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Vucic S, Ferguson TA, Cummings C, Hotchkin MT, Genge A, Glanzman R, Roet KCD, Cudkowicz M, Kiernan MC. Gold Coast diagnostic criteria: Implications for ALS diagnosis and clinical trial enrollment. Muscle Nerve 2021; 64:532-537. [PMID: 34378224 DOI: 10.1002/mus.27392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/10/2022]
Abstract
Diagnostic criteria for amyotrophic lateral sclerosis (ALS) are complex, incorporating multiple levels of certainty from possible through to definite, and are thereby prone to error. Specifically, interrater variability was previously established to be poor, thereby limiting utility as diagnostic enrollment criteria for clinical trials. In addition, the different levels of diagnostic certainty do not necessarily reflect disease progression, adding confusion to the diagnostic algorithm. Realizing these inherent limitations, the World Federation of Neurology, the International Federation of Clinical Neurophysiology, the International Alliance of ALS/MND Associations, the ALS Association (United States), and the Motor Neuron Disease Association convened a consensus meeting (Gold Coast, Australia, 2019) to consider the development of simpler criteria that better reflect clinical practice, and that could merge diagnostic categories into a single entity. The diagnostic accuracy of the novel Gold Coast criteria was subsequently interrogated through a large cross-sectional study, which established an increased sensitivity for ALS diagnosis when compared with previous criteria. Diagnostic accuracy was maintained irrespective of disease duration, functional status, or site of disease onset. Importantly, the Gold Coast criteria differentiated atypical phenotypes, such as primary lateral sclerosis, from the more typical ALS phenotype. It is proposed that the Gold Coast criteria should be incorporated into routine practice and clinical trial settings.
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Affiliation(s)
- Steve Vucic
- Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Angela Genge
- The Neuro, Montreal Neurological Institute, Montreal, Quebec, Canada
| | | | | | - Merit Cudkowicz
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney & Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Shen D, Yang X, Wang Y, He D, Sun X, Cai Z, Li J, Liu M, Cui L. The Gold Coast criteria increases the diagnostic sensitivity for amyotrophic lateral sclerosis in a Chinese population. Transl Neurodegener 2021; 10:28. [PMID: 34372918 PMCID: PMC8351337 DOI: 10.1186/s40035-021-00253-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess and compare the diagnostic utility of a new diagnostic criteria for amyotrophic lateral sclerosis (ALS), abbreviated as the 'Gold Coast Criteria', with the revised El Escorial (rEEC) and Awaji criteria. METHODS Clinical and electrophysiological data of 1185 patients from January 2014 to December 2019 in the Peking Union Medical College Hospital ALS database were reviewed. The sensitivity of the Gold Coast criteria was compared to that of the possible rEEC and Awaji criteria (defined by the proportion of patients categorized as definite, probable, or possible ALS). RESULTS A final diagnosis of ALS was recorded in 1162 patients. The sensitivity of the Gold Coast criteria (96.6%, 95% confidence interval [CI] = 95.3%-97.5%) was greater than that of the rEEC (85.1%, 95%CI = 82.9%-87.1%) and Awaji (85.3%, 95%CI = 83.2%-87.3%). In addition, the sensitivity of the novel criteria maintained robust across subgroups, and the advantage was more prominent in limb-onset ALS patients and those who completed electromyographic tests. In those who did not achieve any of the rEEC diagnostic categories, the sensitivity of Gold Coast criteria was 84.4%. CONCLUSIONS The current study demonstrated that the Gold Coast criteria exhibited greater diagnostic sensitivity than the rEEC and Awaji criteria in a Chinese ALS population. The application of the Gold Coast criteria should be considered in clinical practice and future therapeutic trials.
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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
| | - Yanying Wang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Di He
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xiaohan Sun
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhengyi Cai
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Jinyue Li
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, 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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Lake J, Storm CS, Makarious MB, Bandres-Ciga S. Genetic and Transcriptomic Biomarkers in Neurodegenerative Diseases: Current Situation and the Road Ahead. Cells 2021; 10:1030. [PMID: 33925602 PMCID: PMC8170880 DOI: 10.3390/cells10051030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 12/19/2022] Open
Abstract
Neurodegenerative diseases are etiologically and clinically heterogeneous conditions, often reflecting a spectrum of disease rather than well-defined disorders. The underlying molecular complexity of these diseases has made the discovery and validation of useful biomarkers challenging. The search of characteristic genetic and transcriptomic indicators for preclinical disease diagnosis, prognosis, or subtyping is an area of ongoing effort and interest. The next generation of biomarker studies holds promise by implementing meaningful longitudinal and multi-modal approaches in large scale biobank and healthcare system scale datasets. This work will only be possible in an open science framework. This review summarizes the current state of genetic and transcriptomic biomarkers in Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis, providing a comprehensive landscape of recent literature and future directions.
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Affiliation(s)
- Julie Lake
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA; (J.L.); (M.B.M.)
| | - Catherine S. Storm
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK;
- UCL Movement Disorders Centre, University College London, London WC1E 6BT, UK
| | - Mary B. Makarious
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA; (J.L.); (M.B.M.)
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA; (J.L.); (M.B.M.)
