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Gianferrari G, Zucchi E, Martinelli I, Simonini C, Fini N, Ferro S, Mercati A, Ferri L, Filippini T, Vinceti M, Mandrioli J. Trends in Hospital Admissions for Patients with Amyotrophic Lateral Sclerosis: Insights from a Retrospective Cohort Study in a Province in Northern Italy. Life (Basel) 2024; 14:941. [PMID: 39202683 PMCID: PMC11355426 DOI: 10.3390/life14080941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024] Open
Abstract
ALS is characterized by a highly heterogeneous course, ranging from slow and uncomplicated to rapid progression with severe extra-motor manifestations. This study investigated ALS-related hospitalizations and their connection to clinical aspects, comorbidities, and prognosis. We performed a retrospective cohort study including patients residing in Modena, Italy, newly diagnosed between 2007 and 2017 and followed up until 31 December 2022. Data were obtained from the Emilia Romagna ALS registry, regional hospitals, and medical records. Among the 249 patients, there were 492 hospital admissions, excluding those for diagnostic purposes; 63% of the patients had at least one hospitalization post-diagnosis, with an average stay of 19.90 ± 23.68 days. Younger patients were more likely to be hospitalized multiple times and experienced longer stays (44.23 ± 51.71 days if <65 years; 26.46 ± 36.02 days if older, p < 0.001). Patients who were hospitalized at least once more frequently underwent gastrostomy (64.97%) or non-invasive (66.24%) and invasive (46.50%) ventilation compared to those never hospitalized (21.74%, 31.52%, 13.04%, respectively, p < 0.001 for all). Emergency procedures led to longer hospitalizations (62.84 ± 48.91 days for non-invasive ventilation in emergencies vs. 39.88 ± 46.46 days electively, p = 0.012). Tracheostomy-free survival was not affected by hospitalizations. In conclusion, younger ALS patients undergo frequent and prolonged hospitalizations, especially after emergency interventions, although these do not correlate with reduced survival.
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Affiliation(s)
- Giulia Gianferrari
- Neurosciences PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (G.G.); (E.Z.); (L.F.)
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy; (I.M.); (C.S.); (N.F.)
| | - Elisabetta Zucchi
- Neurosciences PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (G.G.); (E.Z.); (L.F.)
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy; (I.M.); (C.S.); (N.F.)
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy; (I.M.); (C.S.); (N.F.)
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy; (I.M.); (C.S.); (N.F.)
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy; (I.M.); (C.S.); (N.F.)
| | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, 40127 Bologna, Italy;
| | - Andrea Mercati
- Specific Training Course in General Medicine, University of Siena, 53100 Siena, Italy;
| | - Laura Ferri
- Neurosciences PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (G.G.); (E.Z.); (L.F.)
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy; (I.M.); (C.S.); (N.F.)
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy (M.V.)
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy (M.V.)
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy; (I.M.); (C.S.); (N.F.)
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy (M.V.)
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Giometto S, Finocchietti M, Paoletti O, Lombardi N, Celani MG, Sciancalepore F, Lucenteforte E, Kirchmayer U. Adherence to riluzole therapy in patients with amyotrophic lateral sclerosis in three Italian regions-The CAESAR study. Pharmacoepidemiol Drug Saf 2024; 33:e5736. [PMID: 38014926 DOI: 10.1002/pds.5736] [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: 06/12/2023] [Revised: 09/12/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease. Riluzole may increase survival and delay the need for mechanical ventilation. The CAESAR project ('Comparative evaluation of the efficacy and safety of drugs used in rare neuromuscular and neurodegenerative diseases', FV AIFA project 2012-2013-2014) involves evaluating prescribing patterns, and analysing effectiveness and comparative safety of drugs, in patients with neurodegenerative diseases. The aim of this study is to evaluate adherence to riluzole in patients with ALS during the first year of use, identifying adherence clusters. METHODS A retrospective cohort study was conducted using administrative data from Latium, Tuscany, and Umbria. We identified subjects with a new diagnosis of ALS between 2014 and 2019, with the first dispensation of riluzole within 180 days of diagnosis. We considered a two-year look-back period for the characterization of patients, and we followed them from the date of first dispensing of riluzole for 1 year. We calculated 12 monthly adherence measures, through a modified version of the Medication Possession Ratio, estimating drug coverage with Defined Daily Dose. Adherence trajectories were identified using a three-step method: (1) calculation of statistical measures; (2) principal component analysis; (3) cluster analysis. Patient characteristics at baseline and during follow-up were described and compared between adherence groups identified. RESULTS We included 264 ALS patients as new users of riluzole in Latium, 344 in Tuscany, and 63 in Umbria. We observed a higher frequency of males (56.2%) and a mean age of 67.4 (standard deviation, SD, 10.4) in the overall population. We identified two clusters in all regions: one more numerous, including adherent patients (60%, 74%, 88%, respectively), and another one including patients who discontinued therapy (40%, 26%, 12%, respectively). In Tuscany patients discontinuing riluzole more frequently died (28.6% vs. 15.4%, p-value <0.01). Additionally, low-adherers had a higher frequency of central nervous system disorders (69.0% vs. 52.5%, p-value 0.01), and a greater use of non-pharmacological treatments (p-values ≤0.01 for invasive ventilation and tracheostomy). We did not observe any differences in Lazio, whereas in Umbria we observed a higher use of drugs for dementia-related psychiatric problems among low-adherers (57.1% vs. 7.8%, respectively, p-value <0.01), although with small numbers. CONCLUSION Most ALS patients who start riluzole adhere to therapy during the first year. Patients who discontinue therapy early show greater fragility and mortality.
