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Srinivasan V, Homer V, Barton D, Clutterbuck-James A, Jenkins S, Potter C, Brock K, Logan A, Smith D, Bruce L, Nagy Z, Bach SP. A low molecular weight dextran sulphate, ILB®, for the treatment of amyotrophic lateral sclerosis (ALS): An open-label, single-arm, single-centre, phase II trial. PLoS One 2024; 19:e0291285. [PMID: 38990927 PMCID: PMC11239073 DOI: 10.1371/journal.pone.0291285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 06/02/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig´s disease, is a rare neurological condition and is the most common motor neurone disease. It is a fatal disease with specific loss of motor neurons in the spinal cord, brain stem, and motor cortex leading to progressive paralysis and usually death within five years of diagnosis. There remains no cure for ALS, and management is focused on a combination of neuroprotective medication, respiratory support, and management by multidisciplinary clinics. PATIENTS AND METHODS This prospective, single-arm, open-label phase II clinical trial of sustained weekly administration of 2 mg/kg ILB® (a low-molecular weight dextran sulphate) was conducted in a single UK hospital. Eligible patients were at least 18 years and had a definite diagnosis of ALS according to El Escorial Criteria. The co-primary outcomes were safety, tolerability, and quantity of ILB® administered. EudraCT number. 2018-000668-28. FINDINGS Between 18-Apr-2019 and 27-Mar-2020, 11 patients were recruited and treated for up to 38 weeks. There were no treatment terminations or withdrawals. One serious adverse event was reported, which was not related to ILB® and resolved without sequalae. 270 mild/moderate adverse events were reported with no intolerable events occurring during the trial. The total number of ILB® treatments administered per patient ranged from 4 to 38, with a cumulative dose ranging from 745 to 6668 mg. As a result of the COVID-19 pandemic and the high-risk status of study participants, recruitment and treatment was suspended early in Mar-2020. At the long-term follow-up, three patients had died after the trial was halted, between 53 and 62 weeks after their final ILB® injection. INTERPRETATION Long-term weekly ILB® injections of 2 mg/kg was well tolerated and had an acceptable safety profile in patients with ALS. TRIAL REGISTRATION EudraCT: 2018-000668-28. clinicaltrials.gov: NCT03705390. This trial adheres to the principles of GCP in the design, conduct, recording and reporting of clinical trials as listed in part 2, "Conditions and Principles which apply to all Clinical Trials" under the header "Principles based on Articles 2 to 5 of the EU GCP Directive" in the Medicines for Human Use Clinical Trials Regulations (as amended in SI 2006/1928). For clarity, the study did not conform to all aspects of the International Conference on Harmonisation (ICH) E6 R2 Guidelines for GCP (also known as 'ICH GCP'). Of note, we did not use an external database, perform 100% source data verification, and only primary outcome data were analysed in parallel by a second, independent statistician.
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Affiliation(s)
- Venkataramanan Srinivasan
- Neurology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Victoria Homer
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Darren Barton
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Abigail Clutterbuck-James
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Siân Jenkins
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Claire Potter
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Kristian Brock
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Ann Logan
- Department of Biomedical Sciences, University of Warwick, Coventry, United Kingdom
- Axolotl Consulting Limited, Droitwich, United Kingdom
| | - Donna Smith
- Birmingham Clinical Trials Unit, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Lars Bruce
- Tikomed AB, Karlsfältsvägen, Viken, Sweden
| | - Zsuzsanna Nagy
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Simon P Bach
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Howard IM, Sedarsky K, Gallagher M, Miller M, Puffer RC. Combat-related peripheral nerve injuries. Muscle Nerve 2024. [PMID: 38837797 DOI: 10.1002/mus.28168] [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: 11/21/2023] [Revised: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Active-duty service members (ADSM) and military Veterans represent a population with increased occupational risk for nerve injuries sustained both during training operations and wartime. Mechanisms of war-related nerve injuries have evolved over time, from the musket ball-related traumas described by S.W. Mitchell to complex blast injuries and toxic exposures sustained during Middle East conflicts in the 21st century. Commonly encountered nerve injury etiologies in this population currently include compression, direct trauma, nutritional deficits, traumatic limb amputation, toxic chemical exposures, or blast-related injuries. Expeditious identification and comprehensive, interdisciplinary treatment of combat-associated neuropathies, as well as prevention of these injuries whenever possible is critical to reduce chronic morbidity and disability for service members and to maintain a well-prepared military. However, diagnosis of a combat-associated nerve injury may be particularly challenging due to comorbid battlefield injuries or delayed presentation of neuropathy from military toxic exposures. Advances in imaging for nerve injury, including MRI and ultrasound, provide useful tools to compliment EMG in establishing a diagnosis of combat-associated nerve injury, particularly in the setting of anatomic disruption or edema. Surgical techniques can improve pain control or restoration of function. In all cases, comprehensive interdisciplinary rehabilitation provides the best framework for optimization of recovery. Further work is needed to prevent combat-associated nerve injuries and promote nerve recovery following injury.
