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Casado Gama H, Amorós MA, Andrade de Araújo M, Sha CM, Vieira MP, Torres RG, Souza GF, Junkes JA, Dokholyan NV, Leite Góes Gitaí D, Duzzioni M. Systematic review and meta-analysis of dysregulated microRNAs derived from liquid biopsies as biomarkers for amyotrophic lateral sclerosis. Noncoding RNA Res 2024; 9:523-535. [PMID: 38511059 PMCID: PMC10950706 DOI: 10.1016/j.ncrna.2024.02.006] [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: 10/24/2023] [Revised: 01/05/2024] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
The discovery of disease-specific biomarkers, such as microRNAs (miRNAs), holds the potential to transform the landscape of Amyotrophic Lateral Sclerosis (ALS) by facilitating timely diagnosis, monitoring treatment response, and accelerating drug discovery. Such advancement could ultimately improve the quality of life and survival rates for ALS patients. Despite more than a decade of research, no miRNA biomarker candidate has been translated into clinical practice. We conducted a systematic review and meta-analysis to quantitatively synthesize data from original studies that analyzed miRNA expression from liquid biopsies via PCR and compared them to healthy controls. Our analysis encompasses 807 miRNA observations from 31 studies, stratified according to their source tissue. We identified consistently dysregulated miRNAs in serum (hsa-miR-3665, -4530, -4745-5p, -206); blood (hsa-miR-338-3p, -183-5p); cerebrospinal fluid (hsa-miR-34a-3p); plasma (hsa-miR-206); and neural-enriched extracellular vesicles from plasma (hsa-miR-146a-5p, -151a-5p, -10b-5p, -29b-3p, and -4454). The meta-analyses provided further support for the upregulation of hsa-miR-206, hsa-miR-338-3p, hsa-miR-146a-5p and hsa-miR-151a-5p, and downregulation of hsa-miR-183-5p, hsa-miR-10b-5p, hsa-miR-29b-3p, and hsa-miR-4454 as consistent indicators of ALS across independent studies. Our findings provide valuable insights into the current understanding of miRNAs' dysregulated expression in ALS patients and on the researchers' choices of methodology. This work contributes to the ongoing efforts towards discovering disease-specific biomarkers.
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Affiliation(s)
- Hemerson Casado Gama
- Laboratory of Pharmacological Innovation, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas -AL, 57072-900, Brazil
| | - Mariana A. Amorós
- Laboratory of Pharmacological Innovation, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas -AL, 57072-900, Brazil
| | - Mykaella Andrade de Araújo
- Department of Cellular and Molecular Biology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas -AL, 57072-900, Brazil
| | - Congzhou M. Sha
- Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Hershey, PA, 17033, United States
| | - Mirella P.S. Vieira
- Laboratory of Pharmacological Innovation, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas -AL, 57072-900, Brazil
| | - Rayssa G.D. Torres
- Laboratory of Pharmacological Innovation, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas -AL, 57072-900, Brazil
| | - Gabriela F. Souza
- Laboratory of Pharmacological Innovation, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas -AL, 57072-900, Brazil
| | - Janaína A. Junkes
- Postgraduate Program in Society, Technologies and Public Policies, Tiradentes University Centre, AL, 57038-000, Brazil
| | - Nikolay V. Dokholyan
- Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Hershey, PA, 17033, United States
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, 17033, United States
| | - Daniel Leite Góes Gitaí
- Department of Cellular and Molecular Biology, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas -AL, 57072-900, Brazil
| | - Marcelo Duzzioni
- Laboratory of Pharmacological Innovation, Institute of Biological Sciences and Health, Federal University of Alagoas, Maceió, Alagoas -AL, 57072-900, Brazil
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Koehn LM, Steele JR, Schittenhelm RB, Turner BJ, Nicolazzo JA. Sex-Dependent Changes to the Intestinal and Hepatic Abundance of Drug Transporters and Metabolizing Enzymes in the SOD1 G93A Mouse Model of Amyotrophic Lateral Sclerosis. Mol Pharm 2024; 21:1756-1767. [PMID: 38415587 DOI: 10.1021/acs.molpharmaceut.3c01089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is characterized by death and dysfunction of motor neurons that result in a rapidly progressing loss of motor function. While there are some data on alterations at the blood-brain barrier (BBB) in ALS and their potential impact on CNS trafficking of drugs, little is reported on the impact of this disease on the expression of drug-handling proteins in the small intestine and liver. This may impact the dosing of the many medicines that individuals with ALS are prescribed. In the present study, a proteomic evaluation was performed on small intestine and liver samples from postnatal day 120 SOD1G93A mice (a model of familial ALS that harbors a human mutant form of superoxide dismutase 1) and wild-type (WT) littermates (n = 7/genotype/sex). Untargeted, quantitative proteomics was undertaken using either label-based [tandem mass tag (TMT)] or label-free [data-independent acquisition (DIA)] acquisition strategies on high-resolution mass spectrometric instrumentation. Copper chaperone for superoxide dismutase (CCS) was significantly higher in SOD1G93A samples compared to the WT samples for both sexes and tissues, therefore representing a potential biomarker for ALS in this mouse model. Relative to WT mice, male SOD1G93A mice had significantly different proteins (Padj < 0.05, |fold-change|>1.2) in the small intestine (male 22, female 1) and liver (male 140, female 3). This included an up-regulation of intestinal transporters for dietary glucose [solute carrier (SLC) SLC5A1] and cholesterol (Niemann-Pick c1-like 1), as well as for several drugs (e.g., SLC15A1), in the male SOD1G93A mice. There was both an up-regulation (e.g., SLCO2A1) and down-regulation (ammonium transporter rh type b) of transporters in the male SOD1G93A liver. In addition, there was both an up-regulation (e.g., phosphoenolpyruvate carboxykinase) and down-regulation (e.g., carboxylesterase 1) of metabolizing enzymes in the male SOD1G93A liver. This proteomic data set identified male-specific changes to key small intestinal and hepatic transporters and metabolizing enzymes that may have important implications for the bioavailability of nutrients and drugs in individuals with ALS.