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Hannaford A, Pavey N, van den Bos M, Geevasinga N, Menon P, Shefner JM, Kiernan MC, Vucic S. Diagnostic Utility of Gold Coast Criteria in Amyotrophic Lateral Sclerosis. Ann Neurol 2021; 89:979-986. [PMID: 33565111 DOI: 10.1002/ana.26045] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The diagnosis of amyotrophic lateral sclerosis (ALS) remains problematic, with current diagnostic criteria (revised El Escorial [rEEC] and Awaji) being complex and prone to error. Consequently, the diagnostic utility of the recently proposed Gold Coast criteria was determined in ALS. METHODS We retrospectively reviewed 506 patients (302 males, 204 females) to compare the diagnostic accuracy of the Gold Coast criteria to that of the Awaji and rEEC criteria (defined by the proportion of patients categorized as definite, probable, or possible ALS) in accordance with standards of reporting of diagnostic accuracy criteria. RESULTS The sensitivity of Gold Coast criteria (92%, 95% confidence interval [CI] = 88.7-94.6%) was comparable to that of Awaji (90.3%, 95% CI = 86.69-93.2%) and rEEC (88.6, 95% CI = 84.8-91.7%) criteria. Additionally, the Gold Coast criteria sensitivity was maintained across different subgroups, defined by site of onset, disease duration, and functional disability. In atypical ALS phenotypes, the Gold Coast criteria exhibited greater sensitivity and specificity. INTERPRETATION The present study established the diagnostic utility of the Gold Coast criteria in ALS, with benefits evident in bulbar and limb onset disease patients, as well as atypical phenotypes. The Gold Coast criteria should be considered in clinical practice and therapeutic trials. ANN NEUROL 2021;89:979-986.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Nathan Pavey
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | | | - Parvathi Menon
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | | | - Steve Vucic
- Westmead Clinical School, University of Sydney, Sydney, Australia
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The Importance of Diagnostic and Prognostic Biomarker Identification and Classification Towards Understanding ALS Pathogenesis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1339:119-120. [DOI: 10.1007/978-3-030-78787-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vijayakumar UG, Milla V, Cynthia Stafford MY, Bjourson AJ, Duddy W, Duguez SMR. A Systematic Review of Suggested Molecular Strata, Biomarkers and Their Tissue Sources in ALS. Front Neurol 2019; 10:400. [PMID: 31139131 PMCID: PMC6527847 DOI: 10.3389/fneur.2019.00400] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease, is an incurable neurodegenerative condition, characterized by the loss of upper and lower motor neurons. It affects 1-1.8/100,000 individuals worldwide, and the number of cases is projected to increase as the population ages. Thus, there is an urgent need to identify both therapeutic targets and disease-specific biomarkers-biomarkers that would be useful to diagnose and stratify patients into different sub-groups for therapeutic strategies, as well as biomarkers to follow the efficacy of any treatment tested during clinical trials. There is a lack of knowledge about pathogenesis and many hypotheses. Numerous "omics" studies have been conducted on ALS in the past decade to identify a disease-signature in tissues and circulating biomarkers. The first goal of the present review was to group the molecular pathways that have been implicated in monogenic forms of ALS, to enable the description of patient strata corresponding to each pathway grouping. This strategy allowed us to suggest 14 strata, each potentially targetable by different pharmacological strategies. The second goal of this review was to identify diagnostic/prognostic biomarker candidates consistently observed across the literature. For this purpose, we explore previous biomarker-relevant "omics" studies of ALS and summarize their findings, focusing on potential circulating biomarker candidates. We systematically review 118 papers on biomarkers published during the last decade. Several candidate markers were consistently shared across the results of different studies in either cerebrospinal fluid (CSF) or blood (leukocyte or serum/plasma). Although these candidates still need to be validated in a systematic manner, we suggest the use of combinations of biomarkers that would likely reflect the "health status" of different tissues, including motor neuron health (e.g., pNFH and NF-L, cystatin C, Transthyretin), inflammation status (e.g., MCP-1, miR451), muscle health (miR-338-3p, miR-206) and metabolism (homocysteine, glutamate, cholesterol). In light of these studies and because ALS is increasingly perceived as a multi-system disease, the identification of a panel of biomarkers that accurately reflect features of pathology is a priority, not only for diagnostic purposes but also for prognostic or predictive applications.
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Affiliation(s)
| | | | | | | | | | - Stephanie Marie-Rose Duguez
- Northern Ireland Center for Stratified Medicine, Biomedical Sciences Research Institute, Londonderry, United Kingdom
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Kaji R, Imai T, Iwasaki Y, Okamoto K, Nakagawa M, Ohashi Y, Takase T, Hanada T, Shimizu H, Tashiro K, Kuzuhara S. Ultra-high-dose methylcobalamin in amyotrophic lateral sclerosis: a long-term phase II/III randomised controlled study. J Neurol Neurosurg Psychiatry 2019; 90:451-457. [PMID: 30636701 PMCID: PMC6581107 DOI: 10.1136/jnnp-2018-319294] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of intramuscular ultra-high-dose methylcobalamin in patients with amyotrophic lateral sclerosis (ALS). METHODS 373 patients with ALS (El Escorial definite or probable; laboratory-supported probable; duration ≤36 months) were randomly assigned to placebo, 25 mg or 50 mg of methylcobalamin groups. The primary endpoints were the time interval to primary events (death or full ventilation support) and changes in the Revised ALS Functional Rating Scale (ALSFRS-R) score from baseline to week 182. Efficacy was also evaluated using post-hoc analyses in patients diagnosed early (entered ≤12 months after symptom onset). RESULTS No significant differences were detected in either primary endpoint (minimal p value=0.087). However, post-hoc analyses of methylcobalamin-treated patients diagnosed and entered early (≤12 months' duration) showed longer time intervals to the primary event (p<0.025) and less decreases in the ALSFRS-R score (p<0.025) than the placebo group. The incidence of treatment-related adverse events was similar and low in all groups. CONCLUSION Although ultra-high-dose methylcobalamin did not show significant efficacy in the whole cohort, this treatment may prolong survival and retard symptomatic progression without major side effects if started early. TRIAL REGISTRATION NUMBER NCT00444613.
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Affiliation(s)
- Ryuji Kaji
- Department of Neurology, Tokushima University Hospital, Tokushima, Japan
| | - Takashi Imai
- National Hospital Organization Miyagi National Hospital, Sendai, Japan.,Tokushukai ALS Care Center, Tokushukai, Japan
| | - Yasuo Iwasaki
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Koichi Okamoto
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Gunma, Japan
| | - Masanori Nakagawa
- North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Hachioji, Japan
| | | | | | | | - Kunio Tashiro
- Department of Neurology, Hokuyukai Neurological Hospital, Sapporo, Japan
| | - Shigeki Kuzuhara
- School of Nursing, Suzuka University of Medical Science, Suzuka, Japan
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Amin Lari A, Ghavanini AA, Bokaee HR. A review of electrophysiological studies of lower motor neuron involvement in amyotrophic lateral sclerosis. Neurol Sci 2019; 40:1125-1136. [PMID: 30877611 DOI: 10.1007/s10072-019-03832-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/07/2019] [Indexed: 02/08/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving both the upper and lower motor neuron diseases. In this review, we studied and compared different articles regarding the electrodiagnostic criteria for diagnosis of lower motor neuron pathology in ALS. We reviewed the most recent articles and metaanalysis regarding various lower motor neuron electrodiagnostic methods for ALS and their sensitivities. We concluded that Awaji Shima criteria is by far the most sensitive criteria for diagnosis of ALS.
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Affiliation(s)
- Ali Amin Lari
- Canadian Neurologic Center, Mississauga, ON, Canada.
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Geevasinga N, Howells J, Menon P, van den Bos M, Shibuya K, Matamala JM, Park SB, Byth K, Kiernan MC, Vucic S. Amyotrophic lateral sclerosis diagnostic index: Toward a personalized diagnosis of ALS. Neurology 2019; 92:e536-e547. [PMID: 30709964 DOI: 10.1212/wnl.0000000000006876] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/28/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of the study was to assess the utility of a novel amyotrophic lateral sclerosis (ALS) diagnostic index (ALSDI). METHODS A prospective multicenter study was undertaken on patients presenting with suspected ALS. The reference standard (Awaji criteria) was applied to all patients at recruitment. Patients were randomly assigned to a training (75%) and a test (25%) cohort. The ALSDI was developed in the training cohort and its diagnostic utility was subsequently assessed in the test cohort. RESULTS A total of 407 patients were recruited, with 305 patients subsequently diagnosed with ALS and 102 with a non-ALS mimicking disorder. The ALSDI reliably differentiated ALS from neuromuscular disorders in the training cohort (area under the curve 0.92, 95% confidence interval 0.89-0.95), with ALSDI ≥4 exhibiting 81.6% sensitivity, 89.6% specificity, and 83.5% diagnostic accuracy. The ALSDI diagnostic utility was confirmed in the test cohort (area under the curve 0.90, 95% confidence interval 0.84-0.97), with ALSDI ≥4 exhibiting 83.3% sensitivity, 84% specificity, and 83.5% diagnostic accuracy. In addition, the diagnostic utility of the ALSDI was confirmed in patients who were Awaji negative at recruitment and in those exhibiting a predominantly lower motor neuron phenotype. CONCLUSION The ALSDI reliably differentiates ALS from mimicking disorders at an early stage in the disease process. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with suspected ALS, the ALSDI distinguished ALS from neuromuscular mimicking disorders.
