinov I, Hesebeck-Brinckmann J, Conrad J, Weishaupt JH, Schumann P, Körtvélyessy P, Meyer T, Ruf WP, Witzel S, Senel M, Tumani H, Ludolph AC. Effects of tofersen treatment in patients with SOD1-ALS in a "real-world" setting - a 12-month multicenter cohort study from the German early access program. EClinicalMedicine 2024; 69:102495. [PMID: 38384337 PMCID: PMC10878861 DOI: 10.1016/j.eclinm.2024.102495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/16/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
Background In April 2023, the antisense oligonucleotide tofersen was approved by the U.S. Food and Drug Administration (FDA) for treatment of SOD1-amyotrophic lateral sclerosis (ALS), after a decrease of neurofilament light chain (NfL) levels had been demonstrated. Methods Between 03/2022 and 04/2023, 24 patients with SOD1-ALS from ten German ALS reference centers were followed-up until the cut-off date for ALS functional rating scale revised (ALSFRS-R), progression rate (loss of ALSFRS-R/month), NfL, phosphorylated neurofilament heavy chain (pNfH) in cerebrospinal fluid (CSF), and adverse events. Findings During the observation period, median ALSFRS-R decreased from 38.0 (IQR 32.0-42.0) to 35.0 (IQR 29.0-42.0), corresponding to a median progression rate of 0.11 (IQR -0.09 to 0.32) points of ALSFRS-R lost per month. Median serum NfL declined from 78.0 pg/ml (IQR 37.0-147.0 pg/ml; n = 23) to 36.0 pg/ml (IQR 22.0-65.0 pg/ml; n = 23; p = 0.02), median pNfH in CSF from 2226 pg/ml (IQR 1061-6138 pg/ml; n = 18) to 1151 pg/ml (IQR 521-2360 pg/ml; n = 18; p = 0.02). In the CSF, we detected a pleocytosis in 73% of patients (11 of 15) and an intrathecal immunoglobulin synthesis (IgG, IgM, or IgA) in 9 out of 10 patients. Two drug-related serious adverse events were reported. Interpretation Consistent with the VALOR study and its Open Label Extension (OLE), our results confirm a reduction of NfL serum levels, and moreover show a reduction of pNfH in CSF. The therapy was safe, as no persistent symptoms were observed. Pleocytosis and Ig synthesis in CSF with clinical symptoms related to myeloradiculitis in two patients, indicate the potential of an autoimmune reaction. Funding No funding was received towards this study.
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Affiliation(s)
| | - Johannes Dorst
- Department of Neurology, Ulm University, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
| | - David Brenner
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | - Zeynep Elmas
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | - Özlem Parlak
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | - Zeljko Uzelac
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | | | - Kristina Mayer
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | - Ulrike Weiland
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | | | - Joachim Schuster
- Department of Neurology, Ulm University, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
| | | | - Kathrin Müller
- Department of Neurology, Ulm University, 89081, Ulm, Germany
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, 89081, Ulm, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, 89081, Ulm, Germany
| | | | - Tatiana Simak
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | | | - Elke Fröhlich
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | - Antje Knehr
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), University Hospital Erlangen, 91054, Erlangen, Germany
| | - Alexander German
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Julian Grosskreutz
- Precision Neurology of Neuromuscular and Motoneuron Diseases, University of Lübeck, 23538, Lübeck, Germany
| | - Thomas Klopstock
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, 80336, München, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Munich, 81377, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377, Munich, Germany
| | - Peter Reilich
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Florian Schöberl
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Tim Hagenacker
- Department of Neurology and Center for Translational Neuro and Behavioral Sciences (C-TNBS), University Hospital Essen, 45127, Essen, Germany
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, 44789, Bochum, Germany
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE) Site Dresden, 01307, Dresden, Germany
| | - Maximilian Vidovic
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Martin Jentsch
- Department of Neurology, Helios Klinikum Krefeld, 47805, Krefeld, Germany
| | - Thomas Haarmeier
- Department of Neurology, Helios Klinikum Krefeld, 47805, Krefeld, Germany
| | - Patrick Weydt
- Department for Neurodegenerative Disorders and Gerontopsychiatry, Bonn University, 53127, Bonn, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Bonn, 53127, Bonn, Germany
| | - Ivan Valkadinov
- Division for Neurodegenerative Diseases, Neurology Department, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Jasper Hesebeck-Brinckmann
- Division for Neurodegenerative Diseases, Neurology Department, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Julian Conrad
- Division for Neurodegenerative Diseases, Neurology Department, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Jochen Hans Weishaupt
- Division for Neurodegenerative Diseases, Neurology Department, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Peggy Schumann
- Ambulanzpartner Soziotechnologie GmbH, 13353, Berlin, Germany
| | - Peter Körtvélyessy
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Magdeburg, 39120, Magdeburg, Germany
| | - Thomas Meyer
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
| | | | - Simon Witzel
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | - Makbule Senel
- Department of Neurology, Ulm University, 89081, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, Ulm University, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
| | - Albert Christian Ludolph
- Department of Neurology, Ulm University, 89081, Ulm, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Site Ulm, 89081, Ulm, Germany
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10
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Thomas A, Garg D, Srivastava AK, Kumar A, Pandit AK, Vibha D, Vivekanandhan S, Shukla G, Prasad K. Clinical factors and vascular endothelial growth factor as determinants of disease progression in Indian patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:46-52. [PMID: 37710422 DOI: 10.1080/21678421.2023.2256362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder. Prognostication remains sub-optimally defined. We aimed to assess clinical determinants of disease progression rates in Indian patients with ALS and to assess the role of vascular endothelial growth factor (VEGF) in disease progression. METHODS In this cross-sectional study, consecutive patients with clinically definite/probable ALS according to the revised El Escorial criteria and controls were included. Patients were classified into fast or slow progressors based on disease progression rate (DPR). Serum and CSF VEGF level was assessed for patients and controls. RESULTS Of 142 patients recruited, 93 (65.5%) were male. Mean age at enrollment was 49.37 ± 12.65 years. Mean duration of symptoms was 20.53 ± 20.88 months. Mean DPR was 1.14 ± 0.94. Based on DPR, 81 (57%) patients were slow progressors and 61 (43%) were fast progressors. Univariate analysis demonstrated a statistically significant association of DPR with age at onset, symptom duration, time to spread, wasting of small muscles of the hand, frontal release signs, and neurophysiologic bulbar abnormalities. On multivariate analysis, age at onset and symptom duration had a significant association with disease progression. The CSF VEGF levels of ALS patients (46.18 ± 27.8) were significantly elevated compared to controls (25.95 ± 25.64 pg/ml) (p = 0.001), but not serum VEGF. CONCLUSION Age at symptom onset and duration of disease had a significant impact on disease progression in Indian patients with ALS. CSF VEGF levels were significantly elevated in ALS compared to controls, indicating the role of CSF VEGF as a potential biomarker.
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Affiliation(s)
- Aneesha Thomas
- Department of Neurology, All India Institute of Medicine Sciences, New Delhi, India and
| | - Divyani Garg
- Department of Neurology, All India Institute of Medicine Sciences, New Delhi, India and
| | | | - Amit Kumar
- Department of Neurology, All India Institute of Medicine Sciences, New Delhi, India and
| | - Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medicine Sciences, New Delhi, India and
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medicine Sciences, New Delhi, India and
| | - Subbiah Vivekanandhan
- Department of Neurochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Shukla
- Department of Neurology, All India Institute of Medicine Sciences, New Delhi, India and
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medicine Sciences, New Delhi, India and
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11
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Nagel G, Kurz D, Peter RS, Rosenbohm A, Koenig W, Dupuis L, Bäzner H, Börtlein A, Dempewolf S, Schabet M, Hecht M, Kohler A, Opherk C, Naegele A, Sommer N, Lindner A, Tumani H, Ludolph AC, Rothenbacher D. Cystatin C based estimation of chronic kidney disease and amyotrophic lateral sclerosis in the ALS registry Swabia: associated risk and prognostic value. Sci Rep 2023; 13:19594. [PMID: 37949878 PMCID: PMC10638424 DOI: 10.1038/s41598-023-46179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
Kidney function as part of metabolic changes could be associated with amyotrophic lateral-sclerosis (ALS). We investigated the associations between estimated chronic kidney disease (CKD), based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) cystatin C equation, and the risk at onset and prognostic value of CKD for ALS. Between October 2010 and June 2014, 362 ALS cases (59.4% men, mean age 65.7 years) and 681 controls (59.5% men, means age 66.3 years) were included in a population-based case-control study based on the ALS registry Swabia in Southern Germany. All ALS cases were followed-up (median 89.7 months), 317 died. Serum samples were measured for cystatin C to estimate the glomerular filtration rate (eGFR) according to the CKD-EPI equation. Information on covariates were assessed by an interview-based standardized questionnaire. Conditional logistic regression models were applied to calculate odds ratios (OR) for risk of ALS associated with eGFR/CKD stages. Time-to-death associated with renal parameters at baseline was assessed in ALS cases only. ALS cases were characterized by lower body mass index, slightly lower smoking prevalence, more intense occupational work and lower education than controls. Median serum cystatin-C based eGFR concentrations were lower in ALS cases than in controls (54.0 vs. 59.5 mL/min pro 1.73 m2). The prevalence of CKD stage ≥ 3 was slightly higher in ALS cases than in controls (14.1 vs. 11.0%). In the adjusted models, CKD stage 2 (OR 1.82, 95% CI 1.32, 2.52) and stage 3 (OR 2.34, 95% CI 1.38, 3.96) were associated with increased ALS risk. In this cohort of ALS cases, eGFR and CKD stage ≥ 3 (HR 0.94; 95% CI 0.64, 1.38) were not associated with prognosis. In this case-control study, higher CKD stages were associated with increased ALS risk, while in the prospective cohort of ALS cases, no indication of an association of CysC-based CKD on mortality was seen. In addition, our work strengthens the importance to evaluate renal function using a marker independent of muscle mass in ALS patients.
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Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - Deborah Kurz
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | | | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Luc Dupuis
- Université de Strasbourg, Inserm, UMR-S1118, Centre de Recherches en Biomédecine de Strasbourg, Strasbourg, France
| | - Hansjörg Bäzner
- Department of Neurology, Klinikum Stuttgart, Stuttgart, Germany
| | - Axel Börtlein
- Department of Neurology, Klinikum Stuttgart, Stuttgart, Germany
| | - Silke Dempewolf
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Schabet
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Hecht
- Department of Neurology, Klinikum Kaufbeuren, Kliniken Ostallgäu Kaufbeuren, Kaufbeuren, Germany
| | - Andreas Kohler
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Christian Opherk
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Andrea Naegele
- Department of Neurology, Christophsbad Goeppingen, Goeppingen, Germany
| | - Norbert Sommer
- Department of Neurology, Christophsbad Goeppingen, Goeppingen, Germany
| | - Alfred Lindner
- Department of Neurology, Marienhospital Stuttgart, Stuttgart, Germany
| | | | - Albert C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE), Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
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12
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Heinrich F, Cordts I, Günther R, Stolte B, Zeller D, Schröter C, Weyen U, Regensburger M, Wolf J, Schneider I, Hermann A, Metelmann M, Kohl Z, Linker RA, Koch JC, Radelfahr F, Schönfelder E, Gardt P, Mohajer-Peseschkian T, Osmanovic A, Klopstock T, Dorst J, Ludolph AC, Schöffski O, Boentert M, Hagenacker T, Deschauer M, Lingor P, Petri S, Schreiber-Katz O. Economic evaluation of Motor Neuron Diseases: a nationwide cross-sectional analysis in Germany. J Neurol 2023; 270:4922-4938. [PMID: 37356024 PMCID: PMC10511618 DOI: 10.1007/s00415-023-11811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Motor Neuron Diseases (MND) are rare diseases but have a high impact on affected individuals and society. This study aims to perform an economic evaluation of MND in Germany. METHODS Primary patient-reported data were collected including individual impairment, the use of medical and non-medical resources, and self-rated Health-Related Quality of Life (HRQoL). Annual socio-economic costs per year as well as Quality-Adjusted Life Years (QALYs) were calculated. RESULTS 404 patients with a diagnosis of Amyotrophic Lateral Sclerosis (ALS), Spinal Muscular Atrophy (SMA) or Hereditary Spastic Paraplegia (HSP) were enrolled. Total annual costs per patient were estimated at 83,060€ in ALS, 206,856€ in SMA and 27,074€ in HSP. The main cost drivers were informal care (all MND) and disease-modifying treatments (SMA). Self-reported HRQoL was best in patients with HSP (mean EuroQoL Five Dimension Five Level (EQ-5D-5L) index value 0.67) and lowest in SMA patients (mean EQ-5D-5L index value 0.39). QALYs for patients with ALS were estimated to be 1.89 QALYs, 23.08 for patients with HSP and 14.97 for patients with SMA, respectively. Cost-utilities were estimated as follows: 138,960€/QALY for ALS, 525,033€/QALY for SMA, and 49,573€/QALY for HSP. The main predictors of the high cost of illness and low HRQoL were disease progression and loss of individual autonomy. CONCLUSION As loss of individual autonomy was the main cost predictor, therapeutic and supportive measures to maintain this autonomy may contribute to reducing high personal burden and also long-term costs, e.g., care dependency and absenteeism from work.