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Affiliation(s)
- Liam M Koehn
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville 3052, Victoria, Australia
| | - Joel R Steele
- Monash Proteomics and Metabolomics Platform, Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - Ralf B Schittenhelm
- Monash Proteomics and Metabolomics Platform, Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - Bradley J Turner
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Joseph A Nicolazzo
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville 3052, Victoria, Australia
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Gondim FDAA, Pinto WBVDR, Chieia MAT, Correia CDC, Cunha FMB, Dourado MET, França Júnior MC, Marques Júnior W, Oliveira ASB, Rodrigues CL, Silva DJD, Dias-Tosta E. Definitions, phenomenology, diagnosis, and management of the disorders of laughter and crying in amyotrophic lateral sclerosis (ALS): Consensus from ALS and Motor Neuron Disease Scientific Department of the Brazilian Academy of Neurology. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:764-775. [PMID: 37647907 PMCID: PMC10468253 DOI: 10.1055/s-0043-1771176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The spectrum of neuropsychiatric phenomena observed in amyotrophic lateral sclerosis (ALS) is wide and not fully understood. Disorders of laughter and crying stand among the most common manifestations. The aim of this study is to report the results of an educational consensus organized by the Brazilian Academy of Neurology to evaluate the definitions, phenomenology, diagnosis, and management of the disorders of laughter and crying in ALS patients. Twelve members of the Brazilian Academy of Neurology - considered to be experts in the field - were recruited to answer 12 questions about the subject. After exchanging revisions, a first draft was prepared. A face-to-face meeting was held in Fortaleza, Brazil on 9.23.22 to discuss it. The revised version was subsequently emailed to all members of the ALS Scientific Department from the Brazilian Academy of Neurology and the final revised version submitted for publication. The prevalence of pseudobulbar affect/pathological laughter and crying (PBA/PLC) in ALS patients from 15 combined studies and 3906 patients was 27.4% (N = 1070), ranging from 11.4% to 71%. Bulbar onset is a risk factor but there are limited studies evaluating the differences in prevalence among the different motor neuron diseases subtypes, including patients with and without frontotemporal dementia. Antidepressants and a combination of dextromethorphan and quinidine (not available in Brazil) are possible therapeutic options. This group of panelists acknowledge the multiple gaps in the current literature and reinforces the need for further studies.
