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Sarmet M, Santos DB, Mangilli LD, Million JL, Maldaner V, Zeredo JL. Chronic respiratory failure negatively affects speech function in patients with bulbar and spinal onset amyotrophic lateral sclerosis: retrospective data from a tertiary referral center. LOGOP PHONIATR VOCO 2024; 49:17-26. [PMID: 35767076 DOI: 10.1080/14015439.2022.2092209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 02/04/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
Background: Although dysarthria and respiratory failure are widely described in literature as part of the natural history of Amyotrophic lateral sclerosis (ALS), the specific interaction between them has been little explored.Aim: To investigate the relationship between chronic respiratory failure and the speech of ALS patients.Materials and methods: In this cross-sectional retrospective study we reviewed the medical records of all patients diagnosed with ALS that were accompanied by a tertiary referral center. In order to determine the presence and degree of speech impairment, the Amyotrophic Lateral Sclerosis Functional Rating Scale-revised (ALSFRS-R) speech sub-scale was used. Respiratory function was assessed through spirometry and through venous blood gasometry obtained from a morning peripheral venous sample. To determine whether differences among groups classified by speech function were significant, maximum and mean spirometry values of participants were compared using multivariate analysis of variance (MANOVA) with Tukey's post hoc test.Results: Seventy-five cases were selected, of which 73.3% presented speech impairment and 70.7% respiratory impairment. Respiratory and speech functions were moderately correlated (seated FVC r = 0.64; supine FVC r = 0.60; seated FEV1 r = 0.59 and supine FEV1 r = 0.54, p < .001). Multivariable logistic regression revealed that the following variables were significantly associated with the presence of speech impairment after adjusting for other risk factors: seated FVC (odds ratio [OR] = 0.862) and seated FEV1 (OR = 1.106). The final model was 81.1% predictive of speech impairment. The presence of daytime hypercapnia was not correlated to increasing speech impairment.Conclusion: The restrictive pattern developed by ALS patients negatively influences speech function. Speech is a complex and multifactorial process, and lung volume presents a pivotal role in its function. Thus, we were able to find that lung volumes presented a significant correlation to speech function, especially in those with bulbar onset and respiratory impairment. Neurobiological and physiological aspects of this relationship should be explored in further studies with the ALS population.
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Affiliation(s)
- Max Sarmet
- Graduate Department of Health Science and Technology, University of Brasília (UnB), Brasília, Brazil
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
| | - Dante Brasil Santos
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
- UniEvangélica, Graduate Program of Human Movement and Rehabilitation, Anápolis, Brazil
| | | | - Janae Lyon Million
- Department of Human Biology, University of California Santa Cruz, Santa Cruz, CA, United States of America
| | - Vinicius Maldaner
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
- UniEvangélica, Graduate Program of Human Movement and Rehabilitation, Anápolis, Brazil
| | - Jorge L Zeredo
- Graduate Department of Health Science and Technology, University of Brasília (UnB), Brasília, Brazil
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Young CA, Ealing J, McDermott CJ, Williams TL, Al-Chalabi A, Majeed T, Talbot K, Harrower T, Faull C, Malaspina A, Annadale J, Mills RJ, Tennant A. Measuring disability in amyotrophic lateral sclerosis/motor neuron disease: the WHODAS 2.0-36, WHODAS 2.0-32, and WHODAS 2.0-12. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:63-70. [PMID: 35876069 DOI: 10.1080/21678421.2022.2102926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 01/26/2023]
Abstract
Aim: To investigate whether the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) can provide interval level measurement of disability in Amyotrophic Lateral Sclerosis (ALS), allowing parametric analyses. Methods: Data on the WHODAS 12, 32, and 36-item versions, from 1120 patients studied at one or more time points, were fit to the Rasch model and comparisons made against ALSFRS-R, King's staging, and mortality. Trajectory modeling was undertaken for a newly diagnosed (≤6 months) cohort of 454 individuals. Results: Total scores for WHODAS 32 and 36-item versions can be converted to interval level measurement suitable for individual clinical use, and the 12-item WHODAS total for group use. The 36-item version is shown to be equivalent to the 32-item version. Expected correlations were seen with King's staging, ALSFRS-R, and EQ-5D-5L. Trajectory analysis of disability (WHODAS 2.0) showed three clearly demarcated groups with differences in King's staging, depressive symptomatology and mortality, but not age. Conclusions: The WHODAS 2.0 is a brief patient reported outcome measure which can be used to measure disability in ALS. Provided the patient answers all 36 (32 if not working) items, the conversion table produces an interval level estimate for parametric analyses. The different trajectories demonstrated from diagnosis support the concept of a prodromal period, and suggest the WHODAS 2.0 could be used for surveillance of at risk populations, such as those with genetic predisposition.
