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Shen D, Yang X, He D, Zhang K, Liu S, Sun X, Li J, Cai Z, Liu M, Zhang X, Liu Q, Cui L. Clinical and genetic characteristics of 1672 cases of amyotrophic lateral sclerosis in China: a single-center retrospective study. J Neurol 2024; 271:5541-5548. [PMID: 38896262 DOI: 10.1007/s00415-024-12513-y] [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: 04/17/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. In recent years, continuous discoveries of new ALS-causing genes have enhanced the understanding of the genotype-phenotype relationship in ALS, aiding in disease progression prediction and providing a more comprehensive basis for genetic diagnosis. METHODS A total of 1672 ALS patients who visited the Neurology Department of Peking Union Medical College Hospital between January 2014 and December 2022 and met the revised El Escorial diagnostic criteria were included. Clinical data were collected, whole exome sequencing and dynamic mutation screening of the C9ORF72 gene were performed, and the clinical phenotypes and genotypes of the patients were analyzed. RESULTS The average age of onset for the 1672 ALS patients was 52.6 ± 11.2 years (range 17-85 years), with a median disease duration of 14 months at the time of visit (interquartile range 9-24 months, range 2-204 months). The male to female ratio was 833:839. The patients included 297 (17.8%) with bulbar onset, 198 (11.8%) with flail arm/leg syndrome, 89 (5.3%) with familial ALS, and 52 (3.1%) with concomitant frontotemporal dementia (FTD). Pathogenic variants associated with ALS were detected in 175 patients (10.5% of the cohort), with the most common mutations being SOD1, FUS, and ANXA11. Among patients with familial ALS, 56.2% (50/89) had genetic mutations, compared to 7.9% (125/1583) in sporadic ALS cases. From the perspective of phenotype-genotype correlation, (1) In ALS-FTD patients, the most common genetic mutations were ANXA11 and C9ORF72 repeat expansions. Patients with flail arm/leg syndrome more frequently carried mutations in SOD1, ANXA11, and hnRNPA1; (2) Despite genetic heterogeneity, it was observed that mutations in FUS and NEK1 were more common in males, and patients with FUS mutations had a younger age of onset; mutations in SOD1 and SQSTM1 were more likely to present with lower limb onset. CONCLUSION This study provides comprehensive data on the genetic characteristics of ALS patients in China through large-scale clinical data and genetic analysis of 1672 cases. Differences in age of onset, onset site, and clinical phenotype among ALS patients with different genotypes can help clinicians better predict disease progression and provide a basis for precise diagnosis and individualized treatment.
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Affiliation(s)
- Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xunzhe Yang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Di He
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Kang Zhang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Shuangwu Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xiaohan Sun
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Jinyue Li
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhengyi Cai
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xue Zhang
- McKusick-Zhang Center for Genetic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qing Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China.
- McKusick-Zhang Center for Genetic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China.
- Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Liu X, Chen L, Ye S, Liu X, Zhang Y, Fan D. Postural instability and lower extremity dysfunction in upper motor neuron-dominant amyotrophic lateral sclerosis. Front Neurol 2024; 15:1406109. [PMID: 39076845 PMCID: PMC11284044 DOI: 10.3389/fneur.2024.1406109] [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: 03/24/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Abstract
Background Upper motor neuron-dominant ALS (UMND ALS) is recognized to have early onset and good prognosis, but may have a rapid decline in motor function due to gait instability in the early stage. We investigated changes in lower extremity function in UMND ALS, particularly UMND ALS patients accompanied with postural instability or repeated falls (UMND ALS plus). Results Among the 2,353 ALS patients reviewed, 211 (9.0%) had UMND ALS. UMND ALS had a longer diagnosis delay and restricted symptoms. Although UMND ALS patients had better lower extremity function and strength than matched classic ALS patients on first evaluation, there was no difference in the time of needing assistance or not being able to walk after disease onset. In contrast, UMND ALS plus has severe UMN symptoms and a more rapid decline in motor function. The lower extremity function was no better than that in the matched classic ALS. The prognosis of UMND ALS and UMND ALS plus were significantly better than those of overall ALS. Conclusion UMND ALS has restricted symptoms but has a rapid decline in lower extremity function in the early stage of the disease. The motor function decline of UMND ALS plus is as fast as classic ALS. Whether these patients represent a distinct subgroup of ALS deserves further investigation.