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Affiliation(s)
- Francisco de Assis Aquino Gondim
- Universidade Federal do Ceará, Departamento de Clínica Médica, Núcleo de Desenvolvimento e Pesquisa de Medicamentos, Fortaleza CE, Brazil
| | - Wladimir Bocca Vieira de Rezende Pinto
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia/Ebserh, Setor de Investigações nas Doenças Neuromusculares, São Paulo SP, Brazil
| | - Marco Antônio Troccoli Chieia
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia/Ebserh, Setor de Investigações nas Doenças Neuromusculares, São Paulo SP, Brazil
| | | | | | | | | | - Wilson Marques Júnior
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências, Ribeirão Preto SP, Brazil
| | - Acary Souza Bulle Oliveira
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia/Ebserh, Setor de Investigações nas Doenças Neuromusculares, São Paulo SP, Brazil
| | | | - Delson José da Silva
- Universidade Federal de Goiás, Hospital das Clínicas, Unidade de Neurologia e Neurocirurgia/Ebserh, Goiânia GO, Brazil
| | - Elza Dias-Tosta
- Comissão de Ética da Academia Brasileira de Neurologia, São Paulo SP, Brazil
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Petri S, Grehl T, Grosskreutz J, Hecht M, Hermann A, Jesse S, Lingor P, Löscher W, Maier A, Schoser B, Weber M, Ludolph AC. Guideline "Motor neuron diseases" of the German Society of Neurology (Deutsche Gesellschaft für Neurologie). Neurol Res Pract 2023; 5:25. [PMID: 37316950 DOI: 10.1186/s42466-023-00251-x] [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: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION In 2021, the Deutsche Gesellschaft für Neurology published a new guideline on diagnosis and therapy of motor neuron disorders. Motor neuron disorders affect upper motor neurons in the primary motor cortex and/or lower motor neurons in the brain stem and spinal cord. The most frequent motor neuron disease amyotrophic lateral sclerosis (ALS) is a rapidly progressive disease with an average life expectancy of 2-4 years with a yearly incidence of 3.1/100,000 in Central Europe (Rosenbohm et al. in J Neurol 264(4):749-757, 2017. https://doi.org/10.1007/s00415-017-8413-3 ). It is considered a rare disease mainly due to its low prevalence as a consequence of short disease duration. RECOMMENDATIONS These guidelines comprise recommendations regarding differential diagnosis, neuroprotective therapies and multidisciplinary palliative care including management of respiration and nutrition as well as provision of assistive devices and end-of-life situations. CONCLUSION Diagnostic and therapeutic guidelines are necessary due the comparatively high number of cases and the aggressive disease course. Given the low prevalence and the severe impairment of patients, it is often impossible to generate evidence-based data so that ALS guidelines are partially dependent on expert opinion.
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Affiliation(s)
- Susanne Petri
- Klinik für Neurologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Torsten Grehl
- Neurologie, Alfried-Krupp-Krankenhaus, Essen, Germany
| | | | - Martin Hecht
- Neurologie, Bezirkskrankenhaus Kaufbeuren, Kaufbeuren, Germany
| | | | | | | | - Wolfgang Löscher
- Neurologie, Medizinische Universität Innsbruck, Innsbruck, Austria
- ÖGN, Vienna, Austria
| | - André Maier
- Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Marcus Weber
- Muskelzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
- SNG, St. Gallen, Switzerland
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Meyer T, Salkic E, Grehl T, Weyen U, Kettemann D, Weydt P, Günther R, Lingor P, Koch JC, Petri S, Hermann A, Prudlo J, Großkreutz J, Baum P, Boentert M, Metelmann M, Norden J, Cordts I, Weishaupt JH, Dorst J, Ludolph A, Koc Y, Walter B, Münch C, Spittel S, Dreger M, Maier A, Körtvélyessy P. Performance of serum neurofilament light chain in a wide spectrum of clinical courses of amyotrophic lateral sclerosis-a cross-sectional multicenter study. Eur J Neurol 2023; 30:1600-1610. [PMID: 36899448 DOI: 10.1111/ene.15773] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND AND PURPOSE The objective was to assess the performance of serum neurofilament light chain (sNfL) in amyotrophic lateral sclerosis (ALS) in a wide range of disease courses, in terms of progression, duration and tracheostomy invasive ventilation (TIV). METHODS A prospective cross-sectional study at 12 ALS centers in Germany was performed. sNfL concentrations were age adjusted using sNfL Z scores expressing the number of standard deviations from the mean of a control reference database and correlated to ALS duration and ALS progression rate (ALS-PR), defined by the decline of the ALS Functional Rating Scale. RESULTS In the total ALS cohort (n = 1378) the sNfL Z score was elevated (3.04; 2.46-3.43; 99.88th percentile). There was a strong correlation of sNfL Z score with ALS-PR (p < 0.001). In patients with long (5-10 years, n = 167) or very long ALS duration (>10 years, n = 94) the sNfL Z score was significantly lower compared to the typical ALS duration of <5 years (n = 1059) (p < 0.001). Furthermore, in patients with TIV, decreasing sNfL Z scores were found in correlation with TIV duration and ALS-PR (p = 0.002; p < 0.001). CONCLUSIONS The finding of moderate sNfL elevation in patients with long ALS duration underlined the favorable prognosis of low sNfL. The strong correlation of sNfL Z score with ALS-PR strengthened its value as progression marker in clinical management and research. The lowering of sNfL in correlation with long TIV duration could reflect a reduction either in disease activity or in the neuroaxonal substrate of biomarker formation during the protracted course of ALS.