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Affiliation(s)
- Nimeshan Geevasinga
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - James Howells
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Parvathi Menon
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Mehdi van den Bos
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Kazumoto Shibuya
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - José Manuel Matamala
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Susanna B Park
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Karen Byth
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Matthew C Kiernan
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia
| | - Steve Vucic
- From Westmead Clinical School (N.G., P.M., M.v.d.B., S.V.), Brain and Mind Center (J.H., K.S., J.M.M., S.B.P., M.C.K.), and NHMRC Clinical Trials Centre (K.B.), University of Sydney; and Westmead Hospital (K.B.), Research and Education Network, Sydney, Australia.
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Diagnostic criteria for amyotrophic lateral sclerosis: A multicentre study of inter-rater variation and sensitivity. Clin Neurophysiol 2018; 130:307-314. [PMID: 30573424 DOI: 10.1016/j.clinph.2018.11.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/14/2018] [Accepted: 11/11/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study assesses inter-rater agreement and sensitivity of diagnostic criteria for amyotrophic lateral sclerosis (ALS). METHODS Clinical and electrophysiological data of 399 patients with suspected ALS were collected by eleven experienced physicians from ten different countries. Eight physicians classified patients independently and blinded according to the revised El Escorial Criteria (rEEC) and to the Awaji Criteria (AC). Inter-rater agreement was assessed by Kappa coefficients, sensitivity by majority diagnosis on 350 patients with follow-up data. RESULTS Inter-rater agreement was generally low both for rEEC and AC. Agreement was best on the categories "Not-ALS", "Definite", and "Probable", and poorest for "Possible" and "Probable Laboratory-supported". Sensitivity was equal for rEEC (64%) and AC (63%), probably due to downgrading of "Probable Laboratory-supported" patients by AC. However, AC was significantly more effective in classifying patients as "ALS" versus "Not-ALS" (p < 0.0001). CONCLUSIONS Inter-rater variation is high both for rEEC and for AC probably due to a high complexity of the rEEC inherent in the AC. The gain of AC on diagnostic sensitivity is reduced by the omission of the "Probable Laboratory-supported" category. SIGNIFICANCE The results highlight a need for initiatives to develop simpler and more reproducible diagnostic criteria for ALS in clinical practice and research.
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Rushkevich YN, Haliyeuskaya OV, Likhachev SA. [Sleep-disordered breathing in motor neuron disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:119-123. [PMID: 30059061 DOI: 10.17116/jnevro201811842119] [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: 11/18/2022]
Abstract
AIM To study sleep-disordered breathing (SDB) in patients with motor neuron disease (MND). MATERIAL AND METHODS Ninety-two patients, 50 women and 42 men, were examined Median age was 62 [55; 67.5] years, MND duration 12 [8.9; 27.1] months. The control group consisted of 46 patients (26 men; 20 women). A portable polysomnographic study (PSG) (Polymate YH-1000C (BMC, China)) was conducted immediately after the diagnosis of MND, that is, at a relatively early stage. RESULTS AND CONCLUSION Significant changes in PSG in comparison with the control have been revealed. Significant differences were found between the results of PSG in MND patients with different disease onsets. The most vulnerable to the development of SDB were patients with bulbar onset of amyotrophic lateral sclerosis. Minimal SpO2, index of desaturation, duration of apnea can serve as markers for the analysis of SDB during screening studies based on established correlations.
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Affiliation(s)
- Y N Rushkevich
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - O V Haliyeuskaya
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - S A Likhachev
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
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12
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Rushkevich YN, Pashkouskaya ID, Likhachev SA. [Neurospecific proteins in cerebrospinal fluid and in the bloodserum of patients with amyotrophic lateral sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:75-80. [PMID: 29927408 DOI: 10.17116/jnevro20181185175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To determine concentrations of neurospecific enolase (NSE) and S100b protein in bloodserum and cerebrospinal fluid (CSF) in patients with amyotrophic lateral sclerosis (ALS) with different forms (onset) and duration of ALS. MATERIAL AND METHODS Concentrations of NSE and S100b in serum and CSF were studied in 86 patients with different forms and duration of ALS. RESULTS AND CONCLUSION Concentrations of NSE and S100b protein in CSF were significantly higher in the group of patients with bulbar form and in the group with duration of disease less than 1 year compared to the control group. There was a negative correlation of S100b protein in CSF with ALSFRSR score in the group of patients with bulbar ALS. An increase in NSE concentration in CSF and serum in patients with cervico-thoracic form of ALS and in patients with disease duration from 1 to 4 years was found. Concentrations of protein S100b remained the same. A significant decrease in the concentration gradient of S100b protein (CSF/serum) in patients with disease duration more than 1 year suggests the disturbances of blood-brain barrier permeability with increasing ALS duration and confirms the role of these changes in the pathogenesis of the disease.
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Affiliation(s)
- Yu N Rushkevich
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - I D Pashkouskaya
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - S A Likhachev
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
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Kaiserova M, Grambalova Z, Otruba P, Stejskal D, Prikrylova Vranova H, Mares J, Mensikova K, Kanovsky P. Cerebrospinal fluid levels of chromogranin A and phosphorylated neurofilament heavy chain are elevated in amyotrophic lateral sclerosis. Acta Neurol Scand 2017; 136:360-364. [PMID: 28185258 DOI: 10.1111/ane.12735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Various cerebrospinal fluid (CSF) biomarkers are being studied to improve the sensitivity and specificity of the diagnostic methods for amyotrophic lateral sclerosis (ALS). AIMS OF THE STUDY The aim of our study was to establish the CSF levels of chromogranin A (CgA) and phosphorylated neurofilament heavy chain (pNF-H) in patients with ALS in order to assess these proteins as possible biomarkers of ALS. METHODS Cerebrospinal fluid levels of CgA and pNF-H were examined and mutually compared in 15 patients with sporadic ALS and 16 gender- and age-matched controls. RESULTS Lumbar CSF CgA levels were increased in the patients with ALS compared to the controls (median 235 vs 138, P=.031). Lumbar CSF pNF-H levels were significantly increased in the patients with ALS compared to the control group (median 3091 vs 213, P<.0001). CONCLUSIONS Identifying CSF biomarkers in ALS is important in order to establish the diagnosis in the early stages of the disease. pNF-H seems to be a good biomarker for the diagnosis of ALS. If confirmed on a larger group of patients, CgA may also become useful in the diagnosis of sporadic ALS.