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Affiliation(s)
- Felix Heinrich
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Isabell Cordts
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Benjamin Stolte
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Carsten Schröter
- Hoher Meißner Clinic, Neurology, 37242 Bad Sooden-Allendorf, Germany
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, 44789 Bochum, Germany
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Center for Rare Diseases Erlangen (ZSEER), University Hospital Erlangen, 91054 Erlangen, Germany
| | - Joachim Wolf
- Department of Neurology, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany
| | - Ilka Schneider
- Department of Neurology, Martin-Luther University Halle/Saale, 06120 Halle, Germany
- Department of Neurology, Klinikum Sankt Georg, 04129 Leipzig, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
- German Center for Neurodegenerative Diseases Rostock/Greifswald, 18147 Rostock, Germany
| | - Moritz Metelmann
- Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Zacharias Kohl
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - Ralf A. Linker
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, 37075 Göttingen, Germany
| | - Florentine Radelfahr
- Friedrich-Baur-Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany
| | - Erik Schönfelder
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Pavel Gardt
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Tara Mohajer-Peseschkian
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
- Essener Zentrum Für Seltene Erkrankungen (EZSE), Universitätsmedizin Essen, University Hospital Essen, Essen, Germany
| | - Thomas Klopstock
- Friedrich-Baur-Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Oliver Schöffski
- Chair of Health Management, School of Business, Economics and Society, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, 90403 Nuremberg, Germany
| | - Matthias Boentert
- Department of Neurology with the Institute of Translational Neurology, University Hospital Münster, 48149 Münster, Germany
- Department of Medicine, UKM Marienhospital, 48565 Steinfurt, Germany
| | - Tim Hagenacker
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany
| | - Marcus Deschauer
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
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13
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Alves I, Gromicho M, Oliveira Santos M, Pinto S, Pronto-Laborinho A, Swash M, de Carvalho M. Demographic changes in a large motor neuron disease cohort in Portugal: a 27 year experience. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-11. [PMID: 37295966 DOI: 10.1080/21678421.2023.2220747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
Objective: Motor Neuron Diseases (MND) have a large clinical spectrum, being the most common amyotrophic lateral sclerosis (ALS) but there is significant clinical heterogeneity. Our goal was to investigate this heterogeneity and any potential changes during a long period. Methods: We performed a retrospective cohort study among a large Portuguese cohort of MND patients (n = 1550) and investigated changing patterns in clinical and demographic characteristics over the 27-year period of our database. With that aim, patients were divided into three 9-year groups according to the date of their first visit to our unit: P1, 1994-2002; P2, 2003-2011; P3, 2012-2020. Results: The overall cohort's clinical and demographic characteristics are consistent with clinical experience, but our findings point to gradual changes over time. Time pattern analysis revealed statistically significant differences in the distribution of clinical phenotypes, the average age of onset, diagnostic delay, the proportin of patients using respiratory support with noninvasive ventilation (NIV), time to NIV, and survival. Across time, in the overall cohort, we found an increasing age at onset (p = 0.029), a decrease of two months in diagnostic delay (p < 0.001) and a higher relative frequency of progressive muscular atrophy patients. For ALS patients with spinal onset, from P1 to P2, there was a more widespread (54.8% vs 69.4%, p = 0.005) and earlier (36.9 vs 27.2 months, p = 0.05) use of NIV and a noteworthy 13-month increase in median survival (p = 0.041). Conclusions: Our results probably reflect better comprehensive care, and they are relevant for future studies exploring the impact of new treatments on ALS patients.
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Affiliation(s)
- Inês Alves
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Marta Gromicho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Oliveira Santos
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal, and
| | - Susana Pinto
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Pronto-Laborinho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Michael Swash
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Mamede de Carvalho
- Centro de Estudos Egas Moniz, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa-Norte, Lisboa, Portugal, and
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Tzeplaeff L, Wilfling S, Requardt MV, Herdick M. Current State and Future Directions in the Therapy of ALS. Cells 2023; 12:1523. [PMID: 37296644 PMCID: PMC10252394 DOI: 10.3390/cells12111523] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder affecting upper and lower motor neurons, with death resulting mainly from respiratory failure three to five years after symptom onset. As the exact underlying causative pathological pathway is unclear and potentially diverse, finding a suitable therapy to slow down or possibly stop disease progression remains challenging. Varying by country Riluzole, Edaravone, and Sodium phenylbutyrate/Taurursodiol are the only drugs currently approved in ALS treatment for their moderate effect on disease progression. Even though curative treatment options, able to prevent or stop disease progression, are still unknown, recent breakthroughs, especially in the field of targeting genetic disease forms, raise hope for improved care and therapy for ALS patients. In this review, we aim to summarize the current state of ALS therapy, including medication as well as supportive therapy, and discuss the ongoing developments and prospects in the field. Furthermore, we highlight the rationale behind the intense research on biomarkers and genetic testing as a feasible way to improve the classification of ALS patients towards personalized medicine.
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Affiliation(s)
- Laura Tzeplaeff
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, 81675 München, Germany
| | - Sibylle Wilfling
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany;
- Center for Human Genetics Regensburg, 93059 Regensburg, Germany
| | - Maria Viktoria Requardt
- Formerly: Department of Neurology with Institute of Translational Neurology, Münster University Hospital (UKM), 48149 Münster, Germany;
| | - Meret Herdick
- Precision Neurology, University of Lübeck, 23562 Luebeck, Germany
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15
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Gangfuß A, Kohl Z. [Amyotrophic lateral sclerosis-Motor neuron disease with a wide clinical and genetic spectrum]. DER NERVENARZT 2023:10.1007/s00115-023-01479-3. [PMID: 37121991 DOI: 10.1007/s00115-023-01479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is the most frequent motor neuron disease. Besides a timely diagnosis, precise knowledge of the clinical manifestations and differential diagnoses is essential. While most patients develop the disease at an older age, hereditary causes play a more frequent role in the juvenile forms. OBJECTIVE What is the current state of ALS diagnostics, which new treatment options exist? MATERIAL AND METHOD Literature search using Pubmed.gov. RESULTS The main focus is on an individualized symptomatic treatment as no curative treatment approaches exist. However, new insights into the genetic and pathophysiological principles of the different forms of ALS open the way for future disease-modifying treatment options. CONCLUSION In cases of a clinical suspicion of ALS molecular genetic diagnostics should be considered, particularly in juvenile and young adult patients, to exclude differential diagnoses and to enable patients access to new treatment approaches.
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Affiliation(s)
- Andrea Gangfuß
- Abteilung für Pädiatrische Neurologie, Zentrum für Neuromuskuläre Erkrankungen, Zentrum für Translationale Neuro- und Verhaltenswissenschaften, Universität Duisburg-Essen, Essen, Deutschland
| | - Zacharias Kohl
- Spezialambulanz Bewegungsstörungen und Motoneuronerkrankungen, Klinik und Poliklinik für Neurologie, Universität Regensburg, Regensburg, Deutschland.
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16
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Herrmann C, Dorst J. Differenzialdiagnose der Amyotrophen Lateralsklerose in der
klinischen Praxis. KLIN NEUROPHYSIOL 2023. [DOI: 10.1055/a-2012-2736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
ZusammenfassungDie Diagnose der Amyotrophen Lateralsklerose (ALS) beruht vorwiegend auf
klinischen Kriterien und kann aufgrund des heterogenen Erscheinungsbildes gerade
in frühen Krankheitsstadien mitunter schwierig sein. Wegweisend sind der
Nachweis einer kombinierten Pathologie des oberen und unteren Motoneurons, der
fokale Onset, das Ausbreitungsmuster (Spreading), das typische Verteilungsmuster
der Paresen, das Vorhandensein oder Fehlen nicht-motorischer Zusatzsymptome
sowie Art und Geschwindigkeit der Krankheitsprogredienz. Dieser Review stellt
Charakteristika der ALS sowohl im Hinblick auf die klinische Untersuchung als
auch apparativer Zusatzdiagnostik in Abgrenzung zu den wichtigsten
Differenzialdiagnosen in Form von Einschlusskörperchenmyositis,
Chronisch Inflammatorischer Demyelinisierender Polyneuropathie (CIDP),
Mulifokaler Motorischer Neuropathie (MMN), adulter Form der Spinalen
Muskelatrophie (SMA), Kennedy-Syndrom und Hereditärer Spastischer
Paralyse (HSP) dar.
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17
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MEHTA PAUL, RAYMOND JAIME, PUNJANI RESHMA, HAN MOON, LARSON THEODORE, KAYE WENDY, NELSON LORENEM, TOPOL BARBARA, MURAVOV OLEG, GENSON CORINA, HORTON DKEVIN. Prevalence of amyotrophic lateral sclerosis in the United States using established and novel methodologies, 2017. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:108-116. [PMID: 35422180 PMCID: PMC9568617 DOI: 10.1080/21678421.2022.2059380] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective:To estimate the prevalence of amyotrophic lateral sclerosis (ALS) in the United States for 2017 using data from the National ALS Registry (Registry) as well as capture-recapture methodology to account for under-ascertainment. Established in 2010, the Registry collects and examines data on ALS patients in the US to better describe the epidemiology of ALS (i.e. risk factor exposures, demographics).Methods: The Registry compiled data from national administrative databases (from the Centers for Medicare and Medicaid Services, the Veterans Health Administration, and the Veterans Benefits Administration) and a voluntary enrollment data through a web portal (www.cdc.gov/als). To estimate the number of missing cases, capture-recapture methodology was utilized.Results: The Registry conservatively identified 17,800 adult persons (lower-bound estimate) who met the Registry definition of ALS for an age-adjusted prevalence of 5.5 per 100,000 US population. Using capture-recapture methodology, we obtained a "mean case count" of 24,821 ALS cases (prevalence of 7.7 per 100,000 U.S. population) and estimated the upper-bound estimate to be 31,843 cases (prevalence of 9.9 per 100,000 U.S. population). The pattern of patient characteristics (e.g. age, sex, and race/ethnicity) remained unchanged from previous Registry reports. Overall, ALS was most common among whites, males, and persons aged 60-69 years. The age groups with the lowest number of cases were persons aged 18-39 years. Males had a higher prevalence than females overall and across all data sources.Conclusions: Existing Registry methodology, along with capture-recapture methodology, are being used to better describe the epidemiology and demographics of ALS in the US.