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Affiliation(s)
- Ileana M Howard
- Rehabilitation Care Services, VA Puget Sound Healthcare System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Kaye Sedarsky
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Gallagher
- Rehabilitation Care Services, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Matthew Miller
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ross C Puffer
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Hobin F, De Vocht J, Lamaire N, Beyens H, Ombelet F, Van Damme P. Specialized multidisciplinary care improves ALS survival in Belgium: a population-based retrospective study. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:282-289. [PMID: 38240367 DOI: 10.1080/21678421.2024.2304058] [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: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
ALS is a neurodegenerative disease characterized by loss of motor neurons, resulting in progressive weakness and wasting of muscles. The average survival time is 2-5 years, mostly due to respiratory failure. Since current therapies can prolong survival time by only a few months, multidisciplinary care remains the cornerstone of the management of ALS. At the ALS Expert Centre of University Hospitals Leuven, a large proportion of Belgian ALS patients are seen for diagnosis and a significant number is also in follow-up with the multidisciplinary team. In this retrospective study, we compared the outcome of incident patients who were in follow-up at our site with patients who were not in follow-up. We included 659 patients of which 557 (84.5%) received specialized care at the ALS Expert Centre. After adjusting for clinically relevant prognostic parameters, multidisciplinary follow-up significantly prolonged survival (p = 0.004; HR = 0.683; CI 95% [0.528 - 0.884]). This increase in survival is mainly driven by patients with spinal onset (p = 0.035; HR = 0.746; CI 95% [0.568 - 0.980]), since no significant increased survival time was observed in patients with bulbar onset (p = 0.28; HR = 0.778; CI 95% [0.495 - 1.223]). These data confirm that multidisciplinary follow-up contributes to a better outcome of patients, emphasizing the importance of multidisciplinary specialized care in ALS.
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Affiliation(s)
- Frederik Hobin
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, and Leuven Brain Institute (LBI), KU Leuven-University of Leuven, Leuven, Belgium, and
- VIB, Centre for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Joke De Vocht
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, and Leuven Brain Institute (LBI), KU Leuven-University of Leuven, Leuven, Belgium, and
- VIB, Centre for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Nikita Lamaire
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Beyens
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Fouke Ombelet
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, and Leuven Brain Institute (LBI), KU Leuven-University of Leuven, Leuven, Belgium, and
- VIB, Centre for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Philip Van Damme
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, and Leuven Brain Institute (LBI), KU Leuven-University of Leuven, Leuven, Belgium, and
- VIB, Centre for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
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Oh J, An J, Park K, Park Y. Psychosocial interventions for people with amyotrophic lateral sclerosis and motor neuron disease and their caregivers: a scoping review. BMC Nurs 2024; 23:75. [PMID: 38287331 PMCID: PMC10823680 DOI: 10.1186/s12912-024-01721-6] [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: 11/02/2023] [Accepted: 01/07/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND As amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) is a fatal progressive neurodegenerative disorder, patients experience severe impairments, with patients and family caregivers facing emotional distress and exhaustion. Several psychosocial interventions are aimed at providing tailored support for ALS/MND patients and caregivers. The aim of this study was to conduct a scoping review and present a comprehensive overview of psychosocial interventions designed for individuals and families affected by ALS/MND, while also pinpointing research gaps. METHODS This scoping review utilized Arksey and O'Malley's methodological framework to investigate psychosocial interventions designed for individuals with ALS/MND and their families. The study adhered to the PRISMA-ScR checklist for reporting. RESULTS A total of 27 articles describing 25 interventions met the inclusion criteria. The predominant interventions observed in the research encompassed education-related strategies, closely followed by behavior therapy, counseling, social support interventions, and psychotherapy interventions. Across the majority of the studies, findings indicated promising feasibility and acceptability of these interventions. Notably, a significant proportion of quantitative investigations yielded one or more statistically significant effects, while qualitative studies consistently reported favorable outcomes, including enhancements in well-being and heightened awareness of individual circumstances. CONCLUSIONS Given the progressive and debilitating nature of this condition, coupled with the absence of a cure, the adoption of a psychosocial approach can prove beneficial for both ALS/MND patients and their families. However, high-quality RCTs with a large sample size are recommended to examine and confirm the effectiveness.