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Affiliation(s)
- Sabrina Giometto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Niccolò Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Mata S, Bussotti M, Del Mastio M, Barilaro A, Piersanti P, Lombardi M, Cincotta M, Torricelli S, Leccese D, Sperti M, Rodolico GR, Nacmias B, Sorbi S. Epidemiology of amyotrophic lateral sclerosis in the north east Tuscany in the 2018–2021 period. eNeurologicalSci 2023; 31:100457. [PMID: 37008534 PMCID: PMC10063398 DOI: 10.1016/j.ensci.2023.100457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/14/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Background The incidence of Amyotrophic Lateral Sclerosis (ALS) varies among different geographical areas and seems to increase over time. This study aimed to examine the epidemiologic data of ALS in the north-east Tuscany and compare the results with those of similar surveys. Methods Data from ALS cases diagnosed in Florence and Prato Hospitals were prospectively collected from 1st June 2018 to 31st May 2021. Results The age- and sex-adjusted incidence rate of ALS in cases per 100,000 population was 2.71 (M/F ratio: 1.21), significantly higher as compared to that reported in the 1967-1976 decade in the same geographical area (0.714). The age- and sex-adjusted incidence rate among resident strangers was similar to that of the general population (2.69). A slightly higher incidence rate (4.36) was observed in the north-east area of Florence province, which includes the Mugello valley. The mean prevalence was of 7.17/100,00. The mean age at diagnosis was 69.7 years, with a peak between 70 and 79 years among men and a smoother age curve among women. Conclusions ALS epidemiological features in north-east Tuscany are in line with other Italian and European Centers. The dramatic increase of the local disease burden over the last decades probably reflects better ascertainment methods and health system.
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Gianferrari G, Martinelli I, Zucchi E, Simonini C, Fini N, Vinceti M, Ferro S, Gessani A, Canali E, Valzania F, Sette E, Pugliatti M, Tugnoli V, Zinno L, Stano S, Santangelo M, De Pasqua S, Terlizzi E, Guidetti D, Medici D, Salvi F, Liguori R, Vacchiano V, Casmiro M, Querzani P, Currò Dossi M, Patuelli A, Morresi S, Longoni M, De Massis P, Rinaldi R, Borghi A, Amedei A, Mandrioli J. Epidemiological, Clinical and Genetic Features of ALS in the Last Decade: A Prospective Population-Based Study in the Emilia Romagna Region of Italy. Biomedicines 2022; 10:biomedicines10040819. [PMID: 35453569 PMCID: PMC9031824 DOI: 10.3390/biomedicines10040819] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Increased incidence rates of amyotrophic lateral sclerosis (ALS) have been recently reported across various Western countries, although geographic and temporal variations in terms of incidence, clinical features and genetics are not fully elucidated. This study aimed to describe demographic, clinical feature and genotype–phenotype correlations of ALS cases over the last decade in the Emilia Romagna Region (ERR). From 2009 to 2019, our prospective population-based registry of ALS in the ERR of Northern Italy recorded 1613 patients receiving a diagnosis of ALS. The age- and sex-adjusted incidence rate was 3.13/100,000 population (M/F ratio: 1.21). The mean age at onset was 67.01 years; women, bulbar and respiratory phenotypes were associated with an older age, while C9orf72-mutated patients were generally younger. After peaking at 70–75 years, incidence rates, among women only, showed a bimodal distribution with a second slight increase after reaching 90 years of age. Familial cases comprised 12%, of which one quarter could be attributed to an ALS-related mutation. More than 70% of C9orf72-expanded patients had a family history of ALS/fronto-temporal dementia (FTD); 22.58% of patients with FTD at diagnosis had C9orf72 expansion (OR 6.34, p = 0.004). In addition to a high ALS incidence suggesting exhaustiveness of case ascertainment, this study highlights interesting phenotype–genotype correlations in the ALS population of ERR.
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Affiliation(s)
- Giulia Gianferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.G.); (M.V.); (J.M.)
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence: ; Tel.: +39-05-9396-1640; Fax: +39-05-9396-3775
| | - Elisabetta Zucchi
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.G.); (M.V.); (J.M.)
- Department of Science of Public Health, Research Centre in Environmental, Genetic and Nutritional Epidemiology, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, 40127 Bologna, Italy;
| | - Annalisa Gessani
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
| | - Elena Canali
- Neurology Unit, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (E.C.); (F.V.)
| | - Franco Valzania
- Neurology Unit, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (E.C.); (F.V.)
| | - Elisabetta Sette
- Department of Neuroscience and Rehabilitation, St. Anna Hospital, 44124 Ferrara, Italy; (E.S.); (M.P.); (V.T.)
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, St. Anna Hospital, 44124 Ferrara, Italy; (E.S.); (M.P.); (V.T.)
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Valeria Tugnoli
- Department of Neuroscience and Rehabilitation, St. Anna Hospital, 44124 Ferrara, Italy; (E.S.); (M.P.); (V.T.)
| | - Lucia Zinno
- Department of Neuroscience, University of Parma, 43121 Parma, Italy; (L.Z.); (S.S.)
| | - Salvatore Stano
- Department of Neuroscience, University of Parma, 43121 Parma, Italy; (L.Z.); (S.S.)
| | - Mario Santangelo
- Department of Neurology, Carpi Hospital, 41014 Modena, Italy; (M.S.); (S.D.P.)
| | - Silvia De Pasqua
- Department of Neurology, Carpi Hospital, 41014 Modena, Italy; (M.S.); (S.D.P.)
| | - Emilio Terlizzi
- Department of Neurology, G. Da Saliceto Hospital, 29121 Piacenza, Italy; (E.T.); (D.G.)
| | - Donata Guidetti
- Department of Neurology, G. Da Saliceto Hospital, 29121 Piacenza, Italy; (E.T.); (D.G.)
| | - Doriana Medici
- Department of Neurology, Fidenza Hospital, 43036 Parma, Italy;
| | - Fabrizio Salvi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Rocco Liguori
- Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy; (R.L.); (V.V.)
| | - Veria Vacchiano
- Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy; (R.L.); (V.V.)
| | - Mario Casmiro
- Department of Neurology, Faenza and Ravenna Hospital, 48121 Ravenna, Italy; (M.C.); (P.Q.)
| | - Pietro Querzani
- Department of Neurology, Faenza and Ravenna Hospital, 48121 Ravenna, Italy; (M.C.); (P.Q.)
| | - Marco Currò Dossi
- Department of Neurology, Infermi Hospital, 47923 Rimini, Italy; (M.C.D.); (M.L.)
| | - Alberto Patuelli
- Department of Neurology and Stroke Unit, “Morgagni-Pierantoni” Hospital, 47121 Forlì, Italy;
| | - Simonetta Morresi
- Department of Neurology and Stroke Unit, Bufalini Hospital, 47521 Cesena, Italy;
| | - Marco Longoni
- Department of Neurology, Infermi Hospital, 47923 Rimini, Italy; (M.C.D.); (M.L.)