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Affiliation(s)
- PAUL MEHTA
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - JAIME RAYMOND
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - RESHMA PUNJANI
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - MOON HAN
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - THEODORE LARSON
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - WENDY KAYE
- McKing Consulting Corporation, Atlanta, GA, USA
| | - LORENE M. NELSON
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - BARBARA TOPOL
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - OLEG MURAVOV
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - CORINA GENSON
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - D. KEVIN HORTON
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
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18
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Falcão de Campos C, Gromicho M, Uysal H, Grosskreutz J, Kuzma-Kozakiewicz M, Oliveira Santos M, Pinto S, Petri S, Swash M, de Carvalho M. Trends in the diagnostic delay and pathway for amyotrophic lateral sclerosis patients across different countries. Front Neurol 2023; 13:1064619. [PMID: 36733448 PMCID: PMC9886675 DOI: 10.3389/fneur.2022.1064619] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disease with a median survival of 2-5 years. An early diagnosis is essential for providing ALS patients the finest management possible. Studies from different countries report a similar median diagnostic delay of around 12 months, which is still far from desirable. We analyzed the diagnostic pathway in different countries in order to identify the major challenges. Methods We studied a cohort of 1,405 ALS patients from five different centers, in four different countries (Turkey, Germany, Poland, and Portugal), which collaborated in a common database. Demographic, disease and sociocultural factors were collected. Time from first symptom onset to first medical evaluation and to diagnosis, the specialist assessment and investigations requested were analyzed. Factors contributing to diagnostic delay were evaluated by multivariate linear regression. Results The median diagnostic delay from first symptom onset was 11 months and was similar between centers. Major differences were seen in the time from symptom onset to first medical evaluation. An earlier first medical evaluation was associated with a longer time to diagnosis, highlighting that ALS diagnosis is not straightforward in the early stages of the disease. The odds for ALS diagnosis were superior when evaluated by a neurologist and increased over time. Electromyography was decisive in establishing the diagnosis. Conclusions We suggest that a specific diagnostic test for ALS-a specific biomarker-will be needed to achieve early diagnosis. Early referral to a neurologist and to electromyography is important for early ALS diagnosis.
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Affiliation(s)
- Catarina Falcão de Campos
- Instituto de Fisiologia, Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal,Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa-Norte, Lisbon, Portugal,*Correspondence: Catarina Falcão de Campos ✉
| | - Marta Gromicho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Hilmi Uysal
- Department of Neurology and Clinical Neurophysiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Miguel Oliveira Santos
- Instituto de Fisiologia, Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal,Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa-Norte, Lisbon, Portugal
| | - Susana Pinto
- Instituto de Fisiologia, Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal,Department of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal,Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa-Norte, Lisbon, Portugal
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19
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A new method for estimating under-recruitment of a patient registry: a case study with the Ohio Registry of Amyotrophic Lateral Sclerosis. Sci Rep 2022; 12:14721. [PMID: 36042373 PMCID: PMC9428141 DOI: 10.1038/s41598-022-18944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 12/04/2022] Open
Abstract
We developed a disease registry to collect all incident amyotrophic lateral sclerosis (ALS) cases diagnosed during 2016–2018 in Ohio. Due to incomplete case ascertainment and limitations of the traditional capture-recapture method, we proposed a new method to estimate the number of cases not recruited by the Registry and their spatial distribution. Specifically, we employed three statistical methods to identify reference counties with normal case-population relationships to build a Poisson regression model for estimating case counts in target counties that potentially have unrecruited cases. Then, we conducted spatial smoothing to adjust outliers locally. We validated the estimates with ALS mortality data. We estimated that 119 total cases (95% CI [109, 130]) were not recruited, including 36 females (95% CI [31, 41]) and 83 males (95% CI [74, 99]), and were distributed unevenly across the state. For target counties, including estimated unrecruited cases increased the correlation between the case count and mortality count from r = 0.8494 to 0.9585 for the total, from 0.7573 to 0.8270 for females, and from 0.6862 to 0.9292 for males. The advantage of this method in the spatial perspective makes it an alternative to capture-recapture for estimating cases missed by disease registries.
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20
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Luker J, Woodman R, Schultz D. The incidence and prevalence of motor neurone disease in South Australia. Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:195-202. [PMID: 35934980 DOI: 10.1080/21678421.2022.2108326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background: Motor neurone disease (MND) is a neurodegenerative disease that leads to significant morbidity and mortality. The Global Burden of Disease (GBD) project estimated the MND all-age global prevalence is 4.5 (95% confidence interval (CI)=4.1-5.0) per 100,000 persons and the all-age incidence of 0.78 (95% CI = 0.71-0.86) per 100,000 person-years. Whether the prevalence and incidence of MND within South Australia using registry data is in keeping with these global estimates has not been studied. Objective: To describe the prevalence and annual incidence rates (IRs) of MND in South Australia between 2017 and 2019. Methods: A retrospective cohort study calculating the point prevalence of MND on 31 December 2017, 2018 and 2019 utilizing data from the Australasian Motor Neurone Disease Registry (AMNDR). The annual IRs between 2017 and 2019 were calculated using population data reported in the 2016 Australian census and age-standardized rates utilized the world population from the United Nations Population Division's World Population Prospects. Results: A total of 256 MND patients were identified, of whom 114 were alive on 31 December 2019. Based on the 2016 population of 1,676,653 persons, the estimated prevalence was 6.79 per 100,000 persons. The crude IR for the all-age South Australian population was 3.34 per 100,000 person-years (95% CI, 2.85-3.88). The estimated annual IRs based on those ≥20 yo were 4.98 (3.84-6.35), 3.68 (2.71-4.88), and 4.21 (3.17-5.49) per 100,000 person-years for 2017, 2018, and 2019, respectively. Conclusion: The crude prevalence and incidence of MND in South Australia were considerably higher than global estimates. This may reflect higher rates of the disease or higher rates of case ascertainment compared to the GBD project.
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Affiliation(s)
- Jackson Luker
- College of Medicine and Public Health, Flinders University, Adelaide, Australia and.,Flinders Medical Centre, Bedford Park, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Adelaide, Australia and
| | - David Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia and.,Flinders Medical Centre, Bedford Park, Australia
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21
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Van Schoor E, Ospitalieri S, Moonen S, Tomé SO, Ronisz A, Ok O, Weishaupt J, Ludolph AC, Van Damme P, Van Den Bosch L, Thal DR. Increased pyroptosis activation in white matter microglia is associated with neuronal loss in ALS motor cortex. Acta Neuropathol 2022; 144:393-411. [PMID: 35867112 DOI: 10.1007/s00401-022-02466-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is characterized by the degeneration of motor neurons in the motor cortex, brainstem, and spinal cord. Although ALS is considered a motor neuron disorder, neuroinflammation also plays an important role. Recent evidence in ALS disease models indicates activation of the inflammasome and subsequent initiation of pyroptosis, an inflammatory type of cell death. In this study, we determined the expression and distribution of the inflammasome and pyroptosis effector proteins in post-mortem brain and spinal cord from ALS patients (n = 25) and controls (n = 19), as well as in symptomatic and asymptomatic TDP-43A315T transgenic and wild-type mice. Furthermore, we evaluated its correlation with the presence of TDP-43 pathological proteins and neuronal loss. Expression of the NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome, pyroptosis effector protein cleaved Gasdermin D (GSDMD), and IL-18 was detected in microglia in human ALS motor cortex and spinal cord, indicative of canonical inflammasome-triggered pyroptosis activation. The number of cleaved GSDMD-positive precentral white matter microglia was increased compared to controls and correlated with a decreased neuronal density in human ALS motor cortex. Neither of this was observed in the spinal cord. Similar results were obtained in TDP-43A315T mice, where microglial pyroptosis activation was significantly increased in the motor cortex upon symptom onset, and correlated with neuronal loss. There was no significant correlation with the presence of TDP-43 pathological proteins both in human and mouse tissue. Our findings emphasize the importance of microglial NLRP3 inflammasome-mediated pyroptosis activation for neuronal degeneration in ALS and pave the way for new therapeutic strategies counteracting motor neuron degeneration in ALS by inhibiting microglial inflammasome/pyroptosis activation.
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Affiliation(s)
- Evelien Van Schoor
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), O&N IV Herestraat 49-bus 1032, 3000, Leuven, Belgium. .,Laboratory of Neurobiology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium. .,Center for Brain & Disease Research, VIB, Leuven, Belgium.
| | - Simona Ospitalieri
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), O&N IV Herestraat 49-bus 1032, 3000, Leuven, Belgium
| | - Sebastiaan Moonen
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), O&N IV Herestraat 49-bus 1032, 3000, Leuven, Belgium.,Center for Brain & Disease Research, VIB, Leuven, Belgium.,Laboratory for the Research of Neurodegenerative Diseases, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium
| | - Sandra O Tomé
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), O&N IV Herestraat 49-bus 1032, 3000, Leuven, Belgium
| | - Alicja Ronisz
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), O&N IV Herestraat 49-bus 1032, 3000, Leuven, Belgium
| | - Orkun Ok
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), O&N IV Herestraat 49-bus 1032, 3000, Leuven, Belgium
| | - Jochen Weishaupt
- Department of Neurology, Ulm University, Ulm, Germany.,Divisions of Neurodegeneration, Department of Neurology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Ulm, Germany
| | - Philip Van Damme
- Laboratory of Neurobiology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Center for Brain & Disease Research, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Ludo Van Den Bosch
- Laboratory of Neurobiology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - Dietmar Rudolf Thal
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), O&N IV Herestraat 49-bus 1032, 3000, Leuven, Belgium. .,Department of Pathology, University Hospitals Leuven, Leuven, Belgium.
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22
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Fast Versus Slow Disease Progression in Amyotrophic Lateral Sclerosis – Clinical and Genetic Factors at the Edges of the Survival Spectrum. Neurobiol Aging 2022; 119:117-126. [DOI: 10.1016/j.neurobiolaging.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
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23
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Kandler K, Witzel S, Eder K, Rothenbacher D, Nagel G, Peter RS, Schuster J, Dorst J, Rosenbohm A, Ludolph AC. Phenotyping of the thoracic-onset variant of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:563-565. [PMID: 34667101 DOI: 10.1136/jnnp-2021-326712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Affiliation(s)
| | - Simon Witzel
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany
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24
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Halbgebauer S, Steinacker P, Verde F, Weishaupt J, Oeckl P, von Arnim C, Dorst J, Feneberg E, Mayer B, Rosenbohm A, Silani V, Ludolph AC, Otto M. Comparison of CSF and serum neurofilament light and heavy chain as differential diagnostic biomarkers for ALS. J Neurol Neurosurg Psychiatry 2022; 93:68-74. [PMID: 34417339 DOI: 10.1136/jnnp-2021-327129] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Elevated levels of neurofilament light (NfL) and heavy (NfH) chain in amyotrophic lateral sclerosis (ALS) cerebrospinal fluid (CSF) and serum reflect neuro-axonal degeneration and are used as diagnostic biomarkers. However, studies comparing the differential diagnostic potential for ALS of all four parameters are missing. Here, we measured serum NfL/NfH and CSF NfL/NfH in a large cohort of ALS and other neurological disorders and analysed the differential diagnostic potential. METHODS In total CSF and serum of 294 patients were analysed. The diagnostic groups comprised: ALS (n=75), frontotemporal lobar degeneration (FTLD) (n=33), Alzheimer's disease (n=20), Parkinson's disease (dementia) (n=18), Creutzfeldt-Jakob disease (n=11), non-neurodegenerative controls (n=77) (Con) and 60 patients who were seen under the direct differential diagnosis of a patient with ALS (Con.DD). RESULTS CSF and serum NfL and NfH showed significantly increased levels in ALS (p<0.0001) compared with Con and Con.DD. The difference between ALS and FTLD was markedly stronger for NfH than for NfL. CSF and serum NfL demonstrated a stronger correlation (r=0.84 (95% CI 0.80 to 0.87), p<0.001) than CSF and serum NfH (r=0.68 (95% CI 0.61 to 0.75), p<0.0001). Comparing ALS and Con.DD, receiver operating characteristic analysis revealed the best area under the curve (AUC) value for CSF NfL (AUC=0.94, 95% CI 0.91 to 0.98), followed by CSF NfH (0.93, 95% CI 0.88 to 0.98), serum NfL (0.93, 95% CI 0.89 to 0.97) and serum NfH (0.88, 95% CI 0.82 to 0.94). CONCLUSION Our results demonstrate that CSF NfL and NfH as well as serum NfL are equally suited for the differential diagnosis of ALS, whereas serum NfH appears to be slightly less potent.