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Affiliation(s)
- Thomas Meyer
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- APST Research GmbH, Berlin, Germany
| | - Erma Salkic
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Grehl
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Alfried Krupp Krankenhaus, Essen, Germany
| | - Ute Weyen
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Dagmar Kettemann
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Weydt
- Department for Neurodegenerative Disorders and Gerontopsychiatry, Bonn University, Bonn, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Research Site Bonn, Bonn, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Dresden (DZNE), Dresden, Germany
| | - Paul Lingor
- Department of Neurology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Christoph Koch
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andreas Hermann
- Department of Neurology, Translational Neurodegeneration Section "Albrecht-Kossel", University of Rostock, University Medical Center, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Rostock/Greifswald, DZNE, Greifswald, Germany
| | - Johannes Prudlo
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Rostock/Greifswald, DZNE, Greifswald, Germany
- Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock,, Germany
| | - Julian Großkreutz
- Department of Neurology, Universitätsmedizin Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Petra Baum
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Matthias Boentert
- Department of Neurology, Universitätsklinikum Münster, Münster, Germany
| | - Moritz Metelmann
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Jenny Norden
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Isabell Cordts
- Department of Neurology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jochen H Weishaupt
- Division for Neurodegenerative Diseases, Department of Neurology, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Albert Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Ulm (DZNE), Ulm, Germany
| | - Yasemin Koc
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bertram Walter
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Münch
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- APST Research GmbH, Berlin, Germany
| | - Susanne Spittel
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- APST Research GmbH, Berlin, Germany
| | - Marie Dreger
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - André Maier
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Péter Körtvélyessy
- Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Magdeburg (DZNE), Magdeburg, Germany
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Meyer T, Spittel S, Grehl T, Weyen U, Steinbach R, Kettemann D, Petri S, Weydt P, Günther R, Baum P, Schlapakow E, Koch JC, Boentert M, Wolf J, Grosskreutz J, Rödiger A, Ilse B, Metelmann M, Norden J, Koc RY, Körtvélyessy P, Riitano A, Walter B, Hildebrandt B, Schaudinn F, Münch C, Maier A. Remote digital assessment of amyotrophic lateral sclerosis functional rating scale - a multicenter observational study. Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:175-184. [PMID: 35912984 DOI: 10.1080/21678421.2022.2104649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective: Remote self-assessment of the revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R) using digital data capture was investigated for its feasibility as an add-on to ALSFRS-R assessments during multidisciplinary clinic visits. Methods: From August 2017 to December 2021, at 12 ALS centers in Germany, an observational study on remote assessment of the ALSFRS-R was performed. In addition to the assessment of ALSFRS-R during clinic visits, patients were offered a digital self-assessment of the ALSFRS-R - either on a computer or on a mobile application ("ALS-App"). Results: An estimated multicenter cohort of 4,670 ALS patients received care at participating ALS centers. Of these patients, 971 remotely submitted the ALSFRS-R, representing 21% of the multicenter cohort. Of those who opted for remote assessment, 53.7% (n = 521) completed a minimum of 4 ALSFRS-R per year with a mean number of 10.9 assessments per year. Different assessment frequencies were found for patients using a computer (7.9 per year, n = 857) and mobile app (14.6 per year, n = 234). Patients doing remote assessments were more likely to be male and less functionally impaired but many patients with severe disability managed to complete it themselves or with a caregiver (35% of remote ALSFRS-R cohort in King's Stage 4). Conclusions: In a dedicated ALS center setting remote digital self-assessment of ALSFRS-R can provide substantial data which is complementary and potentially an alternative to clinic assessments and could be used for research purposes and person-level patient management. Addressing barriers relating to patient uptake and adherence are key to its success.