- Department of Neurology and Stroke Unit, Bufalini Hospital, 47521 Cesena, Italy;
| | | | - Rita Rinaldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Interaziendale Clinica Neurologica Metropolitana (NeuroMet), 40139 Bologna, Italy;
| | - Annamaria Borghi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, 40133 Bologna, Italy;
| | | | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
- SOD of Interdisciplinary Internal Medicine, Azienda Ospedaliera Universitaria Careggi (AOUC), 50134 Florence, Italy
| | - Jessica Mandrioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.G.); (M.V.); (J.M.)
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (E.Z.); (C.S.); (N.F.); (A.G.)
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Puopolo M, Bacigalupo I, Piscopo P, Lacorte E, Di Pucchio A, Santarelli M, Inghilleri M, Petrucci A, Sabatelli M, Vanacore N. Prevalence of amyotrophic lateral sclerosis in Latium region, Italy. Brain Behav 2021; 11:e2378. [PMID: 34716673 PMCID: PMC8671775 DOI: 10.1002/brb3.2378] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/10/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Prevalence estimate of amyotrophic lateral sclerosis (ALS) ranged between 1.1/100,000 and 11.2/100,000 inhabitants with different design of the study (prospective or retrospective) and sample size. The aim of this study is to conduct for the first time an estimate of the ALS prevalence in the Latium region. MATERIALS AND METHODS The study was performed in Latium, a region located in the center of Italy, with a population, as of January 1, 2016, of 5888.472 inhabitants. In this region, a network of 15 clinical centers (of which 4 referral ALS centers are located in Rome) and 10 local health authorities involved in the diagnosis and treatment of ALS patients has been identified. Each patient was classified according to the El Escorial revised criteria. RESULTS The prevalence study in 2016 identified 353 ALS cases (200 males). By considering population aged >=20 years, the total crude prevalence rate resulted 7.33 (CI95% 6.59-8.14) × 100,000 and 8.75 and 6.05 in males and females, respectively. Age-specific prevalence rates did not differ among males and females in the population aged less than 49 years. The difference emerged in population aged > 50 years. This type of diagnosis was recorded for 343 patients (11 missing). 68% of these patients have a definite diagnosis, 14% likely, 11% possible, and 12% defined as suspect. CONCLUSIONS The estimate of prevalence rates observed in this study is probably in line with the values reported in the literature for prospective prevalence studies.
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Affiliation(s)
- Maria Puopolo
- Department of Neuroscience, National Institute of Health, Rome, Italy
| | - Ilaria Bacigalupo
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Paola Piscopo
- Department of Neuroscience, National Institute of Health, Rome, Italy
| | - Eleonora Lacorte
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Alessandra Di Pucchio
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | | | | | | | - Mario Sabatelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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Brown CA, Lally C, Kupelian V, Flanders WD. Estimated Prevalence and Incidence of Amyotrophic Lateral Sclerosis and SOD1 and C9orf72 Genetic Variants. Neuroepidemiology 2021; 55:342-353. [PMID: 34247168 DOI: 10.1159/000516752] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a rare neurological disorder characterized by progressive deterioration of motor neurons. Assessment of the size/geographic distribution of the ALS population, including ALS with genetic origin, is needed to understand the burden of the disease and the need for clinical intervention and therapy. OBJECTIVES The main objective of this study was to estimate the number of prevalent and incident ALS cases overall and superoxide dismutase 1 (SOD1) and chromosome 9 open reading frame 72 (C9orf72) ALS in 22 countries across Europe (Belgium, France, Germany, Ireland, Italy, Netherlands, Norway, Russia, Spain, Sweden, and UK), North America (USA and Canada), Latin America (Argentina, Brazil, Colombia, Mexico, and Uruguay), and Asia (China, Japan, South Korea, and Taiwan). METHODS A comprehensive literature search was conducted to identify population-based studies reporting ALS prevalence and/or incidence rates. Pooled prevalence and incidence rates were obtained using a meta-analysis approach at the country and regional geographic level. A country-level pooled estimate was used when ≥2 studies were available per country and geographic regional pooled estimates were used otherwise. The proportion of cases with a SOD1 or C9orf72 mutation among sporadic (sALS) and familial (fALS) cases were obtained from a previous systematic review and meta-analysis. RESULTS Pooled prevalence rates (per 100,000 persons) and incidence rates (per 100,000 person-years) were 6.22 and 2.31 for Europe, 5.20 and 2.35 for North America, 3.41 and 1.25 for Latin America, 3.01 and 0.93 for Asian countries excluding Japan, and 7.96 and 1.76 for Japan, respectively. Significant heterogeneity in reported incidence and prevalence was observed within and between countries/geographic regions. The estimated number of 2020 ALS cases across the 22 countries is 121,028 prevalent and 41,128 incident cases. The total estimated number of prevalent SOD1 cases is 2,876 cases, of which, 1,342 (47%) were fALS and 1,534 (53%) were sALS, and the number of incident SOD1 cases is 946 (434 [46%] fALS and 512 [54%] sALS). The total estimated number of prevalent C9orf72 cases is 4,545 (1,198 [26%] fALS, 3,347 [74%] sALS), and the number of incident C9orf72 cases is 1,706 (450 [26%] fALS and 1,256 [74%] sALS). DISCUSSION The estimated number of patients with SOD1 and C9orf72 ALS suggests that although the proportions of SOD1 and C9orf72 are higher among those with fALS, the majority of SOD1 and C9orf72 ALS cases may be found among those with sALS (about 53 and 74%, respectively). These results suggest that classification of fALS based on reported family history does not capture the full picture of ALS of genetic origin.