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Affiliation(s)
- Carolyn A Young
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - John Ealing
- Department of Neurology, Greater Manchester Centre for Clinical Neurosciences, Salford, UK
| | | | - Tim L Williams
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK
- Department of Neurology, King's College Hospital, London, UK
| | - Tahir Majeed
- Department of Neurology, Lancashire Teaching Hospital, Preston, UK
| | - Kevin Talbot
- Department of Neurology, University of Oxford, Oxford, UK
| | | | | | | | - Joe Annadale
- Hywel Dda University Health Board, Wales, UK, and
| | - Roger J Mills
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Humoral Influence of Repeated Lineage-Negative Stem/Progenitor Cell Administration on Articulatory Functions in ALS Patients. Stem Cells Int 2020; 2020:8888271. [PMID: 33381192 PMCID: PMC7755492 DOI: 10.1155/2020/8888271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/13/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) remains a fatal, neurodegenerative disease frequently leading to dysarthria and impaired swallowing. Better understanding of ALS pathophysiology is prompting the use of humoral cell therapies. Hence, a repeated cellular therapy was applied to ALS patients as an attempt to prevent speech deterioration. Autologous bone marrow-derived lineage-negative (Lin−) cells were intrathecally administered three times at six-week intervals to 42 sporadic ALS patients. Patients were examined for articulatory functions using subjective (VHI) and objective (FDA) scales. Selected trophic, proinflammatory factors and expression profiles of miRNA were measured in cerebrospinal fluid (CSF) and plasma by multiplex Luminex and q-PCR in different timepoints. Of the 42 patients who received the Lin− cells, 6 showed improvement in articulatory functions, 27 remained stable, and 9 deteriorated after 18 weeks of therapy according to FDA scale. Clinical improvement was particularly evident by the 7th day of each cell application and concerned better cough and swallow reflex, soft palate, laryngeal time, pitch, and volume. These results correlated with significant changes in the concentration of various trophic and proinflammatory factors and miRNA expression profiles. A multiple application of Lin− cells proved to be safe and feasible. The repeated procedure can potentate a humoral effect and prevent speech deterioration. A short-lasting trophic effect of each Lin− cells administration was observed on local and systemic level. However, further in-depth studies are necessary to sustain the beneficial effect.
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Maksymowicz S, Kukołowicz P, Siwek T, Rakowska A. Validation of the revised Amyotrophic Lateral Sclerosis Functional Rating Scale in Poland and its reliability in conditions of the medical experiment. Neurol Sci 2020; 42:943-949. [PMID: 32676760 PMCID: PMC7870618 DOI: 10.1007/s10072-020-04565-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Abstract
Introduction Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is a basic tool for monitoring disease progression in amyotrophic lateral sclerosis (ALS). This study analyses the reliability of the Polish version of the ALSFRS-R as a tool to assess the health condition of patients with ALS and presents experience related to the use of this tool in monitoring the effects of experimental medical therapy. Materials and methods The scale questionnaire was translated using the cross-translation method. The final tool was used by researcher, who was conducting the interview directly by telephone with patients and their caregivers and additionally compared with neurologopedic measurement. The health status of 60 patients was assessed between 4 and 7 times, which gives a total of 327 observations. Mean patient’s age was 57.5 ± 8.6. The division by sex was 23/35 (female/male). Patients’ health status and severity of symptoms varied. Statistical analysis was performed using explanatory factor analysis and Cronbach’s alpha. Result Validation of the Polish version of the ALSFRS-R supports the reliability and internal consistency of scale. The scale proved also to be a proper tool for monitoring the course of the experimental medical therapy for patients with ALS. However, a qualitative evaluation revealed certain weaknesses of the scale, resulting from a different understanding of the functional assessment by the patient and by the medical specialist and cultural differences. Discussion Although ALSFRS-R is a reliable enough for monitoring patient health, it seems reasonable to pay attention to some difficult points of the questionnaire and its improvement. Electronic supplementary material The online version of this article (10.1007/s10072-020-04565-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stanisław Maksymowicz
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, Collegium Medicum of the University of Warmia and Mazury, Olsztyn, Poland. .,Instytut Terapii Komórkowych S.A., Olsztyn, Poland.
| | | | - Tomasz Siwek
- Instytut Terapii Komórkowych S.A., Olsztyn, Poland.,Department of Neurology, School of Medicine, Collegium Medicum of the University of Warmia and Mazury, Olsztyn, Poland.,University Clinical Hospital, Olsztyn, Poland
| | - Agnieszka Rakowska
- Instytut Terapii Komórkowych S.A., Olsztyn, Poland.,University Clinical Hospital, Olsztyn, Poland
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Liu JX, Pedrosa Domellöf F. Complex Correlations Between Desmin Content, Myofiber Types, and Innervation Patterns in the Human Extraocular Muscles. Invest Ophthalmol Vis Sci 2020; 61:15. [PMID: 32176266 PMCID: PMC7401728 DOI: 10.1167/iovs.61.3.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate whether the distribution of intermediate filament protein desmin is related to the different patterns of innervation in the human extraocular muscles (EOMs). Methods EOM samples were analyzed with immunohistochemistry using antibodies against desmin, vimentin, different myosin heavy chain (MyHC) isoforms, and fetal and adult acetylcholine receptor (AChR) subunits. Neuromuscular junctions (NMJs) were identified with α-bungarotoxin or with antibodies against neurofilament and synaptophysin. Results Desmin was present in the vast majority of myofibers, but it was weakly present or absent in a limited area in the close vicinity of the single en plaque NMJs in less than half of these myofibers. Desmin was either present or lacking in MyHCsto/I myofibers displaying multiple en grappe endings but present in MyHCsto/I myofibers receiving spiral nerve endings. In MyHCeom myofibers displaying multiterminal en plaque endings, desmin was either present or absent irrespective of AChR subunits or EOM layer. Vimentin did not substitute for the lack of desmin. Conclusions The results indicate that the human EOMs have a more complex cytoskeletal organization than other muscles and suggest additional signalling mechanisms from the NMJs to the myofibers.
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Affiliation(s)
- Jing-Xia Liu
- Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden
| | - Fatima Pedrosa Domellöf
- Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden
- Department of Clinical Science, Ophthalmology, Umeå University, Umeå, Sweden
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