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Affiliation(s)
| | | | - Federico Verde
- Department of Neurology - Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Jochen Weishaupt
- Department of Neurology, Institute for Neurodegeneration, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Patrick Oeckl
- Neurology, University of Ulm, Ulm, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE e.V.), Ulm, Germany
| | | | | | - Emily Feneberg
- Department of Neurology, University Hospital Rechts der Isar, Munich, Bayern, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Vincenzo Silani
- Department of Neurology - Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | | | - Markus Otto
- Neurology, University of Ulm, Ulm, Germany .,Department of Neurology, University clinic, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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25
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Rosenbohm A, Peter R, Dorst J, Kassubek J, Rothenbacher D, Nagel G, Ludolph AC. Life Course of Physical Activity and Risk and Prognosis of Amyotrophic Lateral Sclerosis in a German ALS Registry. Neurology 2021; 97:e1955-e1963. [PMID: 34670816 DOI: 10.1212/wnl.0000000000012829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Whether physical activity (PA) is a risk factor for amyotrophic lateral sclerosis (ALS) is controversial because data on lifelong PA are rare. The main objective of this study is to provide insight into PA as a potential risk factor for ALS, reporting data on cumulative PA, leisure-time PA, and occupational PA. This study also aims to gather evidence on the role of PA as a prognostic factor in disease course. METHODS Lifetime PA values collected by questionnaires addressing work and leisure time were quantified into metabolic equivalents (METs). A population-based case-control study embedded in the ALS Registry Swabia served to calculate the odds ratio (OR) of ALS by PA in different time intervals and prognosis. RESULTS In ALS cases (393 cases, 791 age- and sex-matched controls), we observed reduced total PA at interview and up to 5 years before interview compared to controls. Total PA was not associated with ALS risk 5 to 55 years before interview. Heavy occupational work intensity was associated with increased ALS risk (OR 1.97, 95% confidence interval 1.34, 2.89). Total PA levels were associated with survival in a nonlinear manner: inactive patients and highest activity levels (25 MET-h/wk) revealed the worst survival time of 15.4 and 19.3 months, respectively. Best median survival with 29.8 months was seen at 10.5 MET-h/wk after adjustment for other prognostic factors. DISCUSSION Lifetime combined PA decreased sharply several years before disease onset compared to controls. The risk of developing ALS was not associated with former total PA levels 5 to 55 years before interview in contrast to occupational PA, probably reflecting work-associated exposures. We found a strong nonlinear association of current and prediagnostic PA level and survival in ALS cases with the best survival with moderate PA. PA intensity may be a disease-modifying factor with an unfavorable outcome in sedentary and hyperactive behavior. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that PA was not associated with the development of ALS.
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Affiliation(s)
- Angela Rosenbohm
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany.
| | - Raphael Peter
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Johannes Dorst
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Jan Kassubek
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Dietrich Rothenbacher
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Gabriele Nagel
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Albert C Ludolph
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
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McCluskey G, Duddy W, Haffey S, Morrison K, Donaghy C, Duguez S. Epidemiology and survival trends of motor neurone disease in Northern Ireland from 2015 to 2019. Eur J Neurol 2021; 29:707-714. [PMID: 34748676 DOI: 10.1111/ene.15172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE This study evaluates the incidence, prevalence and survival trends of motor neurone disease (MND) in Northern Ireland from 2015 to 2019. METHODS A capture-recapture analysis was performed using five independent data sources. Incidence and prevalence rates were standardized to the European Standard Population. Survival outcomes were analysed using Kaplan-Meier curves and Cox regression analysis. RESULTS Amongst 254 total cases of MND, capture-recapture analysis estimated three missing cases (case ascertainment 98.8%). Age standardized incidence of captured cases was 3.12 per 100,000 (2.73, 3.50) and standardized prevalence ranged from 9.45 to 6.49 per 100,000 from 2015 to 2019. Standardized incidence and prevalence rates in 2006 were 1.4 and 3.3 per 100,000 respectively. Of identified cases, 133 (52.4%) were male; 94.5% had amyotrophic lateral sclerosis; median age of onset was 67 years; median time to diagnosis was 12 months (95% confidence interval 11.2, 12.8); survival from diagnosis was 12 months (95% confidence interval 10.6, 15.4); 25 (9.8%) reported a family history of MND or frontotemporal dementia; and a known MND-associated genetic mutation was identified in 7.9% of total cases, of which the most common was C9orf72 (5.7% of all patients). Factors associated with improved survival were younger age at onset, longer time to diagnosis, attendance at regional MND clinic, and initial neurology presentation as outpatient (all p < 0.001). CONCLUSION The incidence and prevalence of MND in Northern Ireland has increased over the last 10 years, in line with increasing rates reported from other European countries. Improved survival was associated with younger age at onset, longer time to diagnosis, attendance at a regional MND clinic and outpatient presentation to a Neurology Department.
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Affiliation(s)
- Gavin McCluskey
- Department of Neurology, Royal Victoria Hospital, Belfast, UK.,Northern Ireland Centre for Stratified Medicine, Altnagelvin Hospital Campus, Ulster University, Derry, UK
| | - William Duddy
- Northern Ireland Centre for Stratified Medicine, Altnagelvin Hospital Campus, Ulster University, Derry, UK
| | - Stephen Haffey
- Department of Neurophysiology, Royal Victoria Hospital, Belfast, UK
| | - Karen Morrison
- Department of Neurology, Royal Victoria Hospital, Belfast, UK.,Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK
| | | | - Stephanie Duguez
- Northern Ireland Centre for Stratified Medicine, Altnagelvin Hospital Campus, Ulster University, Derry, UK
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27
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Brown CA, Lally C, Kupelian V, Flanders WD. Estimated Prevalence and Incidence of Amyotrophic Lateral Sclerosis and SOD1 and C9orf72 Genetic Variants. Neuroepidemiology 2021; 55:342-353. [PMID: 34247168 DOI: 10.1159/000516752] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a rare neurological disorder characterized by progressive deterioration of motor neurons. Assessment of the size/geographic distribution of the ALS population, including ALS with genetic origin, is needed to understand the burden of the disease and the need for clinical intervention and therapy. OBJECTIVES The main objective of this study was to estimate the number of prevalent and incident ALS cases overall and superoxide dismutase 1 (SOD1) and chromosome 9 open reading frame 72 (C9orf72) ALS in 22 countries across Europe (Belgium, France, Germany, Ireland, Italy, Netherlands, Norway, Russia, Spain, Sweden, and UK), North America (USA and Canada), Latin America (Argentina, Brazil, Colombia, Mexico, and Uruguay), and Asia (China, Japan, South Korea, and Taiwan). METHODS A comprehensive literature search was conducted to identify population-based studies reporting ALS prevalence and/or incidence rates. Pooled prevalence and incidence rates were obtained using a meta-analysis approach at the country and regional geographic level. A country-level pooled estimate was used when ≥2 studies were available per country and geographic regional pooled estimates were used otherwise. The proportion of cases with a SOD1 or C9orf72 mutation among sporadic (sALS) and familial (fALS) cases were obtained from a previous systematic review and meta-analysis. RESULTS Pooled prevalence rates (per 100,000 persons) and incidence rates (per 100,000 person-years) were 6.22 and 2.31 for Europe, 5.20 and 2.35 for North America, 3.41 and 1.25 for Latin America, 3.01 and 0.93 for Asian countries excluding Japan, and 7.96 and 1.76 for Japan, respectively. Significant heterogeneity in reported incidence and prevalence was observed within and between countries/geographic regions. The estimated number of 2020 ALS cases across the 22 countries is 121,028 prevalent and 41,128 incident cases. The total estimated number of prevalent SOD1 cases is 2,876 cases, of which, 1,342 (47%) were fALS and 1,534 (53%) were sALS, and the number of incident SOD1 cases is 946 (434 [46%] fALS and 512 [54%] sALS). The total estimated number of prevalent C9orf72 cases is 4,545 (1,198 [26%] fALS, 3,347 [74%] sALS), and the number of incident C9orf72 cases is 1,706 (450 [26%] fALS and 1,256 [74%] sALS). DISCUSSION The estimated number of patients with SOD1 and C9orf72 ALS suggests that although the proportions of SOD1 and C9orf72 are higher among those with fALS, the majority of SOD1 and C9orf72 ALS cases may be found among those with sALS (about 53 and 74%, respectively). These results suggest that classification of fALS based on reported family history does not capture the full picture of ALS of genetic origin.
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Affiliation(s)
- Carolyn A Brown
- Epidemiologic Research and Methods LLC, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cathy Lally
- Epidemiologic Research and Methods LLC, Atlanta, Georgia, USA
| | | | - W Dana Flanders
- Epidemiologic Research and Methods LLC, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
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28
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Schischlevskij P, Cordts I, Günther R, Stolte B, Zeller D, Schröter C, Weyen U, Regensburger M, Wolf J, Schneider I, Hermann A, Metelmann M, Kohl Z, Linker RA, Koch JC, Stendel C, Müschen LH, Osmanovic A, Binz C, Klopstock T, Dorst J, Ludolph AC, Boentert M, Hagenacker T, Deschauer M, Lingor P, Petri S, Schreiber-Katz O. Informal Caregiving in Amyotrophic Lateral Sclerosis (ALS): A High Caregiver Burden and Drastic Consequences on Caregivers' Lives. Brain Sci 2021; 11:brainsci11060748. [PMID: 34200087 PMCID: PMC8228206 DOI: 10.3390/brainsci11060748] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes progressive autonomy loss and need for care. This does not only affect patients themselves, but also the patients’ informal caregivers (CGs) in their health, personal and professional lives. The big efforts of this multi-center study were not only to evaluate the caregivers’ burden and to identify its predictors, but it also should provide a specific understanding of the needs of ALS patients’ CGs and fill the gap of knowledge on their personal and work lives. Using standardized questionnaires, primary data from patients and their main informal CGs (n = 249) were collected. Patients’ functional status and disease severity were evaluated using the Barthel Index, the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and the King’s Stages for ALS. The caregivers’ burden was recorded by the Zarit Burden Interview (ZBI). Comorbid anxiety and depression of caregivers were assessed by the Hospital Anxiety and Depression Scale. Additionally, the EuroQol Five Dimension Five Level Scale evaluated their health-related quality of life. The caregivers’ burden was high (mean ZBI = 26/88, 0 = no burden, ≥24 = highly burdened) and correlated with patients’ functional status (rp = −0.555, p < 0.001, n = 242). It was influenced by the CGs’ own mental health issues due to caregiving (+11.36, 95% CI [6.84; 15.87], p < 0.001), patients’ wheelchair dependency (+9.30, 95% CI [5.94; 12.66], p < 0.001) and was interrelated with the CGs’ depression (rp = 0.627, p < 0.001, n = 234), anxiety (rp = 0.550, p < 0.001, n = 234), and poorer physical condition (rp = −0.362, p < 0.001, n = 237). Moreover, female CGs showed symptoms of anxiety more often, which also correlated with the patients’ impairment in daily routine (rs = −0.280, p < 0.001, n = 169). As increasing disease severity, along with decreasing autonomy, was the main predictor of caregiver burden and showed to create relevant (negative) implications on CGs’ lives, patient care and supportive therapies should address this issue. Moreover, in order to preserve the mental and physical health of the CGs, new concepts of care have to focus on both, on not only patients but also their CGs and gender-associated specific issues. As caregiving in ALS also significantly influences the socioeconomic status by restrictions in CGs’ work lives and income, and the main reported needs being lack of psychological support and a high bureaucracy, the situation of CGs needs more attention. Apart from their own multi-disciplinary medical and psychological care, more support in care and patient management issues is required.
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Affiliation(s)
- Pavel Schischlevskij
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (P.S.); (L.H.M.); (A.O.); (C.B.); (S.P.)
| | - Isabell Cordts
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Benjamin Stolte
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany;
| | - Carsten Schröter
- Hoher Meißner Clinic, Neurology, 37242 Bad Sooden-Allendorf, Germany;
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, 44789 Bochum, Germany;
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Joachim Wolf
- Department of Neurology, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany;
| | - Ilka Schneider
- Department of Neurology, Martin-Luther University Halle/Saale, 06120 Halle, Germany;
- Department of Neurology, Klinikum Sankt Georg, 04129 Leipzig, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany;
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, 18147 Rostock, Germany
| | - Moritz Metelmann
- Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Zacharias Kohl
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Ralf A. Linker
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, 37075 Göttingen, Germany;
| | - Claudia Stendel
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (C.S.); (T.K.)
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Lars H. Müschen
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (P.S.); (L.H.M.); (A.O.); (C.B.); (S.P.)
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (P.S.); (L.H.M.); (A.O.); (C.B.); (S.P.)
| | - Camilla Binz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (P.S.); (L.H.M.); (A.O.); (C.B.); (S.P.)
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (C.S.); (T.K.)
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (J.D.); (A.C.L.)
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (J.D.); (A.C.L.)
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Matthias Boentert
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, 48149 Münster, Germany;
- Department of Medicine, UKM Marienhospital, 48565 Steinfurt, Germany
| | - Tim Hagenacker
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Marcus Deschauer
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (P.S.); (L.H.M.); (A.O.); (C.B.); (S.P.)