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Affiliation(s)
- Thomas Meyer
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Susanne Spittel
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Torsten Grehl
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Alfried Krupp Krankenhaus, Essen, Germany
| | - Ute Weyen
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Dagmar Kettemann
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Patrick Weydt
- Department for Neurodegenerative Disorders and Gerontopsychiatry, Bonn University, Bonn, Germany
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,DZNE, German Center for Neurodegenerative Diseases, Research Site Dresden, Dresden, Germany
| | - Petra Baum
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Elena Schlapakow
- Department of Neurology, Universitätsklinikum Halle, Halle (Saale), Germany
| | - Jan Christoph Koch
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Matthias Boentert
- Department of Sleep Medicine and Neuromuscular Disorders, Universitätsklinikum Münster, Münster, Germany
| | - Joachim Wolf
- Department of Neurology, Diako Mannheim, Mannheim, Germany
| | - Julian Grosskreutz
- Precision Neurology, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Annekathrin Rödiger
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Benjamin Ilse
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Moritz Metelmann
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Jenny Norden
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ruhan Yasemin Koc
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Péter Körtvélyessy
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alessio Riitano
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bertram Walter
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | | | - Christoph Münch
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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7
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Maier A, Gaudlitz M, Grehl T, Weyen U, Steinbach R, Grosskreutz J, Rödiger A, Koch JC, Lengenfeld T, Weydt P, Günther R, Wolf J, Baum P, Metelmann M, Dorst J, Ludolph AC, Kettemann D, Norden J, Koc RY, Walter B, Hildebrandt B, Münch C, Meyer T, Spittel S. Use and subjective experience of the impact of motor-assisted movement exercisers in people with amyotrophic lateral sclerosis: a multicenter observational study. Sci Rep 2022; 12:9657. [PMID: 35688956 PMCID: PMC9187150 DOI: 10.1038/s41598-022-13761-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Motor-assisted movement exercisers (MME) are devices that assist with physical therapy in domestic settings for people living with ALS. This observational cross-sectional study assesses the subjective experience of the therapy and analyzes users' likelihood of recommending treatment with MME. The study was implemented in ten ALS centers between February 2019 and October 2020, and was coordinated by the research platform Ambulanzpartner. Participants assessed symptom severity, documented frequency of MME use and rated the subjective benefits of therapy on a numerical scale (NRS, 0 to 10 points, with 10 being the highest). The Net Promotor Score (NPS) determined the likelihood of a participant recommending MME. Data for 144 participants were analyzed. Weekly MME use ranged from 1 to 4 times for 41% of participants, 5 to 7 times for 42%, and over 7 times for 17%. Particularly positive results were recorded in the following domains: amplification of a sense of achievement (67%), diminution of the feeling of having rigid limbs (63%), diminution of the feeling of being immobile (61%), improvement of general wellbeing (55%) and reduction of muscle stiffness (52%). Participants with more pronounced self-reported muscle weakness were more likely to note a beneficial effect on the preservation and improvement of muscle strength during MME treatment (p < 0.05). Overall, the NPS for MME was high (+ 61). High-frequency MME-assisted treatment (defined as a minimum of five sessions a week) was administered in the majority of participants (59%) in addition to physical therapy. Most patients reported having achieved their individual therapeutic objectives, as evidenced by a high level of satisfaction with MME therapy. The results bolster the justification for extended MME treatment as part of a holistic approach to ALS care.
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Affiliation(s)
- André Maier
- Outpatient Center for ALS and Other Motor Neuron Diseases, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | | | - Torsten Grehl
- Department of Neurology, Alfried Krupp Krankenhaus, Center for ALS and Other Motor Neuron Disorders, Essen, Germany
| | - Ute Weyen
- Center for ALS and Other Motor Neuron Disorders, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Annekathrin Rödiger
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jan Christoph Koch
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Teresa Lengenfeld
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Patrick Weydt
- Universitätsklinikum Bonn-Klinik Für Neurodegenerative Erkrankungen, Bonn, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Deutschland.,Research Site Dresden, German Centre for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Joachim Wolf
- Department of Neurology, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Petra Baum
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Moritz Metelmann
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Ulm, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Ulm, Ulm, Germany
| | - Dagmar Kettemann
- Outpatient Center for ALS and Other Motor Neuron Diseases, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jenny Norden
- Outpatient Center for ALS and Other Motor Neuron Diseases, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ruhan Yasemin Koc
- Outpatient Center for ALS and Other Motor Neuron Diseases, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bertram Walter
- Outpatient Center for ALS and Other Motor Neuron Diseases, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Christoph Münch
- Outpatient Center for ALS and Other Motor Neuron Diseases, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Thomas Meyer
- Outpatient Center for ALS and Other Motor Neuron Diseases, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Susanne Spittel
- Outpatient Center for ALS and Other Motor Neuron Diseases, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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8
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Pan Y, Nicolazzo JA. Altered Blood-Brain Barrier and Blood-Spinal Cord Barrier Dynamics in Amyotrophic Lateral Sclerosis: Impact on Medication Efficacy and Safety. Br J Pharmacol 2022; 179:2577-2588. [PMID: 35048358 DOI: 10.1111/bph.15802] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022] Open
Abstract
The access of drugs into the central nervous system (CNS) is regulated by the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB). A large body of evidence supports perturbation of these barriers in neurodegenerative diseases, including Alzheimer's disease and Parkinson's disease. Modifications to the BBB and BSCB are also reported in amyotrophic lateral sclerosis (ALS), albeit these modifications have received less attention relative to those in other neurodegenerative diseases. Such alterations to the BBB and BSCB have the potential to impact on CNS exposure of drugs in ALS, modulating the effectiveness of drugs intended to reach the brain and the toxicity of drugs that are not intended to reach the brain. Given the clinical importance of these phenomena, this review will summarise reported modifications to the BBB and BSCB in ALS, discuss their impact on CNS drug exposure and suggest further research directions so as to optimise medicine use in people with ALS.