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Affiliation(s)
- Carolyn A Brown
- Epidemiologic Research and Methods LLC, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cathy Lally
- Epidemiologic Research and Methods LLC, Atlanta, Georgia, USA
| | | | - W Dana Flanders
- Epidemiologic Research and Methods LLC, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
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Chen L, Xu L, Tang L, Xia K, Tian D, Zhang G, Wang Y, Yu Z, Ma J, Zhang Y, Wang F, Sun C, Zhang G, Fu J, Jiao L, Yilihamu M, Wang S, Zhan S, Fan D. Trends in the clinical features of amyotrophic lateral sclerosis: A 14-year Chinese cohort study. Eur J Neurol 2021; 28:2893-2900. [PMID: 34048130 DOI: 10.1111/ene.14943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The aim was to determine the transitional patterns in the clinical characteristics, treatments and comorbidities in amyotrophic lateral sclerosis (ALS) patients over the past 14 years using data from a large clinical cohort in mainland China. METHODS Sporadic ALS patients who visited the Peking University Third Hospital from January 2005 to December 2018 were included in this study. The 14 years were divided into three periods, and changes in the baseline characteristics of the participants were analyzed at 5-year intervals. RESULTS In total, 3410 patients with sporadic ALS were recruited: 2181 were men and 1229 were women. The proportion of patients with bulbar-onset ALS increased from 13.0% in 2005-2009 to 19.5% in 2015-2018 (p < 0.001). The mean (standard deviation) age at onset increased from 49.5 (11.4) years in 2005-2009 to 53.0 (11.0) years in 2015-2018 (p < 0.001). ALS patients with diabetes or hypertension showed a delay in ALS onset, and the delay was even more apparent when the patients had both comorbidities. The proportion of riluzole users in 2015-2018 was approximately 2.5-fold of that in 2005-2009 (p < 0.001). CONCLUSIONS In the context of a lack of clinical data on ALS in mainland China, this study evaluated a large cohort of patients diagnosed over a 14-year period. The age at onset and percentage of patients who used riluzole both increased over the study period. Additionally, it was found that patients with comorbidities such as diabetes and hypertension had a delayed age of ALS onset.
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Affiliation(s)
- Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Kailin Xia
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Danyang Tian
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Gan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yajun Wang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Zhou Yu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Jingyue Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yixuan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Fan Wang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Can Sun
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Gaoqi Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Jiayu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Lin Jiao
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Mubalake Yilihamu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
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8
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Vasta R, Moglia C, Manera U, Canosa A, Grassano M, Palumbo F, Cugnasco P, De Marchi F, Mazzini L, Calvo A, ChiÒ A. What is amyotrophic lateral sclerosis prevalence? Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:203-208. [PMID: 34151660 DOI: 10.1080/21678421.2021.1936557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To assess amyotrophic lateral sclerosis (ALS) prevalence and to analyze how this estimate vary according to the historical depth of data collection. Methods: Data from the PARALS register have been used. Crude prevalence ratio was estimated on 31 December 2015 for the period 2015-2013 and then repeated extending the time interval by 3 years each time. For each time interval, prevalence ratio was calculated globally and stratified by sex, age at diagnosis, and phenotype. Prevalence was also calculated considering patients who underwent tracheostomy during the same study period. Results: Prevalence ratios increased proportionally to the length of the time period considered, ranging from 6 (95% CI 5.3-6.7) for a 3-year period to 12.1 (95% CI 11.1-13.1) per 100,000 population for a 21-year period. Prevalence ratio increase was inversely proportional to age at diagnosis, being null in the >85 years class and maximal in the 25-35 age class (+1700%). Among phenotypes, predominant UMN showed the highest increase (from 0.5, 95% CI 0.3-0.8, to 2.1, 95% CI 1.7 - 2.6, +320%). Discussion: Because of the variability of ALS survival, prevalence ratio strongly depends on the length of the follow-up period. A 12-year period should be sufficient to get a reliable estimate of ALS prevalence including long-survival patients.
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Affiliation(s)
- Rosario Vasta
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy
| | - Cristina Moglia
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy, and
| | - Umberto Manera
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy
| | - Antonio Canosa
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy, and
| | - Maurizio Grassano
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy
| | - Francesca Palumbo
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy
| | - Paolo Cugnasco
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy
| | - Fabiola De Marchi
- Department of Neurology, ALS Center, Azienda Ospedaliero Universitaria Maggiore della Carità, and University of Piemonte Orientale, Novara, Italy
| | - Letizia Mazzini
- Department of Neurology, ALS Center, Azienda Ospedaliero Universitaria Maggiore della Carità, and University of Piemonte Orientale, Novara, Italy
| | - Andrea Calvo
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy, and
| | - Adriano ChiÒ
- Department of Neuroscience "Rita Levi Montalcini", ALS Center, University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy, and
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9
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Gamache J, Yun Y, Chiba-Falek O. Sex-dependent effect of APOE on Alzheimer's disease and other age-related neurodegenerative disorders. Dis Model Mech 2020; 13:dmm045211. [PMID: 32859588 PMCID: PMC7473656 DOI: 10.1242/dmm.045211] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The importance of apolipoprotein E (APOE) in late-onset Alzheimer's disease (LOAD) has been firmly established, but the mechanisms through which it exerts its pathogenic effects remain elusive. In addition, the sex-dependent effects of APOE on LOAD risk and endophenotypes have yet to be explained. In this Review, we revisit the different aspects of APOE involvement in neurodegeneration and neurological diseases, with particular attention to sex differences in the contribution of APOE to LOAD susceptibility. We discuss the role of APOE in a broader range of age-related neurodegenerative diseases, and summarize the biological factors linking APOE to sex hormones, drawing on supportive findings from rodent models to identify major mechanistic themes underlying the exacerbation of LOAD-associated neurodegeneration and pathology in the female brain. Additionally, we list sex-by-genotype interactions identified across neurodegenerative diseases, proposing APOE variants as a shared etiology for sex differences in the manifestation of these diseases. Finally, we present recent advancements in 'omics' technologies, which provide a new platform for more in-depth investigations of how dysregulation of this gene affects the development and progression of neurodegenerative diseases. Collectively, the evidence summarized in this Review highlights the interplay between APOE and sex as a key factor in the etiology of LOAD and other age-related neurodegenerative diseases. We emphasize the importance of careful examination of sex as a contributing factor in studying the underpinning genetics of neurodegenerative diseases in general, but particularly for LOAD.