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (P.S.); (L.H.M.); (A.O.); (C.B.); (S.P.)
- Correspondence:
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Clinical Determinants of Disease Progression in Amyotrophic Lateral Sclerosis-A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10081623. [PMID: 33921250 PMCID: PMC8069893 DOI: 10.3390/jcm10081623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that is ultimately fatal but characterized by substantial phenotypic heterogeneity, which is known to impact long-term course and survival. This study investigated clinical determinants of disease progression and outcome in a large cohort of patients with ALS. Methods: Retrospective analysis included comprehensive data from 625 patients who attended a tertiary ALS centre at least twice. Patients were stratified according to five distinct clinical phenotypes: classical ALS; bulbar ALS; ALS with frontotemporal dementia (ALS-FTD); upper motor neuron predominant (UMNP); and lower motor neuron predominant (LMNP). Results: This study confirmed higher age at symptom onset, shorter latency to diagnosis and more rapid decline in the revised ALS Functional Rating Scale sum score as predictors of poor prognosis. Hazard ratios for shorter survival were higher in patients with ALS-FTD versus classical ALS, and in patients with versus without chronic obstructive pulmonary disease (COPD). Mean survival was longest in the UMNP phenotype group. Conclusions: This study confirmed established predictors of shorter survival in ALS and showed that concomitant COPD in particular relates to poor outcome.
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30
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Peseschkian T, Cordts I, Günther R, Stolte B, Zeller D, Schröter C, Weyen U, Regensburger M, Wolf J, Schneider I, Hermann A, Metelmann M, Kohl Z, Linker RA, Koch JC, Büchner B, Weiland U, Schönfelder E, Heinrich F, Osmanovic A, Klopstock T, Dorst J, Ludolph AC, Boentert M, Hagenacker T, Deschauer M, Lingor P, Petri S, Schreiber-Katz O. A Nation-Wide, Multi-Center Study on the Quality of Life of ALS Patients in Germany. Brain Sci 2021; 11:372. [PMID: 33799476 PMCID: PMC7998410 DOI: 10.3390/brainsci11030372] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022] Open
Abstract
Improving quality of life (QoL) is central to amyotrophic lateral sclerosis (ALS) treatment. This Germany-wide, multicenter cross-sectional study analyses the impact of different symptom-specific treatments and ALS variants on QoL. Health-related QoL (HRQoL) in 325 ALS patients was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire 5 (ALSAQ-5) and EuroQol Five Dimension Five Level Scale (EQ-5D-5L), together with disease severity (captured by the revised ALS Functional Rating Scale (ALSFRS-R)) and the current care and therapies used by our cohort. At inclusion, the mean ALSAQ-5 total score was 56.93 (max. 100, best = 0) with a better QoL associated with a less severe disease status (β = -1.96 per increase of one point in the ALSFRS-R score, p < 0.001). "Limb-onset" ALS (lALS) was associated with a better QoL than "bulbar-onset" ALS (bALS) (mean ALSAQ-5 total score 55.46 versus 60.99, p = 0.040). Moreover, with the ALSFRS-R as a covariate, using a mobility aid (β = -7.60, p = 0.001), being tracheostomized (β = -14.80, p = 0.004) and using non-invasive ventilation (β = -5.71, p = 0.030) were associated with an improved QoL, compared to those at the same disease stage who did not use these aids. In contrast, antidepressant intake (β = 5.95, p = 0.007), and increasing age (β = 0.18, p = 0.023) were predictors of worse QoL. Our results showed that the ALSAQ-5 was better-suited for ALS patients than the EQ-5D-5L. Further, the early and symptom-specific clinical management and supply of assistive devices can significantly improve the individual HRQoL of ALS patients. Appropriate QoL questionnaires are needed to monitor the impact of treatment to provide the best possible and individualized care.
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Affiliation(s)
- Tara Peseschkian
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Isabell Cordts
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, 01307 Dresden, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Benjamin Stolte
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany;
| | - Carsten Schröter
- Hoher Meißner Clinic, Neurology, 37242 Bad Sooden-Allendorf, Germany;
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, 44789 Bochum, Germany;
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Joachim Wolf
- Department of Neurology, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany;
| | - Ilka Schneider
- Department of Neurology, Martin-Luther University Halle/Saale, 06120 Halle, Germany;
- Department of Neurology, Klinikum Sankt Georg, 04129 Leipzig, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany;
- German Center for Neurodegenerative Diseases Rostock/Greifswald, 18147 Rostock, Germany
| | - Moritz Metelmann
- Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Zacharias Kohl
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Ralf A. Linker
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, 37075 Göttingen, Germany;
| | - Boriana Büchner
- Friedrich-Baur Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (B.B.); (T.K.)
| | - Ulrike Weiland
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
| | - Erik Schönfelder
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Felix Heinrich
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Thomas Klopstock
- Friedrich-Baur Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (B.B.); (T.K.)
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Matthias Boentert
- Department of Neurology with the Institute of Translational Neurology, University Hospital Münster, 48149 Münster, Germany;
- Department of Medicine, UKM Marienhospital, 48565 Steinfurt, Germany
| | - Tim Hagenacker
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Marcus Deschauer
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
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31
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Jericó I, Elizalde-Beiras I, Pagola I, Torné L, Galbete A, Delfrade-Osinaga J, Vicente E. Clinical features and incidence trends of amyotrophic lateral sclerosis in Navarre, Spain, 2007-2018: a population-based study. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:401-409. [PMID: 33641502 DOI: 10.1080/21678421.2021.1891249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative disorder with a median survival of 3 years. The aim of our study is to analyze the incidence, age-related phenotype and clinical onset, geographical distribution, survival and diagnostic delay of ALS in Navarre. Methods: This is a population-based observational retrospective study, including all residents of Navarre (a northern Spanish region) from 2007 to 2018, who were followed until 30th September 2020. Results: We observed a global incidence 2.47/100,000 person-years, with an upward trend throughout the study, with the highest being in the age group of 70-74 years old. Point prevalence in December 2018 was 6.64/100,000 inhabitants (95%CI: 4.52-8.45). Upper limbs weakness onset was the most frequent in young people (<60 years), and bulbar, lower limbs weakness, generalized and respiratory associated with older age. Bulbar phenotype is the most frequent in women and in 80+ group. The median survival from clinical onset was 27.7 months (95%CI: 24.0-31.4), higher in spinal phenotype and younger onset age, and the diagnosis delay was 10.0 months (95%CI: 8.9-11.2) from clinical onset. Conclusions: We have observed a trend of increasing incidence in older people where the bulbar phenotype and female predominance.
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Affiliation(s)
- Ivonne Jericó
- Department of Neurology, Complejo Hospitalario de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain
| | - Itsaso Elizalde-Beiras
- Department of Health Sciences, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,Primary Care, Servicio Navarro de Salud - Osasunbidea, IdiSNA, Pamplona, Spain
| | - Inmaculada Pagola
- Department of Neurology, Complejo Hospitalario de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain
| | - Laura Torné
- Department of Neurology, Complejo Hospitalario de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain
| | - Arkaitz Galbete
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, IdiSNA, Pamplona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
| | - Josu Delfrade-Osinaga
- Community Health Observatory Section, Instituto de Salud Pública y Laboral de Navarra, IdiSNA, Pamplona, Spain, and.,CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther Vicente
- Department of Health Sciences, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,Community Health Observatory Section, Instituto de Salud Pública y Laboral de Navarra, IdiSNA, Pamplona, Spain, and
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32
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Steinacker P, Feneberg E, Halbgebauer S, Witzel S, Verde F, Oeckl P, Van Damme P, Gaur N, Gray E, Grosskreutz J, Jardel CG, Kachanov M, Kuhle J, Lamari F, Maceski A, Del Mar Amador M, Mayer B, Morelli C, Petri S, Poesen K, Raaphorst J, Salachas F, Silani V, Turner MR, Verbeek MM, Volk AE, Weishaupt JH, Weydt P, Ludolph AC, Otto M. Chitotriosidase as biomarker for early stage amyotrophic lateral sclerosis: a multicenter study. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:276-286. [PMID: 33576252 DOI: 10.1080/21678421.2020.1861023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: Levels of chitotriosidase (CHIT1) are increased in the cerebrospinal fluid (CSF) of amyotrophic lateral sclerosis (ALS) patients reflecting microglial activation. Here, we determine the diagnostic and prognostic potential of CHIT1 for early symptomatic ALS. Methods: Overall, 275 patients from 8 European neurological centers were examined. We included ALS with <6 and >6 months from symptom onset, other motoneuron diseases (oMND), ALS mimics (DCon) and non-neurodegenerative controls (Con). CSF CHIT1 levels were analyzed for diagnostic power and association with progression and survival in comparison to the benchmark neurofilament. The 24-bp duplication polymorphism of CHIT1 was analyzed in a subset of patients (N = 65). Results: Homozygous CHIT1 duplication mutation carriers (9%) invariably had undetectable CSF CHIT1 levels, while heterozygous carriers had similar levels as patients with wildtype CHIT1 (p = 0.414). In both early and late symptomatic ALS CHIT1 levels was increased, did not correlate with patients' progression rates, and was higher in patients diagnosed with higher diagnostic certainty. Neurofilament levels correlated with CHIT1 levels and prevailed over CHIT1 regarding diagnostic performance. Both CHIT1 and neurofilaments were identified as independent predictors of survival in late but not early symptomatic ALS. Evidence is provided that CHIT1 predicts progression in El Escorial diagnostic category in the group of ALS cases with a short duration. Conclusions: CSF CHIT1 level may have additional value in the prognostication of ALS patients with a short history of symptoms classified in diagnostic categories of lower clinical certainty. To fully interpret apparently low CHIT1 levels knowledge of CHIT1 genotype is needed.
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Affiliation(s)
| | - Emily Feneberg
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Simon Witzel
- Department of Neurology, Ulm University, Ulm, Germany
| | - Federico Verde
- Department of Neurology - Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Pathophysiology and Transplantation - "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Patrick Oeckl
- Department of Neurology, Ulm University, Ulm, Germany
| | - Philip Van Damme
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department of Neurosciences, VIB - Center for Brain & Disease Research, Experimental Neurology - Laboratory of Neurobiology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Nayana Gaur
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Elizabeth Gray
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Claude G Jardel
- Department of Metabolic Biochemistry, Hôpitaux Universitaires Pitié Salpeêtrière-Charles Foix, Paris, France
| | - Mykyta Kachanov
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Kuhle
- Neurology, Departments of Biomedicine, Medicine and Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Foudil Lamari
- Department of Metabolic Biochemistry, Hôpitaux Universitaires Pitié Salpeêtrière-Charles Foix, Paris, France
| | - Aleksandra Maceski
- Neurology, Departments of Biomedicine, Medicine and Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Maria Del Mar Amador
- Neurological Diseases Department, Paris ALS Reference Center, Hôpitaux Universitaires Pitié Salpeêtrière-Charles Foix, Paris, France
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Claudia Morelli
- Department of Neurology - Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Koen Poesen
- Laboratory of Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven and Laboratory Medicine, University Hospitals of Leuven, Leuven, Belgium
| | - Joost Raaphorst
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - François Salachas
- Neurological Diseases Department, Paris ALS Reference Center, Hôpitaux Universitaires Pitié Salpeêtrière-Charles Foix, Paris, France
| | - Vincenzo Silani
- Department of Neurology - Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Pathophysiology and Transplantation - "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexander E Volk
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Patrick Weydt
- Department for Neurodegenerative Disorders and Gerontopsychiatry, Bonn University, Bonn, Germany
| | | | - Markus Otto
- Department of Neurology, Ulm University, Ulm, Germany
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33
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Spittel S, Maier A, Kettemann D, Walter B, Koch B, Krause K, Norden J, Münch C, Meyer T. Non-invasive and tracheostomy invasive ventilation in amyotrophic lateral sclerosis: Utilization and survival rates in a cohort study over 12 years in Germany. Eur J Neurol 2020; 28:1160-1171. [PMID: 33210770 DOI: 10.1111/ene.14647] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to investigate utilization rates, treatment pathways and survival prognosis in patients with amyotrophic lateral sclerosis (ALS) undergoing non-invasive (NIV) and tracheostomy invasive ventilation (TIV) in a real-world setting. METHODS A prospective cohort study using a single-centre register of 2702 ALS patients (2007 to 2019) was conducted. Utilization of NIV/TIV and survival data were analysed in three cohorts: (i) non-NIV; (ii) NIV (NIV without subsequent TIV); and (iii) TIV (including TIV preceded by NIV). RESULTS A total of 1720 patients with available data were identified, 72.0% of whom (n = 1238) did not receive ventilation therapy. NIV was performed in 20.8% of patients (n = 358). TIV was performed in 9.5% of patients (n = 164), encompassing both primary TIV (7.2%, n = 124) and TIV with preceding NIV (2.3%, n = 40). TIV was more often utilized without previous NIV (25.7% vs. 8.3% of all ventilated patients), demonstrating that primary TIV was the prevailing pathway for invasive ventilation. The median (range) survival was significantly longer in the NIV cohort (40.8 [37.2-44.3] months) and the TIV cohort (82.1 [68.7-95.6] months) as compared to the non-NIV cohort (33.6 [31.6-35.7] months). CONCLUSIONS Although NIV represents the standard of care, its utilization rate was low. TIV was mainly started without preceding NIV, suggesting that TIV may not be confined to NIV treatment escalation. However, TIV was pursued in a minority of patients who had previously undergone NIV. The survival benefit observed in the patients with NIV was equal to that reported in a controlled pivotal trial, but the prognosis with TIV is highly variable. The determinants of utilization of NIV/TIV and of survival (bulbar syndrome, availability of ventilation-related home nursing, cultural factors) warrant further investigation.