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Affiliation(s)
- Yijun Pan
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Joseph A Nicolazzo
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
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9
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Meyer T. [Amyotrophic lateral sclerosis (ALS) - diagnosis, course of disease and treatment options]. Dtsch Med Wochenschr 2021; 146:1613-1618. [PMID: 34879411 DOI: 10.1055/a-1562-7882] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is an adult-onset motor neuron disorder which is characterized by progressive motor symptoms, such as muscle weakness, muscle atrophy and spasticity. In Germany, 6000-8000 people are affected by ALS. Between 1200 and 1600 newly diagnosed patients are expected each year. Protein deposits in the cytoplasm of motor neurons are a molecular feature of ALS. The most common protein aggregates result from excessive deposition of TDP-43. Familial ALS is present in 5 to 10 % of all ALS patients. Common causal genes include C9orf72, SOD1, FUS, and TARDBP. Genetic factors may be involved even without a family history of ALS and may be underestimated. The disease course and progression are highly variable. Symptom severity and rate of progression are determined by the ALS Functional Scale (ALSFRS-R). Beyond clinical symptoms and the patient's perception of disease burden, measurement of slow vital capacity (SVC), peak cough flow (PCF), and body mass index (BMI) are used to underscore the indications for ventilatory and nutritional interventions, as well as palliative care. The validity of the biomarker neurofilament light chain (NF-L) for estimating prognosis is currently being investigated. ALS is not curable - however, various individual treatment options have to be considered for improving survival, symptom control and social participation. The care in specialized ALS centers is recommended to ensure optimal treatment regarding symptomatic medication, assistive devices, nutrition support and ventilation therapy. Optimal care is achieved by interdisciplinary collaboration of general practitioners, specialized physicians, neurologists and ALS experts being integrated in multiprofessional care networks.
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10
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Meyer T, Maier A, Uzelac Z, Hagenacker T, Günther R, Schreiber-Katz O, Weiler M, Steinbach R, Weyen U, Koch JC, Kettemann D, Norden J, Dorst J, Wurster C, Ludolph AC, Stolte B, Freigang M, Osmanovic A, Petri S, Grosskreutz J, Rödiger A, Griep R, Gaudlitz M, Walter B, Münch C, Spittel S. Treatment expectations and perception of therapy in adult patients with spinal muscular atrophy receiving nusinersen. Eur J Neurol 2021; 28:2582-2595. [PMID: 33960080 DOI: 10.1111/ene.14902] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/10/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE This was an investigation of treatment expectations and of the perception of therapy in adult patients with 5q-associated spinal muscular atrophy (5q-SMA) receiving nusinersen. METHODS A prospective, non-interventional observational study of nusinersen treatment in adult 5q-SMA patients was conducted at nine SMA centers in Germany. The functional status, treatment expectations and perceived outcomes were assessed using the Amyotrophic Lateral Sclerosis Functional Rating Scale-extended (ALS-FRS-ex), the Measure Yourself Medical Outcome Profile (MYMOP2), the Treatment Satisfaction Questionnaire for Medication (TSQM-9) and the Net Promoter Score (NPS). RESULTS In all, 151 patients were included with a median age of 36 years (15-69 years). SMA type 3 (n = 90, 59.6%) prevailed, followed by type 2 (33.8%) and type 1 (6.6%). In SMA types 1-3, median ALS-FRS-ex scores were 25, 33 and 46 (of 60 scale points), respectively. MYMOP2 identified distinct treatment expectations: head verticalization (n = 13), bulbar function (n = 16), arm function (n = 65), respiration (n = 15), trunk function (n = 34), leg function (n = 76) and generalized symptoms (n = 77). Median symptom severity decreased during nusinersen treatment (median observational period 6.1 months, 0.5-16 months) from 3.7 to 3.3 MYMOP2 score points (p < 0.001). The convenience of drug administration was critical (49.7 of 100 TSQM-9 points, SD 22); however, the overall treatment satisfaction was high (74.3, SD 18) and the recommendation rating very positive (NPS +66). CONCLUSIONS Nusinersen was administered across a broad range of ages, disease durations and motor function deficits. Treatment expectations were highly differentiated and related to SMA type and functional status. Patient-reported outcomes demonstrated a positive perception of nusinersen therapy in adult patients with 5q-SMA.