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Affiliation(s)
- Juyeon Oh
- College of Nursing, Dankook University, 119 Dandae-Ro, Dongnam-Gu, Cheonan-Si, Chungcheongnam-Do, 31116, South Korea
| | - Jiwon An
- Department of Nursing, Far East University, 76-32, Daehak-Gil, Gamgok-Myeon, , Eumseong-Gun, Chungcheongbuk-Do, 27601, South Korea
| | - Kyongok Park
- Department of Nursing, Gangneung-Wonju National University, 150, Namwon-Ro, Heungeop-Myeon, Wonju-Si, Gangwon-Do, 26403, South Korea
| | - Youngok Park
- Department of Nursing, Gangneung-Wonju National University, 150, Namwon-Ro, Heungeop-Myeon, Wonju-Si, Gangwon-Do, 26403, South Korea.
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Gwathmey K, Heiman-Patterson TD. Multidisciplinary Clinics in Neuromuscular Medicine. Continuum (Minneap Minn) 2023; 29:1585-1594. [PMID: 37851044 DOI: 10.1212/con.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
ABSTRACT Multidisciplinary care is comprehensive, coordinated clinical care across medical disciplines and allied health professions. Neuromuscular disorders, such as amyotrophic lateral sclerosis and muscular dystrophies, are often associated with disabling weakness and extramuscular symptoms and may benefit from care in a model that consolidates numerous clinic visits into a single more efficient multidisciplinary clinic visit. The goal of the neuromuscular multidisciplinary care model is to improve patient outcomes, patient satisfaction, quality of life, access to medications and equipment, and survival. Although the costs of running a multidisciplinary clinic are high, they are likely associated with cost savings from the patient's perspective. Several barriers to acceptance of multidisciplinary clinics include the distance needed to travel to the clinic and the duration of the clinic visit. Telehealth multidisciplinary clinic visits may address some of these concerns. Further study is needed to understand the value of multidisciplinary clinics and is a necessary step toward creating a sustainable model.
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Huynh A, Adams K, Barnett-Tapia C, Kalra S, Zinman L, Yunusova Y. Accessing and Receiving Speech-Language Pathology Services at the Multidisciplinary Amyotrophic Lateral Sclerosis Clinic: An Exploratory Qualitative Study of Patient Experiences and Needs. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-13. [PMID: 37678221 DOI: 10.1044/2023_jslhr-23-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE This study sought to explore how patients with amyotrophic lateral sclerosis (ALS) presenting with coexisting bulbar and cognitive impairments and their caregivers experienced the speech-language pathologist (SLP) services provided in multidisciplinary ALS clinics in Canada and identified their perceived needs for bulbar symptom management. METHOD This qualitative study was informed by interpretive description. Seven interviews were conducted with patients with severe bulbar dysfunction or severe bulbar and cognitive dysfunction due to ALS or ALS-frontotemporal dementia, respectively, and/or their caregivers. Purposive sampling was used to recruit individuals with severe bulbar or bulbar and cognitive disease. Thematic analysis was used to analyze interview data. RESULTS Patients and caregivers reported difficulties with accessing and receiving SLP services at the multidisciplinary ALS clinic. These difficulties were further exacerbated in those with severe cognitive disease. Participants expressed a need for more specific (i.e., disease and service-related) information and personalized care to address their changing needs and preferences. Engaging caregivers earlier in SLP appointments was perceived as vital to support care planning and provide in-time caregiver education. CONCLUSIONS This study highlighted the challenges experienced by patients and caregivers in accessing and receiving SLP services. There is a pressing need for a more person-centered approach to ALS care and a continuing need for education of SLPs on care provision in cases of complex multisymptom diseases within a multidisciplinary ALS clinic. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24069222.