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Affiliation(s)
- Susanne Spittel
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dagmar Kettemann
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bertram Walter
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Koch
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Krause
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jenny Norden
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Münch
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Thomas Meyer
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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34
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Van Schoor E, Koper MJ, Ospitalieri S, Dedeene L, Tomé SO, Vandenberghe R, Brenner D, Otto M, Weishaupt J, Ludolph AC, Van Damme P, Van Den Bosch L, Thal DR. Necrosome-positive granulovacuolar degeneration is associated with TDP-43 pathological lesions in the hippocampus of ALS/FTLD cases. Neuropathol Appl Neurobiol 2020; 47:328-345. [PMID: 32949047 DOI: 10.1111/nan.12668] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/04/2020] [Indexed: 01/11/2023]
Abstract
AIM Granulovacuolar degeneration (GVD) in Alzheimer's disease (AD) involves the necrosome, which is a protein complex consisting of phosphorylated receptor-interacting protein kinase 1 (pRIPK1), pRIPK3 and phosphorylated mixed lineage kinase domain-like protein (pMLKL). Necrosome-positive GVD was associated with neuron loss in AD. GVD was recently linked to the C9ORF72 mutation in amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration with transactive response DNA-binding protein (TDP-43) pathology (FTLD-TDP). Therefore, we investigated whether GVD in cases of the ALS-FTLD-TDP spectrum (ALS/FTLD) shows a similar involvement of the necrosome as in AD, and whether it correlates with diagnosis, presence of protein aggregates and cell death in ALS/FTLD. METHODS We analysed the presence and distribution of the necrosome in post-mortem brain and spinal cord of ALS and FTLD-TDP patients (n = 30) with and without the C9ORF72 mutation, and controls (n = 22). We investigated the association of the necrosome with diagnosis, the presence of pathological protein aggregates and neuronal loss. RESULTS Necrosome-positive GVD was primarily observed in hippocampal regions of ALS/FTLD cases and was associated with hippocampal TDP-43 inclusions as the main predictor of the pMLKL-GVD stage, as well as with the Braak stage of neurofibrillary tangle pathology. The central cortex and spinal cord, showing motor neuron loss in ALS, were devoid of any accumulation of pRIPK1, pRIPK3 or pMLKL. CONCLUSIONS Our findings suggest a role for hippocampal TDP-43 pathology as a contributor to necrosome-positive GVD in ALS/FTLD. The absence of necroptosis-related proteins in motor neurons in ALS argues against a role for necroptosis in ALS-related motor neuron death.
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Affiliation(s)
- E Van Schoor
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Laboratory of Neurobiology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - M J Koper
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Center for Brain & Disease Research, VIB, Leuven, Belgium.,Laboratory for the Research of Neurodegenerative Diseases, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium
| | - S Ospitalieri
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium
| | - L Dedeene
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Laboratory of Neurobiology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Center for Brain & Disease Research, VIB, Leuven, Belgium.,Laboratory for Molecular Neurobiomarker Research, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - S O Tomé
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium
| | - R Vandenberghe
- Laboratory of Cognitive Neurology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - D Brenner
- Department of Neurology, Ulm University, Ulm, Germany
| | - M Otto
- Department of Neurology, Ulm University, Ulm, Germany
| | - J Weishaupt
- Department of Neurology, Ulm University, Ulm, Germany
| | - A C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
| | - P Van Damme
- Laboratory of Neurobiology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Center for Brain & Disease Research, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - L Van Den Bosch
- Laboratory of Neurobiology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - D R Thal
- Laboratory of Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute (LBI), Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
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35
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Sieverding K, Ulmer J, Bruno C, Satoh T, Tsao W, Freischmidt A, Akira S, Wong PC, Ludolph AC, Danzer KM, Lobsiger CS, Brenner D, Weishaupt JH. Hemizygous deletion of Tbk1 worsens neuromuscular junction pathology in TDP-43 G298S transgenic mice. Exp Neurol 2020; 335:113496. [PMID: 33038415 DOI: 10.1016/j.expneurol.2020.113496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/26/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022]
Abstract
Mutations in the genes TARDBP (encoding the TDP-43 protein) and TBK1 can cause familial ALS. Neuronal cytoplasmatic accumulations of the misfolded, hyperphosphorylated RNA-binding protein TDP-43 are the pathological hallmark of most ALS cases and have been suggested to be a key aspect of ALS pathogenesis. Pharmacological induction of autophagy has been shown to reduce mutant TDP-43 aggregates and alleviate motor deficits in mice. TBK1 is exemplary for several other ALS genes that regulate autophagy. Consequently, we employed double mutant mice with both a heterozygous Tbk1 deletion and transgenic expression of human TDP-43G298S to test the hypothesis that impaired autophagy reduces intracellular clearance of an aggregation-prone protein and enhances toxicity of mutant TDP-43. The heterozygous deletion of Tbk1 did not change expression or cellular distribution of TDP-43 protein, motor neuron loss or reactive gliosis in the spinal cord of double-mutant mice at the age of 19 months. However, it aggravated muscle denervation and, albeit to a small and variable degree, motor dysfunction in TDP-43G298S transgenic mice, as similarly observed in the SOD1G93A transgenic mouse model for ALS before. Conclusively, our findings suggest that TBK1 mutations can affect the neuromuscular synapse.
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Affiliation(s)
| | - Johannes Ulmer
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Clara Bruno
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Takashi Satoh
- Department of Host Defense, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
| | - William Tsao
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Cellular and Molecular Medicine Program, Johns Hopkins University School of Medicine, Baltimore, United States
| | | | - Shizuo Akira
- Department of Host Defense, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
| | - Philip C Wong
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Cellular and Molecular Medicine Program, Johns Hopkins University School of Medicine, Baltimore, United States
| | | | - Karin M Danzer
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Christian S Lobsiger
- Institut du Cerveau et de la Moelle Épinière, Institut National de la Santé et de la Recherche Médicale Unité 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Sorbonne Université, Paris, France
| | - David Brenner
- Department of Neurology, University of Ulm, Ulm, Germany; Division of Neurodegenerative Disorders, Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Jochen H Weishaupt
- Department of Neurology, University of Ulm, Ulm, Germany; Division of Neurodegenerative Disorders, Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Germany.
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Ludolph AC, Emilian S, Dreyhaupt J, Rosenbohm A, Kraskov A, Lemon RN, Del Tredici K, Braak H. Pattern of paresis in ALS is consistent with the physiology of the corticomotoneuronal projections to different muscle groups. J Neurol Neurosurg Psychiatry 2020; 91:991-998. [PMID: 32665323 DOI: 10.1136/jnnp-2020-323331] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE A recent neuroanatomical staging scheme of amyotrophic lateral sclerosis (ALS) indicates that a cortical lesion may spread, as a network disorder, both at the cortical level and via corticofugal tracts, including corticospinal projections providing direct monosynaptic input to α-motoneurons. These projections are involved preferentially and early in ALS. If these findings are clinically relevant, the pattern of paresis in ALS should primarily involve those muscle groups that receive the strongest direct corticomotoneuronal (CM) innervation. METHODS In a large cohort (N=436), we analysed retrospectively the pattern of muscle paresis in patients with ALS using the UK Medical Research Council (MRC) scoring system; we subsequently carried out two independent prospective studies in two smaller groups (N=92 and N=54). RESULTS The results indicated that a characteristic pattern of paresis exists. When pairs of muscle groups were compared within patients, the group known to receive the more pronounced CM connections was significantly weaker. Within patients, there was greater relative weakness (lower MRC score) in thumb abductors versus elbow extensors, for hand extensors versus hand flexors and for elbow flexors versus elbow extensors. In the lower limb, knee flexors were relatively weaker than extensors, and plantar extensors were weaker than plantar flexors. CONCLUSIONS These findings were mostly significant (p<0.01) for all six pairs of muscles tested and provide indirect support for the concept that ALS may specifically affect muscle groups with strong CM connections. This specific pattern could help to refine clinical and electrophysiological ALS diagnostic criteria and complement prospective clinicopathological correlation studies.
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Affiliation(s)
- Albert C Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany .,German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Susanne Emilian
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Alexander Kraskov
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Roger N Lemon
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Kelly Del Tredici
- Department of Neurology, Clinical Neuroanatomy (Center for Biomedical Research), Ulm, Germany
| | - Heiko Braak
- Department of Neurology, Clinical Neuroanatomy (Center for Biomedical Research), Ulm, Germany
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[Gene-specific treatment approaches in amyotrophic lateral sclerosis in the present and future]. DER NERVENARZT 2020; 91:287-293. [PMID: 32076756 DOI: 10.1007/s00115-020-00873-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is monogenic in up to 10% of cases. Various mutation types result in a loss of function, a gain of toxicity or a combination of both. Due to the continuous development of gene-specific approaches, the treatment of the various ALS forms is no longer a dream. Depending on the underlying mutation type and pathomechanism, different antisense oligonucleotide (ASO)-based or viral strategies are available. The SOD1 and C9ORF72 genes are the most frequently mutated ALS genes in Germany and their mutations most likely predominantly lead to a gain of toxicity. For both genes, specific ASOs were developed binding to the respective mRNAs and leading to their degradation and are now being tested in clinical trials after excellent efficacy in the related ALS mouse models, with promising interim results. For the sporadic form of ALS there are also gene-specific approaches that compensate pathomechanisms and are a promising therapeutic option. In this article, gene-specific therapeutic developments in ALS as well as possible pitfalls and challenges are discussed in detail.
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Malek E, Ismail H, Doumiati H, Salameh J. Characteristics of amyotrophic lateral sclerosis in Lebanon-a chart review. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:614-619. [PMID: 32633637 DOI: 10.1080/21678421.2020.1788095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder primarily manifesting as motor deficits. It is caused by motor neuron death and leads to progressive disability and demise. It can present at any age, manifest as several phenotypes, and may have a variable progression pattern. Methods: This retrospective study is based on chart review of subjects presenting to the American University of Beirut Medical Center from June 2015 till March 2020. It aims to describe the characteristics of ALS in Lebanon. Results: Out of 140 subjects identified, 113 had classical ALS. The mean age in classical and atypical ALS were 55.5 and 55.6 years, male gender was predominant in both groups, and the mean duration from disease onset to diagnosis was 10 months in classic ALS compared to 22 months in atypical ALS. The median survival in subjects with classical ALS was 31 months which was significantly lower than atypical ALS phenotypes of 41.5 months. Additionally, more than half of patients (57%) were found to have a moderate ALSFRS-R progression rate. Conclusions: The study is the first to report the characteristics of amyotrophic lateral sclerosis in Lebanon. Moreover, we were able to categorize patients with classical phenotype according to disease progression using the ALSFRS-R score which can be a useful tool in determining disease prognosis at an early stage.