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Affiliation(s)
- Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaoxuan Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yingshuang Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- Key Laboratory for Neuroscience, National Health Commission, Ministry of Education, Peking University, Beijing, China
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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: 28] [Impact Index Per Article: 28.0] [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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Ashhurst JF, Tu S, Timmins HC, Kiernan MC. Progress, development, and challenges in amyotrophic lateral sclerosis clinical trials. Expert Rev Neurother 2022; 22:905-913. [PMID: 36543326 DOI: 10.1080/14737175.2022.2161893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Amyotrophic Lateral Sclerosis (ALS) brings unique challenges to a clinical trial setting, due in part to relatively low disease prevalence coupled with a poor prognosis, in addition to the complexities linked to disease heterogeneity. As critical understanding of the disease develops, particularly in relation to clinical phenotype and the mechanisms of disease progression, so too new concepts evolve in relation to clinical trials, including the advent of precision therapy, targeted to subgroups of ALS patients. AREAS COVERED Individualized, or precision medicine in ALS recognizes the heterogeneous nature of the disease and utilizes information such as the clinical phenotype of the disease, clinical biomarkers, and genotyping to promote a tailored approach to treatment. Separate to these considerations, the present review will discuss clinical trial design and how this can be improved to better match patient and investigator needs in ALS clinical trials. EXPERT OPINION Precision therapy will promote a more focused treatment approach, with the goal of improving clinical outcomes for ALS patients. An increased community awareness of ALS, coupled with significant industry and philanthropic funding for ALS research, is accelerating this process.
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Affiliation(s)
| | - Sicong Tu
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Hannah C Timmins
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Camperdown, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
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Cook SF, Rhodes T, Schlusser C, Han S, Chen C, Zach N, Murthy V, Davé S. A Descriptive Review of Global Real World Evidence Efforts to Advance Drug Discovery and Clinical Development in Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:770001. [PMID: 34819914 PMCID: PMC8606522 DOI: 10.3389/fneur.2021.770001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022] Open
Abstract
Understanding patient clinical progression is a key gateway to planning effective clinical trials and ultimately enabling bringing treatments to patients in need. In a rare disease like amyotrophic lateral sclerosis (ALS), studies of disease natural history critically depend on collaboration between clinical centers, regions, and countries to enable creation of platforms to allow patients, caregivers, clinicians, and researchers to come together and more fully understand the condition. Rare disease registries and collaborative platforms such as those developed in ALS collect real-world data (RWD) in standardized formats, including clinical and biological specimen data used to evaluate risk factors and natural history of disease, treatment patterns and clinical (ClinROs) and patient- reported outcomes (PROs) and validate novel endpoints. Importantly, these data support the development of new therapeutics by supporting the evaluation of feasibility and design of clinical trials and offer valuable information on real-world disease trajectory and outcomes outside of the clinical trial setting for comparative purposes. RWD may help to accelerate therapy development by identifying and validating outcome measures and disease subpopulations. RWD can also make potential contributions to the evaluation of the safety and effectiveness of new indications for approved products and to satisfy post-approval regulatory and market access requirements. There is a lack of amalgamated information on available registries, databases, and other sources of real-world data on ALS; thus, a global review of all available resources was warranted. This targeted review identifies and describes ALS registries, biobanks and collaborative research networks that are collecting and synthesizing RWD for the purposes of increasing patient awareness and advancing scientific knowledge with the hope of expediting future development of new therapies.