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Affiliation(s)
- Thomas Meyer
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Zeljko Uzelac
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Tim Hagenacker
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Dresden, Dresden, Germany
| | | | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Ute Weyen
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Jan Christoph Koch
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Dagmar Kettemann
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jenny Norden
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Albert C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Ulm, Ulm, Germany
| | - Benjamin Stolte
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | - Maren Freigang
- Department of Neurology, Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Annekathrin Rödiger
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Ramona Griep
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | | | - Bertram Walter
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Münch
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Susanne Spittel
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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11
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Peseschkian T, Cordts I, Günther R, Stolte B, Zeller D, Schröter C, Weyen U, Regensburger M, Wolf J, Schneider I, Hermann A, Metelmann M, Kohl Z, Linker RA, Koch JC, Büchner B, Weiland U, Schönfelder E, Heinrich F, Osmanovic A, Klopstock T, Dorst J, Ludolph AC, Boentert M, Hagenacker T, Deschauer M, Lingor P, Petri S, Schreiber-Katz O. A Nation-Wide, Multi-Center Study on the Quality of Life of ALS Patients in Germany. Brain Sci 2021; 11:brainsci11030372. [PMID: 33799476 PMCID: PMC7998410 DOI: 10.3390/brainsci11030372] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022] Open
Abstract
Improving quality of life (QoL) is central to amyotrophic lateral sclerosis (ALS) treatment. This Germany-wide, multicenter cross-sectional study analyses the impact of different symptom-specific treatments and ALS variants on QoL. Health-related QoL (HRQoL) in 325 ALS patients was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire 5 (ALSAQ-5) and EuroQol Five Dimension Five Level Scale (EQ-5D-5L), together with disease severity (captured by the revised ALS Functional Rating Scale (ALSFRS-R)) and the current care and therapies used by our cohort. At inclusion, the mean ALSAQ-5 total score was 56.93 (max. 100, best = 0) with a better QoL associated with a less severe disease status (β = −1.96 per increase of one point in the ALSFRS-R score, p < 0.001). “Limb-onset” ALS (lALS) was associated with a better QoL than “bulbar-onset” ALS (bALS) (mean ALSAQ-5 total score 55.46 versus 60.99, p = 0.040). Moreover, with the ALSFRS-R as a covariate, using a mobility aid (β = −7.60, p = 0.001), being tracheostomized (β = −14.80, p = 0.004) and using non-invasive ventilation (β = −5.71, p = 0.030) were associated with an improved QoL, compared to those at the same disease stage who did not use these aids. In contrast, antidepressant intake (β = 5.95, p = 0.007), and increasing age (β = 0.18, p = 0.023) were predictors of worse QoL. Our results showed that the ALSAQ-5 was better-suited for ALS patients than the EQ-5D-5L. Further, the early and symptom-specific clinical management and supply of assistive devices can significantly improve the individual HRQoL of ALS patients. Appropriate QoL questionnaires are needed to monitor the impact of treatment to provide the best possible and individualized care.
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Affiliation(s)
- Tara Peseschkian
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Isabell Cordts
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, 01307 Dresden, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Benjamin Stolte
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany;
| | - Carsten Schröter
- Hoher Meißner Clinic, Neurology, 37242 Bad Sooden-Allendorf, Germany;
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, 44789 Bochum, Germany;
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Joachim Wolf
- Department of Neurology, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany;
| | - Ilka Schneider
- Department of Neurology, Martin-Luther University Halle/Saale, 06120 Halle, Germany;
- Department of Neurology, Klinikum Sankt Georg, 04129 Leipzig, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany;
- German Center for Neurodegenerative Diseases Rostock/Greifswald, 18147 Rostock, Germany
| | - Moritz Metelmann
- Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Zacharias Kohl
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Ralf A. Linker
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, 37075 Göttingen, Germany;
| | - Boriana Büchner
- Friedrich-Baur Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (B.B.); (T.K.)
| | - Ulrike Weiland
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
| | - Erik Schönfelder
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Felix Heinrich
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Thomas Klopstock
- Friedrich-Baur Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (B.B.); (T.K.)