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Affiliation(s)
- M. Kaiserova
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - Z. Grambalova
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - P. Otruba
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - D. Stejskal
- AGEL Research and Training Institute; Prostejov Czech Republic
- Institute of Medical Chemistry and Biochemistry; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
- Department of Biochemical Sciences; Faculty of Medicine; Ostrava University; Ostrava Czech Republic
| | - H. Prikrylova Vranova
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - J. Mares
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - K. Mensikova
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
| | - P. Kanovsky
- Department of Neurology; Faculty of Medicine and Dentistry; Palacky University and University Hospital; Olomouc Czech Republic
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Al-Chalabi A, Hardiman O, Kiernan MC, Chiò A, Rix-Brooks B, van den Berg LH. Amyotrophic lateral sclerosis: moving towards a new classification system. Lancet Neurol 2017; 15:1182-94. [PMID: 27647646 DOI: 10.1016/s1474-4422(16)30199-5] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 12/18/2022]
Abstract
Amyotrophic lateral sclerosis is a progressive adult-onset neurodegenerative disease that primarily affects upper and lower motor neurons, but also frontotemporal and other regions of the brain. The extent to which each neuronal population is affected varies between individuals. The subsequent patterns of disease progression form the basis of diagnostic criteria and phenotypic classification systems, with considerable overlap in the clinical terms used. This overlap can lead to confusion between diagnosis and phenotype. Formal classification systems such as the El Escorial criteria and the International Classification of Diseases are systematic approaches but they omit features that are important in clinical management, such as rate of progression, genetic basis, or functional effect. Therefore, many neurologists use informal classification approaches that might not be systematic, and could include, for example, anatomical descriptions such as flail-arm syndrome. A new strategy is needed to combine the benefits of a systematic approach to classification with the rich and varied phenotypic descriptions used in clinical practice.
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Affiliation(s)
- Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK.
| | - Orla Hardiman
- Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adriano Chiò
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Benjamin Rix-Brooks
- Carolinas Neuromuscular/ALS-MDA Center, Department of Neurology, Carolinas Medical Center, Carolinas Healthcare System Neurosciences Institute, Charlotte, NC, USA; University of North Carolina School of Medicine-Charlotte Campus, Charlotte, NC, USA
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Netherlands
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Hendriksz CJ, Anheim M, Bauer P, Bonnot O, Chakrapani A, Corvol JC, de Koning TJ, Degtyareva A, Dionisi-Vici C, Doss S, Duning T, Giunti P, Iodice R, Johnston T, Kelly D, Klünemann HH, Lorenzl S, Padovani A, Pocovi M, Synofzik M, Terblanche A, Then Bergh F, Topçu M, Tranchant C, Walterfang M, Velten C, Kolb SA. The hidden Niemann-Pick type C patient: clinical niches for a rare inherited metabolic disease. Curr Med Res Opin 2017; 33:877-890. [PMID: 28276873 DOI: 10.1080/03007995.2017.1294054] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/31/2017] [Accepted: 02/08/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Niemann-Pick disease type C (NP-C) is a rare, inherited neurodegenerative disease of impaired intracellular lipid trafficking. Clinical symptoms are highly heterogeneous, including neurological, visceral, or psychiatric manifestations. The incidence of NP-C is under-estimated due to under-recognition or misdiagnosis across a wide range of medical fields. New screening and diagnostic methods provide an opportunity to improve detection of unrecognized cases in clinical sub-populations associated with a higher risk of NP-C. Patients in these at-risk groups ("clinical niches") have symptoms that are potentially related to NP-C, but go unrecognized due to other, more prevalent clinical features, and lack of awareness regarding underlying metabolic causes. METHODS Twelve potential clinical niches identified by clinical experts were evaluated based on a comprehensive, non-systematic review of literature published to date. Relevant publications were identified by targeted literature searches of EMBASE and PubMed using key search terms specific to each niche. Articles published in English or other European languages up to 2016 were included. FINDINGS Several niches were found to be relevant based on available data: movement disorders (early-onset ataxia and dystonia), organic psychosis, early-onset cholestasis/(hepato)splenomegaly, cases with relevant antenatal findings or fetal abnormalities, and patients affected by family history, consanguinity, and endogamy. Potentially relevant niches requiring further supportive data included: early-onset cognitive decline, frontotemporal dementia, parkinsonism, and chronic inflammatory CNS disease. There was relatively weak evidence to suggest amyotrophic lateral sclerosis or progressive supranuclear gaze palsy as potential niches. CONCLUSIONS Several clinical niches have been identified that harbor patients at increased risk of NP-C.
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Affiliation(s)
- Christian J Hendriksz
- a Salford Royal NHS Foundation Trust , Manchester , UK
- b University of Pretoria , Pretoria , South Africa
| | - Mathieu Anheim
- c University of Strasbourg , Hautepierre Hospital , Strasbourg , France
| | - Peter Bauer
- d Institute of Medical Genetics and Applied Genomics, Tübingen University , Tübingen, Germany
- e CENTOGENE AG , Rostock , Germany
| | | | | | - Jean-Christophe Corvol
- h Sorbonne University , UPMC and Hôpital Pitié-Salpêtrière, Department of Nervous System Diseases , Paris , France
| | | | - Anna Degtyareva
- j Federal State Budget Institution, Research Center for Obstetrics , Gynecology and Perinatology , Moscow , Russia
| | | | - Sarah Doss
- l Charite University Medicine Berlin , Department of Neurology , Berlin , Germany
| | | | - Paola Giunti
- n University College London, Institute of Neurology , London , UK
| | - Rosa Iodice
- o University Federico II Naples , Naples , Italy
| | | | | | - Hans-Hermann Klünemann
- r University Clinic for Psychiatry and Psychotherapy, Regensburg University , Regensburg , Germany
| | - Stefan Lorenzl
- s Ludwig Maximillian University , Munich , Germany
- t Paracelus Medical University , Salzburg , Austria
| | - Alessandro Padovani
- u Neurology Unit, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
| | | | - Matthis Synofzik
- w Department of Neurodegenerative Diseases , Hertie Institute for Clinical Brain Research , Tübingen, Germany
- x German Center for Neurodegenerative Diseases (DZNE) , Tübingen, Germany
| | | | | | - Meral Topçu
- z Hacettepe University Children's Hospital , Ankara , Turkey
| | | | | | | | - Stefan A Kolb
- ac Actelion Pharmaceuticals Ltd , Allschwil , Switzerland
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16
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Tsuji Y, Noto YI, Shiga K, Teramukai S, Nakagawa M, Mizuno T. A muscle ultrasound score in the diagnosis of amyotrophic lateral sclerosis. Clin Neurophysiol 2017; 128:1069-1074. [PMID: 28343888 DOI: 10.1016/j.clinph.2017.02.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/03/2017] [Accepted: 02/19/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aims of this study are to elucidate the frequencies and distribution of fasciculations using muscle ultrasound in patients with amyotrophic lateral sclerosis (ALS) and those with other conditions mimicking ALS, and subsequently to develop a novel fasciculation score for the diagnosis of ALS. METHODS Ultrasound of 21 muscles was performed to detect fasciculations in 36 consecutive patients suspected of having ALS. We developed a fasciculation ultrasound score that indicated the number of muscles with fasciculations in statistically selected muscles. RESULTS A total of 525 muscles in 25 ALS patients and 231 in 11 non-ALS patients were analysed. Using relative operating characteristic and multivariate logistic regression analysis, we selected the trapezius, deltoid, biceps brachii, abductor pollicis brevis, abdominal, vastus lateralis, vastus medialis, biceps femoris, and gastrocnemius muscles for the fasciculation ultrasound score. The mean scores were higher in the ALS group than those in the non-ALS group (5.3±0.5vs. 0.3±0.7) (mean±SD); p<0.001. CONCLUSIONS Two or more of the fasciculation ultrasound scores showed high sensitivity and specificity in differentiating ALS patients from non-ALS patients. SIGNIFICANCE The fasciculation ultrasound score can be a simple and useful diagnostic marker of ALS.