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Affiliation(s)
- Elia Malek
- Neurology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Helen Ismail
- Neurology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hassan Doumiati
- Neurology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johnny Salameh
- Neurology Department, American University of Beirut Medical Center, Beirut, Lebanon
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Schönfelder E, Osmanovic A, Müschen LH, Petri S, Schreiber-Katz O. Costs of illness in amyotrophic lateral sclerosis (ALS): a cross-sectional survey in Germany. Orphanet J Rare Dis 2020; 15:149. [PMID: 32532288 PMCID: PMC7291655 DOI: 10.1186/s13023-020-01413-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder. Consequently, patients undergo a multidisciplinary treatment that often requires intensive use of medical resources. This study provides an estimate on the cost of illness depending on the clinical severity while also analysing the patients’ health-related quality of life. Methods Primary data from patients and caregivers was collected through a standardised questionnaire. Direct medical, direct non-medical and indirect costs were calculated using the latest German health economic guidelines. Patients were divided into five groups according to the King’s staging system. Health-related quality of life was assessed using EuroQoL Group EQ-5D-5L™ questionnaire. Influencing factors on both total cost and quality of life were examined. Results The mean annual total cost of illness was 78,256€ per patient while the lifetime cost per patient was estimated at 246,184€. The prevalence based total burden yearly therefore was 519,776,352€ in Germany. Nearly half of the costs were attributable to informal care. With increase of the clinical severity stage, costs rose and quality of life decreased. The score of the revised Amyotrophic Laterals Sclerosis Functional Rating Scale was identified as one major influencing factor on total costs, while subjective impairment in daily activities and classification into a care level as opposed to having no care level influenced patients’ quality of life. Conclusion It is essential to understand the socioeconomic burden of a disease. These data can be used to improve patient care standards and quality of life while also serving as a basis for cost-benefit analyses during the approval process of new treatments.
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Affiliation(s)
- Erik Schönfelder
- Department of Neurology, Hannover Medical School, OE 7210, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, OE 7210, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Lars Hendrik Müschen
- Department of Neurology, Hannover Medical School, OE 7210, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, OE 7210, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, OE 7210, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
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Schumacher J, Peter RS, Nagel G, Rothenbacher D, Rosenbohm A, Ludolph AC, Dorst J. Statins, diabetes mellitus and prognosis of amyotrophic lateral sclerosis: data from 501 patients of a population-based registry in southwest Germany. Eur J Neurol 2020; 27:1405-1414. [PMID: 32396653 DOI: 10.1111/ene.14300] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/30/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE A wide variety of metabolic changes, including an increased incidence of diabetes mellitus (DM) and dyslipidaemia, has been described in amyotrophic lateral sclerosis (ALS). The aim of this study was to investigate the associations of statin use and history of DM with onset of disease and survival in patients with ALS. METHODS In all, 501 patients (mean age 65.2 ± 10.9 years; 58.5% male) from the ALS Registry Swabia recruited between October 2010 and April 2016 were included in this prospective cohort study. Data were collected using a standardized questionnaire. RESULTS Statin use (n = 65) was not associated with overall survival (P = 0.62). Age of ALS onset in patients with DM was 4.2 years later (95% confidence interval 1.3-7.2 years) than in patients without DM (P < 0.01). The overall survival of patients with high body mass index at study entry (>27.0 kg/m2 , upper quartile, n = 127) was prolonged by more than 5 months compared to patients with low body mass index (<22.0 kg/m2 , lower quartile, n = 123; P = 0.04). CONCLUSIONS This study supports the view that statin use is not associated with overall survival of ALS patients, suggesting that statins are not harmful and should not be discontinued in ALS. Furthermore, the delayed onset of ALS in patients with DM may mirror the potentially protective metabolic profile associated with type 2 DM. Consistently, this study provides further evidence that high body mass index is a positive prognostic factor in ALS.
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Affiliation(s)
- J Schumacher
- Department of Neurology, University of Ulm, Ulm, Germany
| | - R S Peter
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - G Nagel
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - D Rothenbacher
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - A Rosenbohm
- Department of Neurology, University of Ulm, Ulm, Germany
| | - A C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany
| | - J Dorst
- Department of Neurology, University of Ulm, Ulm, Germany
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Abstract
PURPOSE OF REVIEW In amyotrophic lateral sclerosis (ALS), sleep disruption is frequently present and substantially adds to disease burden. This review aims to summarize current knowledge on causes, pathophysiology, and treatment of sleep disturbances in ALS. RECENT FINDINGS Motor neuron degeneration and muscle weakness may lead to muscle cramps, pain, spasticity, immobilization, restless legs, sleep-disordered breathing, and difficulties to clear secretions. Furthermore, existential fears and depression may promote insomnia. Sleep-disordered breathing, and nocturnal hypoventilation in particular, requires ventilatory support which meaningfully prolongs survival and improves health-related quality of life albeit respiratory failure is inevitable. Early indication for non-invasive ventilation can be achieved by inclusion of capnometry in diagnostic sleep studies. Sleep disruption is extremely common in ALS and may arise from different etiologies. The absence of causative therapeutic options for ALS underlines the importance of symptomatic and palliative treatment strategies that acknowledge sleep-related complaints.
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Affiliation(s)
- Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
- Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany.
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Minimizing the Diagnostic Delay in Amyotrophic Lateral Sclerosis: The Role of Nonneurologist Practitioners. Neurol Res Int 2020; 2020:1473981. [PMID: 32455015 PMCID: PMC7238340 DOI: 10.1155/2020/1473981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS), usually fatal in a few years, is a neurodegenerative disorder where the diagnostic delay, although variable according to the studies, remains too long. The main objective of this study was to determine the average time to diagnose ALS and the role of each physician, general practitioner (GP), or specialist (neurologist or not) involved in the management of these patients. The secondary objective was to propose some simple schemes to quickly identify an ALS suspicion with the aim to reduce this delay. Patients and Methods. This retrospective study evaluated the diagnostic delay (and other intermediate delays) of 90 ALS patients registered in the ALS Center of Bordeaux (France) in 2013. The main clinical signs encountered (and their order of appearance) were studied. Results The average diagnostic delay was 17 months, with a median diagnostic delay of 12 months. The average diagnostic delay was 2.7 months between the first symptoms and the first complaint to GP, followed by an additional 6.5 month delay before the patient's first visit to a neurologist. This period could be shortened, especially if GP performed additional tests quickly (p=0.01), as the time spent consulting various specialists often extends this crucial step. Overall, diagnostic delay accounted for 40% of the total duration of the disease progression. Conclusion In relation to total survival time, the diagnostic delay of ALS appears to be proportionately very long, sometimes longer than that observed in previous studies (because it also included the total delay to diagnostic or treatment initiation). The rapid execution of useful additional tests by the first medical doctor, often GP (with the help of a neurologist), considerably reduces the diagnostic delay. The central role of GP seems to be crucial in the management of patients with ALS. The main objective is, of course, to initiate appropriate treatment and care as soon as possible. Finally, based on our results, we also provide a short practical diagram to help nonneurologist practitioners to quickly discuss the diagnosis of ALS in case of some specific symptoms (“red flags”).
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Xu L, Chen L, Wang S, Feng J, Liu L, Liu G, Wang J, Zhan S, Gao P, Fan D. Incidence and prevalence of amyotrophic lateral sclerosis in urban China: a national population-based study. J Neurol Neurosurg Psychiatry 2020; 91:520-525. [PMID: 32139654 DOI: 10.1136/jnnp-2019-322317] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disease and information on disease burden of ALS in mainland China was limited. We aimed to estimate the prevalence and incidence of ALS in China. METHODS We used 2012-2016 data from China's Urban Employee Basic Medical Insurance and Urban Residence Basic Medical Insurance, covering approximately 0.43 billion individuals. ALS cases were identified by the primary diagnosis (International Classification of Diseases code or text of diagnosis) in the insurance database. RESULTS The crude prevalence and incidence in 2016 were 2.91 per 100 000 person-years (95% CI 2.31 to 3.58) and 1.65 (95% CI 1.33 to 2.01), respectively. The standardised prevalence and incidence based on 2010 Chinese census data were 2.97 (95% CI 2.91 to 3.03) and 1.62 (95% CI 1.58 to 1.67), respectively. The annual prevalence between 2013 and 2016 remained relatively constant, ranging from 2.91 (95% CI 2.31 to 3.58) in 2016 to 3.29 (95% CI 2.51 to 4.17) in 2014 (linear regression: β=-0.129, p=0.104). Both rates peaked in the group aged 75-79 years. CONCLUSIONS The prevalence and incidence of ALS in mainland China were lower than those in developed countries, and maintained a relatively stable trend. The age at onset and age at diagnosis for ALS patients were younger than those in developed countries. Further research is expected to clarify the potential pathophysiological mechanism of ALS.
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Affiliation(s)
- Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing 100191, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jingnan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Guozhen Liu
- Peking University Health Information Technology Co. Ltd, 52 North Fourth Ring West Road, Haidian District, Beijing 100080, China
| | - Jinxi Wang
- Beijing Healthcom Data Technology Co. Ltd, 18 Fengtai North Road, Fengtai District, Beijing 100071, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China .,Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing 100191, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing 100191, China
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Hensiek N, Schreiber F, Wimmer T, Kaufmann J, Machts J, Fahlbusch L, Garz C, Vogt S, Prudlo J, Dengler R, Petri S, Nestor PJ, Vielhaber S, Schreiber S. Sonographic and 3T-MRI-based evaluation of the tongue in ALS. NEUROIMAGE-CLINICAL 2020; 26:102233. [PMID: 32171167 PMCID: PMC7068685 DOI: 10.1016/j.nicl.2020.102233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/18/2020] [Accepted: 02/29/2020] [Indexed: 10/27/2022]
Abstract
A few systematic imaging studies employing ultrasound (HRUS) and magnetic resonance imaging (MRI) have suggested tongue measures to aid in diagnosis of amyotrophic lateral sclerosis (ALS). The relationship between structural tongue alterations and the ALS patients' bulbar and overall motor function has not yet been elucidated. We here thus aimed to understand how in-vivo tongue alterations relate to motor function and motor function evolution over time in ALS. Our study included 206 ALS patients and 104 age- and sex-matched controls that underwent HRUS and 3T MRI of the tongue at baseline. Sonographic measures comprised coronal tongue echointensity, area, height, width and height/width ratio, while MRI measures comprised sagittal T1 intensity, tongue area, position and shape. Imaging-derived markers were related to baseline and longitudinal bulbar and overall motor function. Baseline T1 intensity was lower in ALS patients with more severe bulbar involvement at baseline. Smaller baseline coronal (HRUS) and sagittal (MRI) tongue area, smaller coronal height (HRUS) and width (HRUS) as well as more rounded sagittal tongue shape predicated more rapid functional impairment - not only of bulbar, but also of overall motor function - in ALS. Our results suggest that in-vivo sonography und MRI tongue measures could aid as biomarkers to reflect bulbar and motor function impairment.
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Affiliation(s)
- Nathalie Hensiek
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Thomas Wimmer
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Laura Fahlbusch
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Cornelia Garz
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Johannes Prudlo
- Department of Neurology, Rostock University Medical Center, Germany; German Center for Neurodegenerative Diseases (DNZE) within the Helmholtz Association, Rostock, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Peter J Nestor
- Queensland Brain Institute, University of Queensland, Brisbane 4072, Australia
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany; Center for behavioral brain sciences (CBBS), Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany; Center for behavioral brain sciences (CBBS), Magdeburg, Germany.
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Nagel G, Peter RS, Rosenbohm A, Koenig W, Dupuis L, Rothenbacher D, Ludolph AC. Association of Insulin-like Growth Factor 1 Concentrations with Risk for and Prognosis of Amyotrophic Lateral Sclerosis - Results from the ALS Registry Swabia. Sci Rep 2020; 10:736. [PMID: 31959864 PMCID: PMC6971302 DOI: 10.1038/s41598-020-57744-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/20/2019] [Indexed: 11/09/2022] Open
Abstract
We investigated the associations of serum concentration of insulin-like growth factor 1 (IGF1) with risk and prognosis of ALS in the ALS registry (October 2010-June 2014, median follow-up 67.6 months) in a case-control and cohort study, respectively. Serum samples were measured for IGF-1. Information on covariates was collected by standardized questionnaire. We applied conditional logistic regression to appraise the risk and Cox proportional hazards models to appraise the prognostic value of IGF-1. Data of 294 ALS patients (mean age 65.4 (SD 11.0) years, 60.2% men) and 504 controls were included in the case-control study. Median serum IGF-1 concentrations were slightly higher in ALS cases than in controls (101 vs. 99.5 ng/ml). IGF-1 concentrations were not associated with ALS risk in the fully adjusted model (top vs. bottom quartile: OR 1.16; 95%-CI 0.73-1.84, p for trend = 0.44). Among 293 ALS cases (mean age 65.5 (SD 10.5) years, 56.8% men) 243 died during follow-up. We found a statistically significant inverse association between continuous IGF-1 concentrations and survival (p = 0.01). Very high values IGF-1 were associated with a better prognosis of ALS suggesting that functions related to IGF-1 could be involved in survival.