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Affiliation(s)
- Anna Huynh
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | | | | | - Sanjay Kalra
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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Berlowitz DJ, Mathers S, Hutchinson K, Hogden A, Carey KA, Graco M, Whelan BM, Charania S, Steyn F, Allcroft P, Crook A, Sheers NL. The complexity of multidisciplinary respiratory care in amyotrophic lateral sclerosis. Breathe (Sheff) 2023; 19:220269. [PMID: 37830099 PMCID: PMC10567075 DOI: 10.1183/20734735.0269-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/20/2023] [Indexed: 10/14/2023] Open
Abstract
Motor neurone disease/amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder with no known cure, where death is usually secondary to progressive respiratory failure. Assisting people with ALS through their disease journey is complex and supported by clinics that provide comprehensive multidisciplinary care (MDC). This review aims to apply both a respiratory and a complexity lens to the key roles and areas of practice within the MDC model in ALS. Models of noninvasive ventilation care, and considerations in the provision of palliative therapy, respiratory support, and speech and language therapy are discussed. The impact on people living with ALS of both inequitable funding models and the complexity of clinical care decisions are illustrated using case vignettes. Considerations of the impact of emerging antisense and gene modifying therapies on MDC challenges are also highlighted. The review seeks to illustrate how MDC members contribute to collective decision-making in ALS, how the sum of the parts is greater than any individual care component or health professional, and that the MDC per se adds value to the person living with ALS. Through this approach we hope to support clinicians to navigate the space between what are minimum, guideline-driven, standards of care and what excellent, person-centred ALS care that fully embraces complexity could be. Educational aims To highlight the complexities surrounding respiratory care in ALS.To alert clinicians to the risk that complexity of ALS care may modify the effectiveness of any specific, evidence-based therapy for ALS.To describe the importance of person-centred care and shared decision-making in optimising care in ALS.
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Affiliation(s)
- David J. Berlowitz
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
| | - Susan Mathers
- Calvary Health Care Bethlehem, Caulfield South, Australia
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Central Coast Local Health District, Gosford, Australia
| | - Anne Hogden
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Kate A. Carey
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Marnie Graco
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Brooke-Mai Whelan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Salma Charania
- Motor Neurone Disease Association of Queensland, Oxley, Australia
| | - Frederik Steyn
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Allcroft
- Southern Adelaide Palliative Services, Flinders Medical Centre, Bedford Park, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Ashley Crook
- Graduate School of Health, University of Technology Sydney, Chippendale, Australia
- Centre for MND Research and Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Nicole L. Sheers
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
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Kuchinad K, Nadeem M, Mehta AK, Wu DS, Harris CM, Albayda J. Palliative Care Utilization for Hospitalized Patients With Inclusion Body Myositis: A Nationwide Study. J Clin Rheumatol 2023; 29:e130-e133. [PMID: 37370210 DOI: 10.1097/rhu.0000000000001997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Affiliation(s)
| | - Mahrukh Nadeem
- From the Department of Rheumatology, Johns Hopkins Medicine
| | | | - David Shih Wu
- Palliative Care Program, Johns Hopkins Bayview Medical Center
| | - Ché Matthew Harris
- Department of Hospital Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Jemima Albayda
- From the Department of Rheumatology, Johns Hopkins Medicine
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Kvam KA, Benatar M, Brownlee A, Caller T, Das RR, Green P, Kolodziejczak S, Russo J, Sanders D, Sethi N, Stavros K, Stierwalt J, Giles Walters N, Bennett A, Wessels SR, Brooks BR. Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update: Quality Improvement in Neurology. Neurology 2023; 101:223-232. [PMID: 37524529 PMCID: PMC10401684 DOI: 10.1212/wnl.0000000000207166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/24/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Kathryn A Kvam