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Affiliation(s)
- Yukiko Tsuji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Kensuke Shiga
- Department of Medical Education and Primary Care, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Nakagawa
- North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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17
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Traub R, Mitsumoto H. Recent advances and opportunities for improving diagnosis of amyotrophic lateral sclerosis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1213164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rebecca Traub
- Department of Neurology, Columbia University, New York, NY, USA
| | - Hiroshi Mitsumoto
- Department of Neurology, The Eleanor and Lou Gehrig MDA/ALS, Research Center, Columbia University, New York, NY, USA
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18
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Geevasinga N, Loy CT, Menon P, de Carvalho M, Swash M, Schrooten M, Van Damme P, Gawel M, Sonoo M, Higashihara M, Noto YI, Kuwabara S, Kiernan MC, Macaskill P, Vucic S. Awaji criteria improves the diagnostic sensitivity in amyotrophic lateral sclerosis: A systematic review using individual patient data. Clin Neurophysiol 2016; 127:2684-91. [DOI: 10.1016/j.clinph.2016.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 12/12/2022]
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19
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Likhachev SA, Rushkevich YN, Abelskaia IS, Chechik NM, Merkul OV. [Polysomnography in patients with amyotrophic lateral sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:37-41. [PMID: 27240046 DOI: 10.17116/jnevro20161164137-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the characteristics of nocturnal sleep and reveal breathing disorders during sleep in ALS patients using polysomnography. MATERIAL AND METHODS The study included 29 patients with the established diagnosis of ALS, 17 women and 12 men, median age 65 [59; 68] years; mean illness duration 12 [22.9; 27.1] months. The control group consisted of 46 volunteers without complaints of sleep disorder and sleep apnea. The sleep diagnostic system Somnolab 2 Weinmann, Germany was used. RESULTS AND CONCLUSION An increased level of awaketime and a significant decrease in amount of deep sleep and REM sleep were revealed in ALS patients. Sleep breathing disorders are found significantly more often in ALS patients, mainly as alveolar hypoventilation syndrome and less frequently as obstructive sleep apnea. The lower level of mean and minimum blood oxygen saturation and increased respiratory rate were detected. These changes are possibly due to the presence of restrictive respiratory disorders. These disturbances reduce the total duration of sleep, destroy it's structure, exerting a direct influence on the life quality in ALS patients, disrupting their domestic and social activity, contributing to the development of neuropsychological and behavioral disorders.
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Affiliation(s)
- S A Likhachev
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - Yu N Rushkevich
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - I S Abelskaia
- Republican Clinical Medical Center of the President of the Republic of Belarus, Minsk
| | - N M Chechik
- Republican Clinical Medical Center of the President of the Republic of Belarus, Minsk
| | - O V Merkul
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
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20
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Takamatsu N, Nodera H, Mori A, Maruyama-Saladini K, Osaki Y, Shimatani Y, Oda M, Izumi Y, Kaji R. Which muscle shows fasciculations by ultrasound in patients with ALS? THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:49-53. [DOI: 10.2152/jmi.63.49] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Naoko Takamatsu
- Department of Neurology, Tokushima University
- Department of Neurology, Vihara Hananosato Hospital
| | | | - Atsuko Mori
- Department of Neurology, Tokushima University
| | | | | | | | - Masaya Oda
- Department of Neurology, Vihara Hananosato Hospital
| | - Yuishin Izumi
- Department of Neurology, Tokushima University
- Department of Neurology, Vihara Hananosato Hospital
| | - Ryuji Kaji
- Department of Neurology, Tokushima University
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Prognostic Factors in Amyotrophic Lateral Sclerosis: A Population-Based Study. PLoS One 2015; 10:e0141500. [PMID: 26517122 PMCID: PMC4627754 DOI: 10.1371/journal.pone.0141500] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/08/2015] [Indexed: 12/11/2022] Open
Abstract
Objective To determine the prognostic factors associated with survival in amyotrophic lateral sclerosis at diagnosis. Methods This retrospective population-based study evaluated 218 patients treated with riluzole between 2005 and 2014 and described their clinical and demographic profiles after the analysis of clinical data and records from the mortality information system in the Federal District, Brazil. Cox multivariate regression analysis was conducted for the parameters found. Results The study sample consisted of 132 men and 86 women with a mean age at disease onset of 57.2±12.3 years; 77.6% of them were Caucasian. The mean periods between disease onset and diagnosis were 22.7 months among men and 23.5 months among women, and the mean survival periods were 45.7±47.0 months among men and 39.3±29.8 months among women. In addition, 80.3% patients presented non-bulbar-onset amyotrophic lateral sclerosis, and 19.7% presented bulbar-onset. Cox regression analysis indicated worse prognosis for body mass index (BMI) <25 kg/m2 (relative risk [RR]: 3.56, 95% confidence interval [CI]: 1.44–8.86), age >75 years (RR: 12.47, 95% CI: 3.51–44.26), and bulbar-onset (RR: 4.56, 95% CI: 2.06–10.12). Electromyography did not confirm the diagnosis in 55.6% of the suspected cases and in 27.9% of the bulbar-onset cases. Conclusions The factors associated with lower survival in amyotrophic lateral sclerosis were age >75 years, BMI <25 kg/m2, and bulbar-onset.