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Affiliation(s)
- Suzanne F Cook
- CERobs Consulting, LLC, Wrightsville Beach, NC, United States
| | - Thomas Rhodes
- CERobs Consulting, LLC, Wrightsville Beach, NC, United States
| | - Courtney Schlusser
- Gillings School of Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Steve Han
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| | - Chao Chen
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| | - Neta Zach
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| | - Venkatesha Murthy
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| | - Shreya Davé
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
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He Z, Sun B, Feng F, Bai J, Wang H, Wang H, Yang F, Cui F, Huang X. Time of symptoms beyond the bulbar region predicts survival in bulbar onset amyotrophic lateral sclerosis. Neurol Sci 2021; 43:1817-1822. [PMID: 34383162 DOI: 10.1007/s10072-021-05556-w] [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: 05/05/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Spreading pattern and time interval of spreading are getting more and more attention. The aim of present study was to investigate spreading pattern in bulbar onset ALS patients and to explore the relationship between time interval of spreading and survival. METHODS ALS patients with bulbar onset diagnosed at Chinese PLA General Hospital from January 2015 to December 2018 were recruited. Clinical features including gender, onset age, diagnostic delay, the second involved region (SIR), time of symptoms beyond the bulbar region, forced vital capacity (FVC), ALSFRS-R score, electromyography results, and survival time were retrospectively collected. RESULTS A total of 96 bulbar onset ALS patients were collected. Overall patients showed female predominance. Median age at onset was 56 years. Median diagnostic delay was 8.5 months. Median time of symptoms beyond the bulbar region (TBBR) was 7 months. Median ALSFRS-R score at baseline was 40. Fifty-six (58.3%) patients' SIR were upper limb, 6 (6.3%) patients' SIR were lower limb, 3 (3.1%) patients' SIR were upper and lower limbs, and 5 (5.2%) patients' SIR were thoracic region. Twenty-six (27.1%) patients did not report SIR. The median survival time of patients with TBBR ≥ 7 months was significantly longer than that with TBBR < 7 month. Multivariate Cox regression showed that onset age and TBBR were prognostic factors. CONCLUSIONS In bulbar onset ALS patients, cervical region is the second most common SIR. TBBR is an independent prognostic factor.
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Affiliation(s)
- Zhengqing He
- Medical School of Chinese PLA, Beijing, China.,Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Bo Sun
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.,Geriatric Neurological Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Feng Feng
- Department of Neurology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Jiongming Bai
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Haoran Wang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Hongfen Wang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Fei Yang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Fang Cui
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.,Department of Neurology, Hainan Hospital of PLA General Hospital, Hainan, China
| | - Xusheng Huang
- Medical School of Chinese PLA, Beijing, China. .,Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
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7
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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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Phua CS, Ng A, Brooks C, Harrington Z, Vedam H, Huynh T, Seccombe D, Aouad P, Cordato D. Prevalence and factors associated with advanced care directives in a motor neuron disease multidisciplinary clinic in Australia. Postgrad Med J 2020; 97:566-570. [PMID: 32788311 DOI: 10.1136/postgradmedj-2020-138184] [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: 05/14/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decline and death. Multidisciplinary MND clinics provide an integrated approach to management and facilitate discussion on advanced care directives (ACDs). The study objectives are to analyse (1) the prevalence of ACD in our MND clinic, (2) the relationship between ACD and patient demographics and (3) the relationship between ACD decision-making and variables such as NIV, PEG, hospital admissions and location of death. METHODS Using clinic records, all patients who attended the MND clinic in Liverpool Hospital between November 2014 and November 2019 were analysed. Data include MND subtypes, symptom onset to time of diagnosis, time of diagnosis to death, location and reason of death. ACD prevalence, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) requirements were analysed. RESULTS There were 78 patients; M:F=1:1. 44 (56%) patients were limb onset, 28 (36%) bulbar onset, 4 primary lateral sclerosis and 2 flail limb syndrome presentations. 27% patients completed ACDs, while 32% patients declined ACDs. Patients born in Australia or in a majority English-speaking country were more likely to complete ACDs compared to those born in a non-English-speaking country. There was no significant correlation between ACD completion and age, gender, MND subtype, symptom duration, NIV, PEG feeding, location of death. CONCLUSION One-quarter of patients completed ACDs. ACDs did not correlate with patient age, gender, MND subtype and symptom duration or decision-making regarding NIV, PEG feeding or location of death. Further studies are needed to address factors influencing patients' decisions regarding ACDs.