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Michael Benatar
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Alisa Brownlee
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Tracie Caller
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Rohit R Das
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Phil Green
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Sherry Kolodziejczak
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - John Russo
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Danica Sanders
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Nadia Sethi
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Kara Stavros
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Julie Stierwalt
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Nancy Giles Walters
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Amy Bennett
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Scott R Wessels
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
| | - Benjamin Rix Brooks
- From the Department of Neurology and Neurological Sciences (K.A.K.), Stanford University, Palo Alto, CA; Department of Neurology (M.B.), Leonard M. Miller School of Medicine, University of Miami, FL; The ALS Association (A.B., J.R.), Washington, DC; Cheyenne Regional Medical Group (T.C.), WY; Department of Neurology (R.R.D.), UT Southwestern Medical Center, Dallas, TX; I AM ALS (P.G., N.S.), Washington, DC; Crestwood ALS Care Clinic (S.K.), Huntsville, AL; Sean M. Healey & AMG Center for ALS (D.S.), Massachusetts General Hospital, Boston; Department of Neurology (K.S.), Warren Alpert Medical School of Brown University, Providence, RI; Mayo Clinic (J.S.), Rochester, MN; Academy of Nutrition and Dietetics (N.G.W.), Chicago, IL; American Academy of Neurology (A.B., S.R.W.), Minneapolis, MN; and Department of Neurology (B.R.B.), Carolinas Medical Center, University of North Carolina School of Medicine, Charlotte
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Dulski J, Piña AES, Al-Shaikh RH, Petrucelli L, Wszolek ZK. Predominant motor neuron involvement as a manifestation of pathogenic (full range) ATXN3 mutations. Neurol Sci 2023; 44:389-392. [PMID: 36149513 PMCID: PMC10112464 DOI: 10.1007/s10072-022-06410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Jarosław Dulski
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
- Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
- Neurology Department, St Adalbert Hospital, Copernicus PL Ltd., Gdansk, Poland
| | | | - Rana Hanna Al-Shaikh
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, USA
| | - Zbigniew K Wszolek
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Cafarella P, Effing T, Chur-Hansen A. Interventions targeting psychological well-being for motor neuron disease carers: A systematic review. Palliat Support Care 2022; 21:1-17. [PMID: 35287783 DOI: 10.1017/s1478951522000311] [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: 11/08/2022]
Abstract
OBJECTIVES This systematic review considers interventions designed to improve the psychological well-being (PWB) of carers of people with motor neuron disease (MND) using quantitative, qualitative, or mixed-methods studies, and aimed to (1) summarize current research, (2) assess the quality of evidence, and (3) evaluate the effectiveness of interventions. METHOD Mixed-methods systematic review (MMSR) was conducted based on Joanna Briggs Institute methodology for quantitative, qualitative, and mixed-methods reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Thirteen papers met the inclusion criteria, including 12 studies (six mixed-methods, four quantitative, and two qualitative). Four studies described randomized controlled trials, seven detailed uncontrolled longitudinal studies with a single treatment group and a pre-post design, and one was an observational survey. Critical appraisal of the studies revealed a wide range of weaknesses in the quantitative and/or qualitative methodologies. Due to the heterogeneity of interventions, outcomes, and measurements, a narrative and convergent approach to data synthesis was employed. While a minority of studies demonstrated some benefits to hedonic and eudaimonic aspects of PWB, the interpretability of these data was limited by methodological problems. SIGNIFICANCE OF RESULTS This MMSR highlighted a paucity of quality research regarding interventions for the PWB of MND carers. Although some benefits to PWB were demonstrated, most studies suffered from substantial methodological problems, rendering the overall evidence base low. High-quality and carefully designed studies are a priority to enable effective development and testing of much-needed interventions targeting the PWB for MND carers.