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22
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Jang JS, Bae JS. Reply. Muscle Nerve 2015; 52:468-9. [DOI: 10.1002/mus.24731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jae-Sik Jang
- Department of Medicine; Inje University College of Medicine; Busan Korea
| | - Jong Seok Bae
- Department of Neurology; Kangdong Sacred Heart Hospital; Hallym University College of Medicine; Seoul Korea
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23
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de Carvalho M, Costa J, Swash M. Comment on: The Awaji criteria are not always superior to the previous criteria: A meta-analysis. Muscle Nerve 2015; 52:467-8. [DOI: 10.1002/mus.24734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Mamede de Carvalho
- Instituto de Medicina Molecular and Institute of Physiology, Faculty of Medicine; University of Lisbon; Portugal
- Department of Neurosciences; Hospital de Santa Maria-Centro Hospitalar Lisboa Norte; Lisbon Portugal
| | - João Costa
- Instituto de Medicina Molecular and Institute of Physiology, Faculty of Medicine; University of Lisbon; Portugal
- Center for Evidence-Based Medicine, Faculty of Medicine; University of Lisbon; Portugal
| | - Michael Swash
- Instituto de Medicina Molecular and Institute of Physiology, Faculty of Medicine; University of Lisbon; Portugal
- Departments of Neurology and Neuroscience, Royal London Hospital; Queen Mary University of London; London United Kingdom
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24
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Menon P, Geevasinga N, Yiannikas C, Howells J, Kiernan MC, Vucic S. Sensitivity and specificity of threshold tracking transcranial magnetic stimulation for diagnosis of amyotrophic lateral sclerosis: a prospective study. Lancet Neurol 2015; 14:478-84. [PMID: 25843898 DOI: 10.1016/s1474-4422(15)00014-9] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/28/2015] [Accepted: 03/10/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Diagnosis of amyotrophic lateral sclerosis (ALS) remains problematic, with substantial diagnostic delays. We assessed the sensitivity and specificity of a threshold tracking transcranial magnetic stimulation (TMS) technique, which might allow early detection of upper motor neuron dysfunction, for the diagnosis of the disorder. METHODS We did a prospective study of patients referred to three neuromuscular centres in Sydney, Australia, in accordance with the Standards for Reporting of Diagnostic Accuracy. Participants had definite, probable, or possible ALS, as defined by the Awaji criteria; or pure motor disorder with clinical features of upper and lower motor neuron dysfunction in at least one body region, progressing over a 6 month follow-up period; or muscle wasting and weakness for at least 6 months. All patients underwent threshold tracking TMS at recruitment (index test), with application of the reference standard, the Awaji criteria, to differentiate patients with ALS from those with non-ALS disorders. The investigators who did the index test were masked to the results of the reference test and all other investigations. The primary outcome measures were the sensitivity and specificity of TMS in differentiating ALS from non-ALS disorders; these measures were derived from receiver operator curve analysis. FINDINGS Between Jan 1, 2010, and March 1, 2014, we screened 333 patients; 281 met our inclusion criteria. We eventually diagnosed 209 patients with ALS and 68 with non-ALS disorders; the diagnosis of four patients was inconclusive. The threshold tracking TMS technique differentiated ALS from non-ALS disorders with a sensitivity of 73·21% (95% CI 66·66-79·08) and specificity of 80·88% (69·53-89·40) at an early stage in the disease. All patients tolerated the study well, and we did not record any adverse events from performance of the index test. INTERPRETATION The threshold tracking TMS technique reliably distinguishes ALS from non-ALS disorders and, if these findings are replicated in larger studies, could represent a useful diagnostic investigation when combined with the Awaji criteria to prove upper motor neuron dysfunction at early stages of ALS. FUNDING Motor Neuron Disease Research Institute of Australia, National Health and Medical Research Council of Australia, and Pfizer.
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Affiliation(s)
- Parvathi Menon
- Derek Craig Motor Neuron Disease Research Centre, Western Clinical School, University of Sydney, NSW, Australia
| | - Nimeshan Geevasinga
- Derek Craig Motor Neuron Disease Research Centre, Western Clinical School, University of Sydney, NSW, Australia
| | - Con Yiannikas
- Westmead Hospital, Westmead, Royal North Shore Hospital, University of Sydney, NSW, Australia
| | - James Howells
- Brain and Mind Research Institute, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia
| | - Matthew C Kiernan
- Brain and Mind Research Institute, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia
| | - Steve Vucic
- Derek Craig Motor Neuron Disease Research Centre, Western Clinical School, University of Sydney, NSW, Australia; Department of Neurology, University of Sydney, NSW, Australia.
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Jang JS, Bae JS. AWAJI criteria are not always superior to the previous criteria: A meta-analysis. Muscle Nerve 2015; 51:822-9. [DOI: 10.1002/mus.24575] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/29/2014] [Accepted: 01/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Jae-Sik Jang
- Department of Medicine; Inje University College of Medicine; Busan Korea
- University of Missouri-Kansas City; Kansas City Missouri USA
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital; Hallym University College of Medicine; 150 Seongan-ro, Gangdong-gu, Seoul 134-701 Seoul Korea
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26
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Agosta F, Al-Chalabi A, Filippi M, Hardiman O, Kaji R, Meininger V, Nakano I, Shaw P, Shefner J, van den Berg LH, Ludolph A. The El Escorial criteria: strengths and weaknesses. Amyotroph Lateral Scler Frontotemporal Degener 2014; 16:1-7. [PMID: 25482030 DOI: 10.3109/21678421.2014.964258] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The El Escorial criteria for the diagnosis of amyotrophic lateral sclerosis (ALS) were established 20 years ago and have been used as inclusion criteria for clinical trials. However, concerns have been raised concerning their use as diagnostic criteria in clinical practice. Moreover, as modern genetics have shed new light on the heterogeneity of ALS and the close relationship between ALS and frontotemporal dementia (FTD) recognized, the World Federation of Neurology Research Group on ALS/MND has initiated discussions to amend and update the criteria, while preserving the essential components for clinical trial enrolment purposes.
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Affiliation(s)
- Federica Agosta
- San Raffaele Scientific Institute and Vita-Salute San Raffaele University , Milan , Italy
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Moloney EB, de Winter F, Verhaagen J. ALS as a distal axonopathy: molecular mechanisms affecting neuromuscular junction stability in the presymptomatic stages of the disease. Front Neurosci 2014; 8:252. [PMID: 25177267 PMCID: PMC4132373 DOI: 10.3389/fnins.2014.00252] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/29/2014] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is being redefined as a distal axonopathy, in that many molecular changes influencing motor neuron degeneration occur at the neuromuscular junction (NMJ) at very early stages of the disease prior to symptom onset. A huge variety of genetic and environmental causes have been associated with ALS, and interestingly, although the cause of the disease can differ, both sporadic and familial forms of ALS show a remarkable similarity in terms of disease progression and clinical manifestation. The NMJ is a highly specialized synapse, allowing for controlled signaling between muscle and nerve necessary for skeletal muscle function. In this review we will evaluate the clinical, animal experimental and cellular/molecular evidence that supports the idea of ALS as a distal axonopathy. We will discuss the early molecular mechanisms that occur at the NMJ, which alter the functional abilities of the NMJ. Specifically, we focus on the role of axon guidance molecules on the stability of the cytoskeleton and how these molecules may directly influence the cells of the NMJ in a way that may initiate or facilitate the dismantling of the neuromuscular synapse in the presymptomatic stages of ALS.