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Matthias Boentert
- Department of Neurology with the Institute of Translational Neurology, University Hospital Münster, 48149 Münster, Germany;
- Department of Medicine, UKM Marienhospital, 48565 Steinfurt, Germany
| | - Tim Hagenacker
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Marcus Deschauer
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
- Correspondence:
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12
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Spittel S, Maier A, Kettemann D, Walter B, Koch B, Krause K, Norden J, Münch C, Meyer T. Non-invasive and tracheostomy invasive ventilation in amyotrophic lateral sclerosis: Utilization and survival rates in a cohort study over 12 years in Germany. Eur J Neurol 2020; 28:1160-1171. [PMID: 33210770 DOI: 10.1111/ene.14647] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to investigate utilization rates, treatment pathways and survival prognosis in patients with amyotrophic lateral sclerosis (ALS) undergoing non-invasive (NIV) and tracheostomy invasive ventilation (TIV) in a real-world setting. METHODS A prospective cohort study using a single-centre register of 2702 ALS patients (2007 to 2019) was conducted. Utilization of NIV/TIV and survival data were analysed in three cohorts: (i) non-NIV; (ii) NIV (NIV without subsequent TIV); and (iii) TIV (including TIV preceded by NIV). RESULTS A total of 1720 patients with available data were identified, 72.0% of whom (n = 1238) did not receive ventilation therapy. NIV was performed in 20.8% of patients (n = 358). TIV was performed in 9.5% of patients (n = 164), encompassing both primary TIV (7.2%, n = 124) and TIV with preceding NIV (2.3%, n = 40). TIV was more often utilized without previous NIV (25.7% vs. 8.3% of all ventilated patients), demonstrating that primary TIV was the prevailing pathway for invasive ventilation. The median (range) survival was significantly longer in the NIV cohort (40.8 [37.2-44.3] months) and the TIV cohort (82.1 [68.7-95.6] months) as compared to the non-NIV cohort (33.6 [31.6-35.7] months). CONCLUSIONS Although NIV represents the standard of care, its utilization rate was low. TIV was mainly started without preceding NIV, suggesting that TIV may not be confined to NIV treatment escalation. However, TIV was pursued in a minority of patients who had previously undergone NIV. The survival benefit observed in the patients with NIV was equal to that reported in a controlled pivotal trial, but the prognosis with TIV is highly variable. The determinants of utilization of NIV/TIV and of survival (bulbar syndrome, availability of ventilation-related home nursing, cultural factors) warrant further investigation.
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Affiliation(s)
- Susanne Spittel
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dagmar Kettemann
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bertram Walter
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Koch
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Krause
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jenny Norden
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Münch
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Thomas Meyer
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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13
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Steinbach R, Prell T, Gaur N, Stubendorff B, Roediger A, Ilse B, Witte OW, Grosskreutz J. Triage of Amyotrophic Lateral Sclerosis Patients during the COVID-19 Pandemic: An Application of the D50 Model. J Clin Med 2020; 9:jcm9092873. [PMID: 32899481 PMCID: PMC7565659 DOI: 10.3390/jcm9092873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease, the management of which requires the continuous provision of multidisciplinary therapies. Owing to the novel coronavirus disease (COVID-19) pandemic, regular contact with ALS patients at our center was severely restricted and patient care was at risk by delay of supportive therapies. We established a triage system based on the D50 disease progression model and were thus able to identify a prospective cohort with high disease aggressiveness (D50 < 30). Thirty-seven patients with highly aggressive disease were actively offered follow-up, either via telephone or on-site, depending on their disease-specific needs and abilities. We describe here the procedures, obstacles, and results of these prescient efforts during the restrictions caused by COVID-19 in the period between March and June 2020. In conclusion, four patients with highly aggressive disease were initiated with non-invasive ventilation and two received a gastrostomy. We could show that a comparable amount of advanced care was induced in a retrospective cohort within a similar time period one year prior to the COVID-19 outbreak. Our workflow to identify high-risk patients via D50 model metrics can be easily implemented and integrated within existing centers. It helped to maintain a high quality of advanced care planning for our ALS patients.
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Affiliation(s)
- Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Correspondence: ; Tel.: +49-3641-9323-587
| | - Tino Prell
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
| | - Nayana Gaur
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Beatrice Stubendorff
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Annekathrin Roediger
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Benjamin Ilse
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Otto W. Witte
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
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Use of vitamins by participants in amyotrophic lateral sclerosis clinical trials. PLoS One 2020; 15:e0237175. [PMID: 32790757 PMCID: PMC7425848 DOI: 10.1371/journal.pone.0237175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
Patients' vitamin intake is often not documented and is therefore not considered sufficiently in studies of prescribed medication in patients with amyotrophic lateral sclerosis (ALS). We aimed to determine the prevalence of vitamin use by participants in ALS clinical trials. Data about demographics, disease severity (ALS Functional Rating Scale) and concomitant medication were obtained from the Pooled Resource Open-Access ALS Clinical Trials Database, which contains records from more than 6000 ALS patients who participated in 23 phase II/III clinical trials. Information about vitamin intake for all study subjects was coded into major categories. Clinical data of vitamin users and nonusers were compared, and regression analysis was used to explore the associations among clinical parameters, vitamin use and two measures of disease progression. From the 40.996 available medication records from 6274 subjects, 7338 (17.9%) concerned vitamins. One or more vitamins were used by 3331 subjects (53.1%). Most common was vitamin E, vitamin C and multivitamins. Patients who did and did not take vitamins did not differ in terms of disease progression and ALS Functional Rating Scale score. Patients who took vitamins were younger, were more often female, had a shorter time between onset and diagnosis, had shorter disease duration and more frequently had limb-onset types. Disease progression rate and disease aggressiveness were not associated with vitamin use. Despite unclear evidence, the use of vitamins in ALS is common. However, rapid progression was not observed to be associated with vitamin use.
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