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Affiliation(s)
- Julia Gamache
- Division of Translational Brain Sciences, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
- Center for Genomic and Computational Biology, Duke University Medical Center, Durham, NC 27708, USA
| | - Young Yun
- Division of Translational Brain Sciences, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
- Center for Genomic and Computational Biology, Duke University Medical Center, Durham, NC 27708, USA
| | - Ornit Chiba-Falek
- Division of Translational Brain Sciences, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
- Center for Genomic and Computational Biology, Duke University Medical Center, Durham, NC 27708, USA
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10
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Kacem I, Sghaier I, Bougatef S, Nasri A, Gargouri A, Ajroud-Driss S, Gouider R. Epidemiological and clinical features of amyotrophic lateral sclerosis in a Tunisian cohort. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:131-139. [DOI: 10.1080/21678421.2019.1704012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Imen Kacem
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
| | - Ikram Sghaier
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
| | - Sabrine Bougatef
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
| | - Amina Nasri
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
| | - Amina Gargouri
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
| | | | - Riadh Gouider
- Department of Neurology, LR18SP03, Razi Hospital, Tunis, Tunisia,
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
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11
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Leighton DJ, Newton J, Stephenson LJ, Colville S, Davenport R, Gorrie G, Morrison I, Swingler R, Chandran S, Pal S. Changing epidemiology of motor neurone disease in Scotland. J Neurol 2019; 266:817-825. [PMID: 30805795 DOI: 10.1007/s00415-019-09190-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Scotland benefits from an integrated national healthcare team for motor neurone disease (MND) and a tradition of rich clinical data capture using the Scottish MND Register (launched in 1989; one of the first national registers). The Scottish register was re-launched in 2015 as Clinical Audit Research and Evaluation of MND (CARE-MND), an electronic platform for prospective, population-based research. We aimed to determine if incidence of MND is changing over time. METHODS Capture-recapture methods determined the incidence of MND in 2015-2016. Incidence rates for 2015-2016 and 1989-1998 were direct age and sex standardised to allow time-period comparison. Phenotypic characteristics and socioeconomic status of the cohort are described. RESULTS Coverage of the CARE-MND platform was 99%. Crude incidence in the 2015-2017 period was 3.83/100,000 person-years (95% CI 3.53-4.14). Direct age-standardised incidence in 2015 was 3.42/100,000 (95% CI 2.99-3.91); in 2016, it was 2.89/100,000 (95% CI 2.50-3.34). The 1989-1998 direct standardised annual incidence estimate was 2.32/100,000 (95% CI 2.26-2.37). 2015-2016 standardised incidence was 66.9% higher than Northern European estimates. Socioeconomic status was not associated with MND. CONCLUSIONS Our data show a changing landscape of MND in Scotland, with a rise in incidence by 36.0% over a 25-year period. This is likely attributable to ascertainment in the context of improved neurological services in Scotland. Our data suggest that CARE-MND is a reliable national resource and findings can be extrapolated to the other Northern European populations.
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Affiliation(s)
- Danielle J Leighton
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Judith Newton
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Laura J Stephenson
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Richard Davenport
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - George Gorrie
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Institute of Neurosciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Ian Morrison
- Department of Neurology, NHS Tayside, Dundee, UK
| | - Robert Swingler
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building 49 Little France Crescent, Edinburgh, EH16 4TJ, UK. .,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK. .,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK. .,Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.
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12
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Turgut N, Varol SaraÇoglu G, Kat S, Balci K, GÜldiken B, Birgili O, Kabayel L. An epidemiologic investigation of amyotrophic lateral sclerosis in Thrace, Turkey, 2006-2010. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:100-106. [PMID: 30468083 DOI: 10.1080/21678421.2018.1525403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in Thrace, Turkey in a five-year time period (2006-2010). METHODS Study population included residents of three provinces (Edirne, Tekirdag, Kırklareli) in the Thrace region. Cases were ascertained from all of the neurologic centers and hospitals of these provinces. Demographic and clinical information was collected for each patient. Newly diagnosed ALS patients who are fulfilling the El Escorial revised diagnostic criteria were enrolled into the study. RESULTS We identified a total of 145 patients (93 males, 52 females). The mean age at diagnosis was 57.0 ± 13.6. According to El Escorial criteria, 60.0% of the cases were definite ALS, 24.8% were probable, and 15.2% were possible ALS. Thirty-two cases were bulbar (22.1%), 113 cases (77.9%) were spinal onset. Mean time delay from onset to diagnosis was 12.0 ± 11.2 months. Age-gender standardized incidence rates with reference to Turkey, USA 2008 census were 1.9 (95% confidence interval (CI), 1.8-2.1), 1.9 (95%CI, 1.8-2.2) for overall. There were 112 living ALS patients at the end of the study. Crude point prevalence was calculated as 7.3 per 100,000 population (95%CI, 5.9-8.7). CONCLUSIONS This is the first study to provide fundamental data about demographic and clinical characteristics about ALS in Thrace region of Turkey. Incidence and prevalence of ALS in Thrace region of Turkey appear to be comparable with European countries.
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Affiliation(s)
- Nilda Turgut
- a Neurology Department , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Gamze Varol SaraÇoglu
- b Public Health Department , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Selahattin Kat
- c Neurology Department , Edirne State Hospital , Edirne , Turkey
| | - Kemal Balci
- d Neurology Department , Ondokuz Mayıs University School of Medicine , Samsun , Turkey
| | - BabÜrhan GÜldiken
- e Neurology Department , Trakya University School of Medicine , Edirne , Turkey
| | - Ozlem Birgili
- b Public Health Department , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Levent Kabayel
- f Neurology Department , Ekol Hospital , Edirne , Turkey
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13
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Longinetti E, Regodón Wallin A, Samuelsson K, Press R, Zachau A, Ronnevi LO, Kierkegaard M, Andersen PM, Hillert J, Fang F, Ingre C. The Swedish motor neuron disease quality registry. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:528-537. [PMID: 30296856 DOI: 10.1080/21678421.2018.1497065] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We set up the Swedish Motor Neuron Disease (MND) Quality Registry to assure early diagnosis and high-quality health care for all MND patients (mainly amyotrophic lateral sclerosis, ALS), and to create a research base by prospectively following the entire MND population in Sweden. METHODS Since 2015, the MND Quality Registry continuously collects information about a wide range of clinical measures, biological samples, and quality of life outcomes from all MND patients recruited at the time of MND diagnosis in Sweden and followed at each clinic visit approximately every 12 weeks. The Registry includes an Internet based patient own reporting portal that involves patients in the registration of their current symptoms and health status. RESULTS As of 20th January 2017, the MND Quality Registry included 99% of the MND patients of the Stockholm area (N = 194), consisting mostly of ALS patients (N = 153, 78.9%), followed by patients labeled as MND due to a neurophysiology finding but not fulfilling the criteria for ALS (N = 20, 10.3%), primary lateral sclerosis (N = 13, 6.7%), and progressive spinal muscular atrophy patients (N = 8, 4.1%). A higher proportion of these patients were women (N = 100, 52%), and women and men had a similar age at symptoms onset (59 years). CONCLUSIONS Main strengths of the MND Quality Registry are its clinical, quantitative, qualitative, and prospective nature, providing the researchers potential means of identifying appropriate candidates for clinical trials and other research projects, as well as assuring to the patients an effective and adequate time spent on-site with the healthcare professionals.