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Affiliation(s)
- Chun Seng Phua
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, Australia .,School of Medicine, University of New South Wales, Sydney, Australia
| | - Aloysius Ng
- Department of Intensive Care, Lismore Base Hospital, Lismore, Australia
| | - Christopher Brooks
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurosurgery, Liverpool Hospital, Liverpool, Australia
| | - Zinta Harrington
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, Australia
| | - Hima Vedam
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, Australia
| | - Thang Huynh
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Palliative Care, Liverpool Hospital, Liverpool, Australia
| | - Desi Seccombe
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Palliative Care, Liverpool Hospital, Liverpool, Australia
| | - Patrick Aouad
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Dennis Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
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Spencer KR, Foster ZW, Rauf NA, Guilderson L, Collins D, Averill JG, Walker SE, Robey I, Cherry JD, Alvarez VE, Huber BR, McKee AC, Kowall NW, Brady CB, Stein TD. Neuropathological profile of long-duration amyotrophic lateral sclerosis in military Veterans. Brain Pathol 2020; 30:1028-1040. [PMID: 32633852 PMCID: PMC8018169 DOI: 10.1111/bpa.12876] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting both the upper and lower motor neurons. Although ALS typically leads to death within 3 to 5 years after initial symptom onset, approximately 10% of patients with ALS live more than 10 years after symptom onset. We set out to determine similarities and differences in clinical presentation and neuropathology in persons with ALS with long vs. those with standard duration. Participants were United States military Veterans with a pathologically confirmed diagnosis of ALS (n = 179), dichotomized into standard duration (<10 years) and long-duration (≥10 years). The ALS Functional Rating Scale-Revised (ALSFRS-R) was administered at study entry and semi-annually thereafter until death. Microglial density was determined in a subset of participants. long-duration ALS occurred in 76 participants (42%) with a mean disease duration of 16.3 years (min/max = 10.1/42.2). Participants with long-duration ALS were younger at disease onset (P = 0.002), had a slower initial ALS symptom progression on the ALSFRS-R (P < 0.001) and took longer to diagnose (P < 0.002) than standard duration ALS. Pathologically, long-duration ALS was associated with less frequent TDP-43 pathology (P < 0.001). Upper motor neuron degeneration was similar; however, long-duration ALS participants had less severe lower motor neuron degeneration at death (P < 0.001). In addition, the density of microglia was decreased in the corticospinal tract (P = 0.017) and spinal cord anterior horn (P = 0.009) in long-duration ALS. Notably, many neuropathological markers of ALS were similar between the standard and long-duration groups and there was no difference in the frequency of known ALS genetic mutations. These findings suggest that the lower motor neuron system is relatively spared in long-duration ALS and that pathological progression is likely slowed by as yet unknown genetic and environmental modifiers.
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Affiliation(s)
| | | | | | | | | | | | | | - Ian Robey
- Southern Arizona VA Healthcare SystemTucsonAZ
| | - Jonathan D. Cherry
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMA
| | - Victor E. Alvarez
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Bertrand R. Huber
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Ann C. McKee
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
| | - Neil W. Kowall
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of NeurologyBoston University School of MedicineBostonMA
| | - Christopher B. Brady
- VA Boston Healthcare SystemBostonMA,Department of NeurologyBoston University School of MedicineBostonMA,Division of AgingBrigham and Women's Hospital, Harvard Medical SchoolBostonMA
| | - Thor D. Stein
- VA Boston Healthcare SystemBostonMA,Boston University Alzheimer's Disease and CTE Center, Boston University School of MedicineBostonMA,Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMA,Department of Veterans Affairs Medical CenterBedfordMA
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