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Affiliation(s)
- Paul Cafarella
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
- Department of Respiratory Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
- College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Tanja Effing
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
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12
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Su WM, Cheng YF, Jiang Z, Duan QQ, Yang TM, Shang HF, Chen YP. Predictors of survival in patients with amyotrophic lateral sclerosis: A large meta-analysis. EBioMedicine 2021; 74:103732. [PMID: 34864363 PMCID: PMC8646173 DOI: 10.1016/j.ebiom.2021.103732] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023] Open
Abstract
Background The survival time of amyotrophic lateral sclerosis (ALS) is greatly variable and protective or risk effects of the potential survival predictors are controversial. Thus, we aim to undertake a comprehensive meta-analysis of studies investigating non-genetic prognostic and survival factors in patients with ALS. Methods A search of relevant literature from PubMed, Embase, Cochrane library and other citations from 1st January 1966 to 1st December 020 was conducted. Random-effects models were conducted to pool the multivariable or adjusted hazard ratios (HR) by Stata MP 16.0. PROSPERO registration number: CRD42021256923. Findings A total of 5717 reports were identified, with 115 studies meeting pre-designed inclusion criteria involving 55,169 ALS patients. Five dimensions, including demographic, environmental or lifestyle, clinical manifestations, biochemical index, therapeutic factors or comorbidities were investigated. Twenty-five prediction factors, including twenty non-intervenable and five intervenable factors, were associated with ALS survival. Among them, NFL (HR:3.70, 6.80, in serum and CSF, respectively), FTD (HR:2.98), ALSFRS-R change (HR:2.37), respiratory subtype (HR:2.20), executive dysfunction (HR:2.10) and age of onset (HR:1.03) were superior predictors for poor prognosis, but pLMN or pUMN (HR:0.32), baseline ALSFRS-R score (HR:0.95), duration (HR:0.96), diagnostic delay (HR:0.97) were superior predictors for a good prognosis. Our results did not support the involvement of gender, education level, diabetes, hypertension, NIV, gastrostomy, and statins in ALS survival. Interpretation Our study provided a comprehensive and quantitative index for assessing the prognosis for ALS patients, and the identified non-intervenable or intervenable factors will facilitate the development of treatment strategies for ALS. Funding This study was supported by the National Natural Science Fund of China (Grant No. 81971188), the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant No. 2019HXFH046), and the Science and Technology Bureau Fund of Sichuan Province (No. 2019YFS0216).
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Affiliation(s)
- Wei-Ming Su
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang-Fan Cheng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing-Qing Duan
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tian-Mi Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui-Fang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yong-Ping Chen
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare disease center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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13
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Mariani L, Ruoppolo G, Cilfone A, Cocchi C, Preziosi Standoli J, Longo L, Ceccanti M, Greco A, Inghilleri M. Progression of Oropharyngeal Dysphagia in Amyotrophic Lateral Sclerosis: A Retrospective Cohort Study. Dysphagia 2021; 37:868-878. [PMID: 34297153 PMCID: PMC9345800 DOI: 10.1007/s00455-021-10346-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/08/2021] [Indexed: 01/03/2023]
Abstract
Little is known regarding the optimal timing of dysphagia assessment and PEG indication in amyotrophic lateral sclerosis (ALS). The study aims to investigate the progression of dysphagia in a cohort of ALS patients and to analyse whether there are variables linked to a faster progression of dysphagia and faster indication of PEG placement. A retrospective cohort study in 108 individuals with ALS. Fiberoptic endoscopic evaluation of swallowing was performed 6 monthly until PEG indication or death. Dysphagia severity and PEG indication were assessed using Penetration Aspiration Scale. Progression Index (PI) analysed the risk of disease progression (fast/slow) in relation to dysphagia onset and PEG indication. Patients were grouped based on ALS onset and PI. Person-time incidence rates were computed considering dysphagia onset and PEG indication from ALS symptoms during the entire observation period and have been reported as monthly and 6-month rates. Cox regression survival analysis assessed dysphagia and PEG risk factors depending on onset. Person-time incidence rates of dysphagia progression and PEG risk were increased based on type of ALS onset and PI. Patients with a fast progressing disease and with bulbar onset (BO) show statistically significant increased risk of dysphagia (BO 178.10% hazard ratio (HR) = 2.781 P < 0.01; fast 181.10% HR 2.811 P < 0.01). Regarding PEG risk, fast patients and patients with BO had a statistically significant increased risk (fast 147.40% HR 2.474 P < 0.01, BO 165.40% HR 2.654 P < 0.01). Fast PI predicts the likelihood of faster progression of dysphagia and PEG indication and should be included in multidisciplinary assessments and considered in the design of future guidelines regarding dysphagia management in ALS patients. Level of Evidence Level IV.
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Affiliation(s)
- Laura Mariani
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy.
| | - Giovanni Ruoppolo
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Armando Cilfone
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Chiara Cocchi
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Jacopo Preziosi Standoli
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Lucia Longo
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Marco Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Antonio Greco
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Maurizio Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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