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Affiliation(s)
- Elisa Longinetti
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Amanda Regodón Wallin
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Kristin Samuelsson
- b Department of Neurology , Karolinska University Hospital , Stockholm , Sweden.,c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Rayomand Press
- b Department of Neurology , Karolinska University Hospital , Stockholm , Sweden.,c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Anne Zachau
- b Department of Neurology , Karolinska University Hospital , Stockholm , Sweden
| | - Lars-Olof Ronnevi
- b Department of Neurology , Karolinska University Hospital , Stockholm , Sweden.,c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Marie Kierkegaard
- d Function Area Occupational therapy and Physiotherapy , Karolinska University Hospital , Stockholm , Sweden.,e Department of Neurobiology Care Sciences and Society , Karolinska Institutet , Stockholm , Sweden , and
| | - Peter M Andersen
- f Department of Clinical Neurosciences , Umeå University , Stockholm , Sweden
| | - Jan Hillert
- c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Fang Fang
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Caroline Ingre
- b Department of Neurology , Karolinska University Hospital , Stockholm , Sweden.,c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
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14
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Marin B, Boumédiene F, Logroscino G, Couratier P, Babron MC, Leutenegger AL, Copetti M, Preux PM, Beghi E. Variation in worldwide incidence of amyotrophic lateral sclerosis: a meta-analysis. Int J Epidemiol 2018; 46:57-74. [PMID: 27185810 PMCID: PMC5407171 DOI: 10.1093/ije/dyw061] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/14/2022] Open
Abstract
Background To assess the worldwide variation of amyotrophic lateral sclerosis (ALS) incidence, we performed a systematic review and meta-analysis of population-based data published to date. Methods We reviewed Medline and Embase up to June 2015 and included all population-based studies of newly diagnosed ALS cases, using multiple sources for case ascertainment. ALS crude and standardized incidence (on age and sex using the US 2010 population) were calculated. Random effect meta-analysis and meta-regression were performed using the subcontinent as the main study level covariate. Sources of heterogeneity related to the characteristics of the study population and the study methodology were investigated. Results Among 3216 records, 44 studies were selected, covering 45 geographical areas in 11 sub-continents. A total of 13 146 ALS cases and 825 million person-years of follow-up (PYFU) were co-nsidered. The overall pooled worldwide crude ALS incidence was at 1.75 (1.55–1.96)/100 000 PYFU; 1.68 (1.50–1.85)/100 000 PYFU after standardization. Heterogeneity was identified in ALS standardized incidence between North Europe [1.89 (1.46–2.32)/100 000 PYFU] and East Asia [0.83 (0.42–1.24)/100 000 PYFU, China and Japan P = 0.001] or South Asia [0.73 (0.58–0.89)/100 000/PYFU Iran, P = 0.02]. Conversely, homogeneous rates have been reported in populations from Europe, North America and New Zealand [pooled ALS standardized incidence of 1.81 (1.66-1.97)/100 000 PYFU for those areas]. Conclusion This review confirms a heterogeneous distribution worldwide of ALS, and sets the scene to sustain a collaborative study involving a wide international consortium to investigate the link between ancestry, environment and ALS incidence.
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Affiliation(s)
- Benoît Marin
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France.,CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France.,Laboratorio di Malattie Neurologiche, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.,Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.,Unit of Neurodegenerative Diseases, University of Bari 'Aldo Moro', at 'Pia Fondazione Cardinale G. Panico', Lecce, Italy
| | - Farid Boumédiene
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France.,CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
| | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.,Unit of Neurodegenerative Diseases, University of Bari 'Aldo Moro', at 'Pia Fondazione Cardinale G. Panico', Lecce, Italy
| | - Philippe Couratier
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France.,CHU Limoges, Service de Neurologie, Limoges, France
| | - Marie-Claude Babron
- INSERM UMR 946, Genetic Variability and Human Diseases, Paris, France.,University Paris Diderot, UMR 946, Paris, France
| | - Anne Louise Leutenegger
- INSERM UMR 946, Genetic Variability and Human Diseases, Paris, France.,University Paris Diderot, UMR 946, Paris, France
| | - Massimilano Copetti
- Unit of Biostatistics, IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France.,CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
| | - Ettore Beghi
- Laboratorio di Malattie Neurologiche, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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15
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van Es MA, Hardiman O, Chio A, Al-Chalabi A, Pasterkamp RJ, Veldink JH, van den Berg LH. Amyotrophic lateral sclerosis. Lancet 2017; 390:2084-2098. [PMID: 28552366 DOI: 10.1016/s0140-6736(17)31287-4] [Citation(s) in RCA: 794] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis is characterised by the progressive loss of motor neurons in the brain and spinal cord. This neurodegenerative syndrome shares pathobiological features with frontotemporal dementia and, indeed, many patients show features of both diseases. Many different genes and pathophysiological processes contribute to the disease, and it will be necessary to understand this heterogeneity to find effective treatments. In this Seminar, we discuss clinical and diagnostic approaches as well as scientific advances in the research fields of genetics, disease modelling, biomarkers, and therapeutic strategies.