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Affiliation(s)
- Elizabeth B. Moloney
- Department of Regeneration of Sensorimotor Systems, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and ScienceAmsterdam, Netherlands
| | - Fred de Winter
- Department of Regeneration of Sensorimotor Systems, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and ScienceAmsterdam, Netherlands
- Department of Neurosurgery, Leiden University Medical CentreLeiden, Netherlands
| | - Joost Verhaagen
- Department of Regeneration of Sensorimotor Systems, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and ScienceAmsterdam, Netherlands
- Centre for Neurogenomics and Cognitive Research, Vrije Universiteit AmsterdamAmsterdam, Netherlands
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Sato K, Morimoto N, Deguchi K, Ikeda Y, Matsuura T, Abe K. Seven amyotrophic lateral sclerosis patients diagnosed only after development of respiratory failure. J Clin Neurosci 2014; 21:1341-3. [DOI: 10.1016/j.jocn.2013.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/10/2013] [Indexed: 11/28/2022]
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Couratier P, Marin B, Lautrette G, Nicol M, Preux PM. [Epidemiology, clinical spectrum of ALS and differential diagnoses]. Presse Med 2014; 43:538-48. [PMID: 24703738 DOI: 10.1016/j.lpm.2014.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 11/18/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is the most common motor neuron disease in adults. Its incidence in France is estimated at 2.5 per 100,000 population and its prevalence between 5 and 8 per 100,000 inhabitants. Good prognostic factors are age of early onset, a longer time to diagnosis, initial damage to the spinal onset, early management of undernutrition and restrictive respiratory failure. The diagnosis of ALS is primarily clinical and is based on the evidence of involvement of the central motor neuron and peripheral neuron (NMP) in different territories or spinal or bulbar. The EMG confirms the achievement of NMP, shows the extension to clinically preserved areas and allows to exclude some differential diagnoses. The clinical spectrum of ALS is broad: conventional forms beginning brachial, lower limb or bulbar onsets, rarer forms to start breathing, pyramidal forms, forms with cognitive and behavioural impairment. In 5-10% of cases, ALS is familial. In 15% of cases, it is associated with frontotemporal degeneration rather than orbito-frontal type. The main differential diagnoses are guided by the clinic: combining pure motor neuropathy with or without conduction block, post-polio syndrome, cramp-fasciculation syndrome, myasthenia gravis, paraneoplastic syndromes, Sjögren syndrome, retroviral infections, some endocrine disorders, some metabolic diseases, genetic diseases (Kennedy and SMA) and inclusion body myositis.
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Affiliation(s)
- Philippe Couratier
- CHU de Limoges, centre de compétence SLA, service de neurologie, 87000 Limoges, France; Université de Limoges, UMR 1094, faculté de médecine, 87000 Limoges, France.
| | - Benoît Marin
- Université de Limoges, UMR 1094, faculté de médecine, 87000 Limoges, France
| | - Géraldine Lautrette
- CHU de Limoges, centre de compétence SLA, service de neurologie, 87000 Limoges, France
| | - Marie Nicol
- CHU de Limoges, centre de compétence SLA, service de neurologie, 87000 Limoges, France; Université de Limoges, UMR 1094, faculté de médecine, 87000 Limoges, France
| | - Pierre-Marie Preux
- Université de Limoges, UMR 1094, faculté de médecine, 87000 Limoges, France
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Geevasinga N, Menon P, Yiannikas C, Kiernan MC, Vucic S. Diagnostic utility of cortical excitability studies in amyotrophic lateral sclerosis. Eur J Neurol 2014; 21:1451-7. [DOI: 10.1111/ene.12422] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- N. Geevasinga
- Westmead Clinical School; University of Sydney; Sydney NSW Australia
| | - P. Menon
- Westmead Clinical School; University of Sydney; Sydney NSW Australia
| | - C. Yiannikas
- Department of Neurology; Concord Hospital; Sydney NSW Australia
| | - M. C. Kiernan
- Brain and Mind Research Institute; University of Sydney; Sydney NSW Australia
| | - S. Vucic
- Westmead Clinical School; University of Sydney; Sydney NSW Australia
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Gawel M, Kuzma-Kozakiewicz M, Szmidt-Salkowska E, Kamińska A. Are we really closer to improving the diagnostic sensitivity in ALS patients with Awaji criteria? Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:257-61. [DOI: 10.3109/21678421.2014.887118] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sekiguchi T, Kanouchi T, Shibuya K, Noto YI, Yagi Y, Inaba A, Abe K, Misawa S, Orimo S, Kobayashi T, Kamata T, Nakagawa M, Kuwabara S, Mizusawa H, Yokota T. Spreading of amyotrophic lateral sclerosis lesions--multifocal hits and local propagation? J Neurol Neurosurg Psychiatry 2014; 85:85-91. [PMID: 24027298 DOI: 10.1136/jnnp-2013-305617] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether or not the lesions in sporadic amyotrophic lateral sclerosis (ALS) originate from a single focal onset site and spread contiguously by prion-like cell-to-cell propagation in the rostrocaudal direction along the spinal cord, as has been hypothesised (the 'single seed and simple propagation' hypothesis). METHODS Subjects included 36 patients with sporadic ALS and initial symptoms in the bulbar, respiratory or upper limb regions. Abnormal spontaneous activities in needle electromyography (nEMG)-that is, fibrillation potentials, positive sharp waves (Fib/PSWs) or fasciculation potentials (FPs)-were compared among the unilateral muscles innervated by different spinal segments, especially between the T10 and L5 paraspinal muscles, and between the vastus medialis and biceps femoris. Axon length and the proportion of muscle fibre types, which are both related to motoneuronal vulnerability in ALS, are similar in the paired muscles. RESULTS Fourteen of 36 patients showed a non-contiguous distribution of nEMG abnormalities from the onset site, with skipping of intermediate segments. In eight of them, the non-contiguous pattern was evident between paired muscles with the same motoneuronal vulnerability. The non-contiguously affected lumbosacral lesions involved motoneuron columns horizontally or radially proximate to one another, appearing to form a cluster in four of the eight patients. FPs, known to precede Fib/PSWs, were shown more frequently than Fib/PSWs in all the lumbosacral segments but L5, suggesting that 2nd hits occur at L5 and then spread to other lumbosacral segments. CONCLUSIONS In sporadic ALS, the distribution of lower motoneuron involvement cannot be explained by the 'single seed and simple propagation' hypothesis alone. We propose a 'multifocal hits and local propagation' hypothesis instead.