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Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Luc Dupuis
- INSERM U1118, Université de Strasbourg, Strasbourg, France
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Brenner D, Rosenbohm A, Yilmaz R, Müller K, Grehl T, Petri S, Meyer T, Grosskreutz J, Weydt P, Ruf W, Neuwirth C, Weber M, Pinto S, Claeys KG, Schrank B, Jordan B, Knehr A, Günther K, Hübers A, Zeller D, Kubisch C, Jablonka S, Sendtner M, Klopstock T, de Carvalho M, Sperfeld A, Borck G, Volk AE, Dorst J, Weis J, Otto M, Schuster J, Del Tredici K, Braak H, Danzer KM, Freischmidt A, Meitinger T, Ludolph AC, Andersen PM, Weishaupt JH. Reply: Adult-onset distal spinal muscular atrophy: a new phenotype associated with KIF5A mutations. Brain 2019; 142:e67. [PMID: 31612906 DOI: 10.1093/brain/awz306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Torsten Grehl
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Thomas Meyer
- Charité University Hospital, Humboldt-University, Berlin, Germany
| | | | - Patrick Weydt
- Neurology Department, Ulm University, Ulm, Germany.,Department for Neurodegenerative Disorders and Gerontopsychiatry, Bonn University, Bonn, Germany
| | - Wolfgang Ruf
- Neurology Department, Ulm University, Ulm, Germany
| | - Christoph Neuwirth
- Kantonsspital St. Gallen, ALS Outpatient Clinic, St. Gallen, Switzerland
| | - Markus Weber
- Kantonsspital St. Gallen, ALS Outpatient Clinic, St. Gallen, Switzerland
| | - Susana Pinto
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Lisbon, Portugal.,Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Kristl G Claeys
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Berthold Schrank
- Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
| | - Berit Jordan
- Department of Neurology Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Antje Knehr
- Neurology Department, Ulm University, Ulm, Germany
| | | | | | - Daniel Zeller
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Christian Kubisch
- Institute of Human Genetics, Ulm University, Ulm, Germany.,Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sibylle Jablonka
- Institute of Clinical Neurobiology, University Hospital of Würzburg, Würzburg, Germany
| | - Michael Sendtner
- Institute of Clinical Neurobiology, University Hospital of Würzburg, Würzburg, Germany
| | - Thomas Klopstock
- Department of Neurology with Friedrich-Baur-Institute, University of Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Mamede de Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Lisbon, Portugal.,Instituto de Medicina Molecular and Institute of Physiology, Faculty of Medicine, University of Lisbon, Portugal
| | - Anne Sperfeld
- Department of Neurology Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Guntram Borck
- Institute of Human Genetics, Ulm University, Ulm, Germany
| | - Alexander E Volk
- Institute of Human Genetics, Ulm University, Ulm, Germany.,Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Otto
- Neurology Department, Ulm University, Ulm, Germany
| | | | | | - Heiko Braak
- Neurology Department, Ulm University, Ulm, Germany
| | | | | | - Thomas Meitinger
- SyNergy, Munich Cluster for Systems Neurology, Ludwig Maximilians Universität München, Germany.,Institute of Human Genetics, Technische Universität München, München, Germany
| | | | - Peter M Andersen
- Neurology Department, Ulm University, Ulm, Germany.,Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
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47
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Naumann M, Peikert K, Günther R, van der Kooi AJ, Aronica E, Hübers A, Danel V, Corcia P, Pan-Montojo F, Cirak S, Haliloglu G, Ludolph AC, Goswami A, Andersen PM, Prudlo J, Wegner F, Van Damme P, Weishaupt JH, Hermann A. Phenotypes and malignancy risk of different FUS mutations in genetic amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2019; 6:2384-2394. [PMID: 31682085 PMCID: PMC6917314 DOI: 10.1002/acn3.50930] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/29/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Mutations in Fused in Sarcoma (FUS or TLS) are the fourth most prevalent in Western European familial amyotrophic lateral sclerosis (ALS) populations and have been associated with causing both early and very late disease onset. FUS aggregation, DNA repair deficiency, and genomic instability are contributors to the pathophysiology of FUS-ALS, but their clinical significance per se and their influence on the clinical variability have yet to be sufficiently investigated. The aim of this study was to analyze genotype-phenotype correlations and malignancy rates in a newly compiled FUS-ALS cohort. METHODS We cross-sectionally reviewed FUS-ALS patient histories in a multicenter cohort with 36 novel cases and did a meta-analysis of published FUS-ALS cases reporting the largest genotype-phenotype correlation of FUS-ALS. RESULTS The age of onset (median 39 years, range 11-80) was positively correlated with the disease duration. C-terminal domain mutations were found in 90%. Among all, P525L and truncating/ frameshift mutations most frequently caused juvenile onset, rapid disease progression, and atypical ALS often associated with negative family history while the R521 mutation site was associated with late disease onset and pure spinal phenotype. Malignancies were found in one of 40 patients. INTERPRETATION We report the largest genotype-phenotype correlation of FUS-ALS, which enables a careful prediction of the clinical course in newly diagnosed patients. In this cohort, FUS-ALS patients did not have an increased risk for malignant diseases.
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Affiliation(s)
- Marcel Naumann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany.,Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, 18147, Germany
| | - Kevin Peikert
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, 18147, Germany
| | - Rene Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam UMC, Academic Medical Centre, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Eleonora Aronica
- Amsterdam UMC, Department of (Neuro)Pathology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Hübers
- Department of Neurology, German Center for Neurodegenerative Diseases, University of Ulm, Ulm, Germany
| | - Veronique Danel
- Centre expert pour la SLA et les maladies du motoneurone hôpital SALENGRO, CHU, Lille, France
| | - Philippe Corcia
- Centre expert pour la SLA et les maladies du motoneurone hôpital SALENGRO, CHU, Lille, France
| | - Francisco Pan-Montojo
- Department of Neurology, Klinikum der Universität München, Munich Cluster for Systems Neurology, SyNergy, Munich, 81377, Germany
| | - Sebahattin Cirak
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Göknur Haliloglu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, 06100, Turkey
| | - Albert C Ludolph
- Department of Neurology, German Center for Neurodegenerative Diseases, University of Ulm, Ulm, Germany
| | - Anand Goswami
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, 3052074, Germany
| | - Peter M Andersen
- Institute of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, SE-90185, Sweden
| | - Johannes Prudlo
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, 18147, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, 18147, Germany.,Department of Neurology, University of Rostock, Rostock, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Philip Van Damme
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Department for Neuroscience, VIB-KU Leuven Center for Brain & Disease Research, Leuven, Belgium
| | - Jochen H Weishaupt
- Department of Neurology, German Center for Neurodegenerative Diseases, University of Ulm, Ulm, Germany
| | - Andreas Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany.,Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, 18147, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, 18147, Germany.,Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, Rostock, 18147, Germany
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48
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Daria T, Müller K, Oidovdorj G, Baatar K, Boldbaatar P, Sarangerel J, Rentsenbat M, Turbat S, Yadamsuren E, Weydt P, Dambasuren B, Bosookhuu O, Banzrai C, Damchaa B, Pinkhardt EH, Rosenbohm A, Högel J, Andersen P, Borck G, Batmunkh M, Ludolph AC, Weishaupt JH. Genotypes of amyotrophic lateral sclerosis in Mongolia. J Neurol Neurosurg Psychiatry 2019; 90:1300-1302. [PMID: 31358569 DOI: 10.1136/jnnp-2019-320640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Tselmen Daria
- Department of Neurology, University of Ulm, Ulm, Germany.,Central Scientific Laboratory, Institute of Medical Sciences, Ulaanbaatar, Mongolia
| | - Kathrin Müller
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Gansuvd Oidovdorj
- Department of Neurology, Institute of Medical Sciences, Ulaanbaatar, Mongolia
| | - Khandsuren Baatar
- Department of Neurology, Institute of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | - Sarantsetseg Turbat
- Department of Neurology, Institute of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Bolormaa Dambasuren
- Department of Neurology, Institute of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oyungerel Bosookhuu
- Department of Neurology, Institute of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chimeglkham Banzrai
- Department of Neurology, Institute of Medical Sciences, Ulaanbaatar, Mongolia
| | - Baasanjav Damchaa
- Department of Neurology, Institute of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Josef Högel
- Institute of Human Genetics, Ulm University, Ulm, Germany
| | - Peter Andersen
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Guntram Borck
- Institute of Human Genetics, Ulm University, Ulm, Germany
| | - Munkhbat Batmunkh
- Central Scientific Laboratory, Institute of Medical Sciences, Ulaanbaatar, Mongolia
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49
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Rosenbohm A, Nagel G, Peter RS, Brehme T, Koenig W, Dupuis L, Rothenbacher D, Ludolph AC. Association of Serum Retinol-Binding Protein 4 Concentration With Risk for and Prognosis of Amyotrophic Lateral Sclerosis. JAMA Neurol 2019; 75:600-607. [PMID: 29482216 DOI: 10.1001/jamaneurol.2017.5129] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Knowledge about the metabolic states of patients with amyotrophic lateral sclerosis (ALS) may provide a therapeutic approach. Objective To investigate the association between the onset and prognosis of ALS and serum retinol-binding protein 4 (RBP4) concentration as a biomarker for insulin resistance and vitamin A metabolism. Design, Setting, and Participants Case-control design for risk factors of ALS; cohort design for prognostic factors within ALS cases. Between October 1, 2010, and June 30, 2014, a population-based case-control study with randomly selected controls was established based on the ALS Registry Swabia in southern Germany, with a target population of 8.4 million inhabitants. Response rates were 64.8% among the cases and 18.7% among the controls. The dates of analysis were April 2016 to May 2017. Main Outcomes and Measures Serum samples were measured for RBP4. Information on covariates was assessed by an interview-based standardized questionnaire. Main outcomes and measures were adjusted odds ratios for risk of ALS associated with serum RBP4 concentration, as well as time to death associated with RBP4 concentration at baseline in ALS cases only. Conditional logistic regression was applied to calculate multivariable odds ratios for risk of ALS. Survival models were used in cases only to appraise their prognostic value. Results Data from 289 patients with ALS (mean [SD] age, 65.7 [10.5] years; 172 [59.5%] male) and 504 controls (mean [SD] age, 66.3 [9.8] years; 299 [59.3%] male) were included in the case-control study. Compared with controls, ALS cases were characterized by lower body mass index, less educational attainment, smoking, light occupational work intensity, and self-reported diabetes. The median serum RBP4 concentration was lower in ALS cases than in controls (54.0 vs 59.5 mg/L). In the multivariable model, increasing RBP4 concentration was associated with reduced odds for ALS (top vs bottom quartile odds ratio, 0.36; 95% CI, 0.22-0.59; P for trend <.001), which persisted after further adjustment for renal function and for leptin and adiponectin. Among 279 ALS cases during a median follow-up of 14.5 months, 104 died (mean [SD] age, 68.9 [10.3] years; 56 [53.9%] male). In this ALS cohort, an inverse association was found between serum RBP4 concentration as a continuous measure and survival. Conclusions and Relevance RBP4 was inversely related to risk for and prognosis of ALS, suggesting that vitamin A metabolism or impaired insulin signaling could be involved. Further research, including a prospective design and other biological markers, is necessary to clarify the role of insulin resistance in the pathogenesis of ALS.
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Affiliation(s)
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Raphael S Peter
- Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Torben Brehme
- Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany.,Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich
| | - Luc Dupuis
- Institut National de la Santé et de la Récherche Médicale Unité 1118, Université de Strasbourg, Strasbourg, France
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50
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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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