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Affiliation(s)
- Michael A van Es
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Beaumont, Ireland
| | - Adriano Chio
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy; Neuroscience Institute of Turin, Turin, Italy
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK; NIHR Dementia Biomedical Research Unit, King's College London, London, UK
| | - R Jeroen Pasterkamp
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Jan H Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
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Chiò A, Mora G, Moglia C, Manera U, Canosa A, Cammarosano S, Ilardi A, Bertuzzo D, Bersano E, Cugnasco P, Grassano M, Pisano F, Mazzini L, Calvo A. Secular Trends of Amyotrophic Lateral Sclerosis: The Piemonte and Valle d'Aosta Register. JAMA Neurol 2017; 74:1097-1104. [PMID: 28692730 DOI: 10.1001/jamaneurol.2017.1387] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance This study reports the long-term epidemiologic trends of amyotrophic lateral sclerosis (ALS) based on a prospective register. Objective To examine the 20-year epidemiologic trends of ALS in the Piemonte and Valle d'Aosta regions of Italy. Design, Setting, and Participants The Piemonte and Valle d'Aosta Register for ALS (PARALS) is an epidemiologic prospective register that covers 2 Italian regions (population of 4 476 931 inhabitants according to the 2011 census) from January 1, 1995, through December 31, 2014. Case ascertainment is based on multiple sources (neurologic departments, hospital discharge archives, and mortality records). Incidence rates are age and sex standardized for the Italian population of the 2011 census. Age-period-cohort (APC) analysis was performed using a Poisson regression model. Main Outcomes and Measures The primary study outcomes were long-term incidence and prevalence rates of ALS using a prospective design and their determinants. Results During the study period, a total of 2702 patients (mean [SD] age at onset, 65.7 [11.1] years; 1246 [46.1%] female and 1456 [53.9%] male) received a diagnosis of ALS between 1995 and 2014, corresponding to a crude annual incidence rate of 3.03 per 100 000 population (95% CI, 2.85-3.23) and an adjusted incidence rate of 2.78 per 100 000 population (95% CI, 2.57-2.96). The age-adjusted incidence rate increased in the 2 decades of the study (1995-2004: 2.66; 95% CI, 2.50-2.83; 2005-2014: 2.89; 95% CI, 2.71-3.07; P = .04), mostly in women. The adjusted rate ratio of men to women decreased from 1.27:1 (1995-2004) to 1.17:1 (2005-2014). The analysis of deviance for the APC regression models indicated that the drift variable is relevant in explaining the variation of ALS incidence rates over time in the overall population (change in deviance, 4.6553; P = .03) and in women (change in deviance, 3.8821; P = .05) but not in men (change in deviance, 0.77215; P = .38). A total of 479 patients with ALS were alive and had not undergone tracheostomy at the prevalence day (December 31, 2014), corresponding to a crude prevalence rate of 10.54 per 100 000 population (95% CI, 9.64-11.52). Conclusions and Relevance During the 1995 to 2014 period, the crude and adjusted incidences of ALS increased in Piemonte and Valle d'Aosta, mostly in women. The APC model revealed that the increase of ALS incidence is attributable to a birth cohort effect in women, with a peak in the 1930 cohort. The different increase of ALS incidence in men and women points to an effect of exogenous factors with a differential effect on the 2 sexes, acting on a genetic background.
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Affiliation(s)
- Adriano Chiò
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy.,The Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.,The Neuroscience Institute of Torino, Torino, Italy
| | - Gabriele Mora
- ALS Center, "Salvatore Maugeri" Clinical-Scientific Institutes, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Cristina Moglia
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy.,The Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Umberto Manera
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Antonio Canosa
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Stefania Cammarosano
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Antonio Ilardi
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Davide Bertuzzo
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Enrica Bersano
- ALS Center, the Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Paolo Cugnasco
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Maurizio Grassano
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Fabrizio Pisano
- Department of Neurological Rehabilitation, "Salvatore Maugeri" Clinical-Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Veruno, Italy
| | - Letizia Mazzini
- ALS Center, the Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Andrea Calvo
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy.,The Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.,The Neuroscience Institute of Torino, Torino, Italy
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17
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Vinceti M, Filippini T, Mandrioli J, Violi F, Bargellini A, Weuve J, Fini N, Grill P, Michalke B. Lead, cadmium and mercury in cerebrospinal fluid and risk of amyotrophic lateral sclerosis: A case-control study. J Trace Elem Med Biol 2017; 43:121-125. [PMID: 28089071 PMCID: PMC5495626 DOI: 10.1016/j.jtemb.2016.12.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/31/2016] [Indexed: 12/11/2022]
Abstract
Exposure to neurotoxic chemicals such as pesticides, selenium, and heavy metals have been suggested to play a role in the etiology of amyotrophic lateral sclerosis (ALS). We assessed exposure to lead, cadmium, and mercury in 38 ALS patients (16 men and 22 females) and 38 hospital-admitted controls by using their cerebrospinal fluid (CSF) content as biomarker. We determined CSF heavy metal levels with inductively coupled plasma sector field mass spectrometry, according to a methodology specifically developed for this biological matrix. ALS patients had higher median values for Pb (155 vs. 132ng/L) but lower levels for Cd (36 vs. 72ng/L) and Hg (196 vs. 217ng/L). In the highest tertile of exposure, ALS odds ratio was 1.39 (95% CI 0.48-4.25) for Pb, 0.29 (0.08-1.04) for Cd and 3.03 (0.52-17.55) for Hg; however, no dose-response relation emerged. Results were substantially confirmed after conducting various sensitivity analyses, and after stratification for age and sex. Though interpretation of these results is limited by the statistical imprecision of the estimates, and by the possibility that CSF heavy metal content may not reflect long-term antecedent exposure, they do not lend support to a role of the heavy metals cadmium, lead and mercury in ALS etiology.