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Affiliation(s)
- Teruhiko Sekiguchi
- Department of Neurology and Neurological Science, Graduate School, Tokyo Medical and Dental University, , Tokyo, Japan
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[Electrodiagnostic criteria for early diagnosis of bulbar-onset ALS: a comparison of El Escorial, revised El Escorial and Awaji algorithm]. Rev Neurol (Paris) 2013; 170:134-9. [PMID: 24239347 DOI: 10.1016/j.neurol.2013.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 03/03/2013] [Accepted: 10/14/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Diagnosis of bulbar ALS is difficult at the early stage of the disease. According to guidelines, early diagnosis is better in view to optimize the management of affected patients. To improve the sensitivity without losing specificity of the prior criteria, the Board of Awaji has proposed modified electrodiagnostic criteria for ALS. The aim of this study was to evaluate the contribution of needle electromyography in early diagnosis of bulbar ALS by comparing the El Escorial criteria (EEC), Revised El Escorial Criteria (R-EEC) and Awaji algorithm (AA). METHODS In a retrospective study, we analysed clinical and electrophysiological data of 46 patients followed in our center for a bulbar-onset ALS seen for the first time between January 2007 and February 2011. All these patients had bulbar-onset ALS probable or certain at the last follow-up. All data were collected during the first clinical examination and the first electrophysiological study. RESULTS Mean age of the population was 69 (37-90years, sex ratio: 0.91). Using the EEC, 9 patients were diagnosed as definite or probable ALS at the first consultation. Applying the R-EEC, 13 patients were diagnosed as definite or probable ALS and using the AA, 23 patients were diagnosed as definite or probable ALS. The sensitivity of the EEC was 19.5%, the R-EEC was 28.2% and for AA was 49.98%. CONCLUSION AA are more sensitive in early diagnosis of bulbar ALS compared to R-EEC with the contribution of ENMG and when fasciculations are considered as evidence of spontaneous activity. Such an approach can contribute to accelerate an optimal management of the disease. AA are a breakthrough in the diagnosis of ALS especially in the bulbar-onset forms.
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Les critères d’Awaji : les nouveaux critères diagnostiques de la sclérose latérale amyotrophique. Rev Neurol (Paris) 2013; 169:470-5. [DOI: 10.1016/j.neurol.2012.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/22/2012] [Indexed: 11/18/2022]
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Hobson-Webb LD. Neuromuscular ultrasound in polyneuropathies and motor neuron disease. Muscle Nerve 2013; 47:790-804. [DOI: 10.1002/mus.23737] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 12/12/2022]
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Riemenschneider KA, Forshew DA, Miller RG. Multidisciplinary clinics: optimizing treatment for patients with amyotrophic lateral sclerosis. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
SUMMARY Amyotrophic lateral sclerosis is an incurable, lethal neurodegenerative disease. The majority of patients die from respiratory failure within 2–5 years after symptom onset. Recent studies show a paradigm shift in the method of delivering a number of effective treatments through an emerging network of multidisciplinary clinics. This article focuses on the role played by these clinics in raising the standard-of-care for patients with amyotrophic lateral sclerosis. Although newly developed treatments are still underutilized, substantial progress is being made by multidisciplinary clinics, which play a pivotal role in coordinating access to effective therapeutics.
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Affiliation(s)
- Karina A Riemenschneider
- University of Copenhagen, Copenhagen, Denmark
- Forbes Norris ALS Research Center, California Pacific Medical Center, 2324 Sacramento Street, San Francisco, CA 94115, USA
| | - Dallas A Forshew
- Forbes Norris ALS Research Center, California Pacific Medical Center, 2324 Sacramento Street, San Francisco, CA 94115, USA
| | - Robert G Miller
- Forbes Norris ALS Research Center, California Pacific Medical Center, 2324 Sacramento Street, San Francisco, CA 94115, USA.
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Use of Bayesian MUNE to show differing rate of loss of motor units in subgroups of ALS. Clin Neurophysiol 2012; 123:2446-53. [DOI: 10.1016/j.clinph.2012.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 04/12/2012] [Accepted: 04/24/2012] [Indexed: 11/18/2022]
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Factors affecting the diagnostic delay in amyotrophic lateral sclerosis. Clin Neurol Neurosurg 2012; 114:550-4. [DOI: 10.1016/j.clineuro.2011.11.026] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 11/21/2011] [Accepted: 11/21/2011] [Indexed: 11/19/2022]
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Schrooten M, Robberecht W, Van Damme P. From El Escorial to Awaji: where do we go next with the amyotrophic lateral sclerosis criteria? Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.11.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Making an early and accurate diagnosis in amyotrophic lateral sclerosis is important for patients and their families and for entry in clinical trials. Amyotrophic lateral sclerosis remains a clinical diagnosis, requiring the presence of upper and lower motor neuron symptoms and signs in multiple body regions, in patients with a progressive disease course and after exclusion of other diseases that can mimic the clinical presentation. Research criteria have been developed to allow uniform diagnosis. The original El Escorial criteria have been revised twice to improve the sensitivity. In this report, the current scientific status of these criteria is reviewed and suggestions for further adaptations are made.
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Affiliation(s)
- Maarten Schrooten
- Department of Neurology & Experimental Neurology, University Hospitals Leuven, KU Leuven, Belgium
| | - Wim Robberecht
- Department of Neurology & Experimental Neurology, University Hospitals Leuven, KU Leuven, Belgium
- LIND (Leuven Institute of Neurodegenerative Disorders), KU Leuven, Belgium
- Vesalius Research Center, VIB, Leuven, Belgium
| | - Philip Van Damme
- Neurology Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Dengler R. El Escorial or Awaji Criteria in ALS diagnosis, what should we take? Clin Neurophysiol 2012; 123:217-8. [DOI: 10.1016/j.clinph.2011.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/16/2011] [Indexed: 11/27/2022]
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Noto YI, Misawa S, Kanai K, Shibuya K, Isose S, Nasu S, Sekiguchi Y, Fujimaki Y, Nakagawa M, Kuwabara S. Awaji ALS criteria increase the diagnostic sensitivity in patients with bulbar onset. Clin Neurophysiol 2012; 123:382-5. [DOI: 10.1016/j.clinph.2011.05.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 05/22/2011] [Accepted: 05/25/2011] [Indexed: 11/28/2022]
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Andersen PM, Abrahams S, Borasio GD, de Carvalho M, Chio A, Van Damme P, Hardiman O, Kollewe K, Morrison KE, Petri S, Pradat PF, Silani V, Tomik B, Wasner M, Weber M. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)--revised report of an EFNS task force. Eur J Neurol 2011; 19:360-75. [PMID: 21914052 DOI: 10.1111/j.1468-1331.2011.03501.x] [Citation(s) in RCA: 702] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The evidence base for the diagnosis and management of amyotrophic lateral sclerosis (ALS) is weak. OBJECTIVES To provide evidence-based or expert recommendations for the diagnosis and management of ALS based on a literature search and the consensus of an expert panel. METHODS All available medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in February 2011. Recommendations were reached by consensus. RECOMMENDATIONS Patients with symptoms suggestive of ALS should be assessed as soon as possible by an experienced neurologist. Early diagnosis should be pursued, and investigations, including neurophysiology, performed with a high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives/carers should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. Control of symptoms such as sialorrhoea, thick mucus, emotional lability, cramps, spasticity and pain should be attempted. Percutaneous endoscopic gastrostomy feeding improves nutrition and quality of life, and gastrostomy tubes should be placed before respiratory insufficiency develops. Non-invasive positive-pressure ventilation also improves survival and quality of life. Maintaining the patient's ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end-of-life care should be discussed early with the patient and carers, respecting the patient's social and cultural background.
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Affiliation(s)
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- Umeå University, Umeå, Sweden.
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