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Affiliation(s)
- Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia Medical School, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Jessica Mandrioli
- Department of Neurology, Sant'Agostino-Estense Hospital, National Health Service, Local Health Unit of Modena, Modena, Italy
| | - Federica Violi
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Annalisa Bargellini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Nicola Fini
- Department of Neurology, Sant'Agostino-Estense Hospital, National Health Service, Local Health Unit of Modena, Modena, Italy
| | - Peter Grill
- Helmholtz Center Munich, German Research Center for Environmental Health GmbH, Research Unit Analytical BioGeoChemistry, Neuherberg, Germany
| | - Bernhard Michalke
- Helmholtz Center Munich, German Research Center for Environmental Health GmbH, Research Unit Analytical BioGeoChemistry, Neuherberg, Germany
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18
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Wang MD, Little J, Gomes J, Cashman NR, Krewski D. Identification of risk factors associated with onset and progression of amyotrophic lateral sclerosis using systematic review and meta-analysis. Neurotoxicology 2017; 61:101-130. [DOI: 10.1016/j.neuro.2016.06.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
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19
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Hardiman O, Al-Chalabi A, Brayne C, Beghi E, van den Berg LH, Chio A, Martin S, Logroscino G, Rooney J. The changing picture of amyotrophic lateral sclerosis: lessons from European registers. J Neurol Neurosurg Psychiatry 2017; 88:557-563. [PMID: 28285264 DOI: 10.1136/jnnp-2016-314495] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 12/12/2022]
Abstract
Prospective population based-registers of amyotrophic lateral sclerosis (ALS) have operated in Europe for over two decades, and have provided important insights into our understanding of ALS. Here, we review the benefits that population registers have brought to the understanding of the incidence, prevalence, phenotype and genetics of ALS and outline the core operating principles that underlie these registers and facilitate international collaboration. Going forward, we offer lessons learned from our collective experience of operating population-based ALS registers in Europe for over two decades, focusing on register design, maintenance, identification and management of bias and the value of cross-national harmonisation and integration.
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Affiliation(s)
- Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Beaumont, Ireland
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Ettore Beghi
- Neurological Diseases Laboratory, Department of Neurosciences, IRCCS Mario Negri, Milano, Italy
| | - Leonard H van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriano Chio
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Sarah Martin
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - James Rooney
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
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20
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Vinceti M, Malagoli C, Fabbi S, Kheifets L, Violi F, Poli M, Caldara S, Sesti D, Violanti S, Zanichelli P, Notari B, Fava R, Arena A, Calzolari R, Filippini T, Iacuzio L, Arcolin E, Mandrioli J, Fini N, Odone A, Signorelli C, Patti F, Zappia M, Pietrini V, Oleari P, Teggi S, Ghermandi G, Dimartino A, Ledda C, Mauceri C, Sciacca S, Fiore M, Ferrante M. Magnetic fields exposure from high-voltage power lines and risk of amyotrophic lateral sclerosis in two Italian populations. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:583-589. [PMID: 28569083 DOI: 10.1080/21678421.2017.1332078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aetiology of amyotrophic lateral sclerosis (ALS), a rare and extremely severe neurodegenerative disease, has been associated with magnetic fields exposure. However, evidence for such a relation in the general population is weak, although the previous null results might also be due to exposure misclassification, or a relationship might exist only for selected subgroups. To test such a hypothesis we carried out a population-based case-control study in two Northern and Southern Italy regions, including 703 ALS cases newly diagnosed from 1998 to 2011 and 2737 controls randomly selected from the residents in the study provinces. Overall, we found that a residence near high-voltage power lines, within the corridors yielding a magnetic fields of ≥0.1 μT, was not associated with an excess disease risk, nor did we identify a dose-response relationship after splitting the exposed corridor according to the 0.1, 0.2 and 0.4 μT cut-points of exposure. These results were confirmed taking into account age at onset, period of diagnosis, sex, geographical area, and length of exposure. Overall, despite the residual possibility of unmeasured confounding or small susceptible subgroups not identified in our study, these results appear to confirm that the exposure to magnetic fields from power lines occurring in the general population is not associated with increased ALS risk.
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Affiliation(s)
- Marco Vinceti
- a Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy.,b Department of Epidemiology , Boston University School of Public Health , Boston , MA , USA
| | - Carlotta Malagoli
- a Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy
| | - Sara Fabbi
- c Department of Engineering "Enzo Ferrari" , University of Modena and Reggio Emilia , Modena , Italy
| | - Leeka Kheifets
- d Department of Epidemiology , UCLA Fielding School of Public Health , Los Angeles , CA , USA
| | - Federica Violi
- a Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy
| | - Maurizio Poli
- e Emilia-Romagna Regional Agency for Environmental Prevention and Energy (ARPAE) , Emilia-Romagna Region , Italy
| | - Salvatore Caldara
- f Sicilia Regional Agency for Environmental Prevention (ARPA) , Palermo , Italy
| | - Daniela Sesti
- e Emilia-Romagna Regional Agency for Environmental Prevention and Energy (ARPAE) , Emilia-Romagna Region , Italy
| | - Silvia Violanti
- e Emilia-Romagna Regional Agency for Environmental Prevention and Energy (ARPAE) , Emilia-Romagna Region , Italy
| | - Paolo Zanichelli
- e Emilia-Romagna Regional Agency for Environmental Prevention and Energy (ARPAE) , Emilia-Romagna Region , Italy
| | - Barbara Notari
- e Emilia-Romagna Regional Agency for Environmental Prevention and Energy (ARPAE) , Emilia-Romagna Region , Italy
| | - Roberto Fava
- e Emilia-Romagna Regional Agency for Environmental Prevention and Energy (ARPAE) , Emilia-Romagna Region , Italy
| | - Alessia Arena
- f Sicilia Regional Agency for Environmental Prevention (ARPA) , Palermo , Italy
| | - Roberta Calzolari
- f Sicilia Regional Agency for Environmental Prevention (ARPA) , Palermo , Italy
| | - Tommaso Filippini
- a Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy
| | - Laura Iacuzio
- a Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy
| | - Elisa Arcolin
- a Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy
| | - Jessica Mandrioli
- g Department of Neuroscience , S.Agostino-Estense Hospital, Policlinico University Hospital , Modena , Italy
| | - Nicola Fini
- g Department of Neuroscience , S.Agostino-Estense Hospital, Policlinico University Hospital , Modena , Italy
| | - Anna Odone
- h Department of Biomedical , Biotechnological, and Translational Sciences, University of Parma , Parma , Italy
| | - Carlo Signorelli
- h Department of Biomedical , Biotechnological, and Translational Sciences, University of Parma , Parma , Italy.,i University 'Vita-Salute' San Raffaele , Milan , Italy
| | - Francesco Patti
- j Department of Medical , Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania , Catania , Italy
| | - Mario Zappia
- j Department of Medical , Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania , Catania , Italy
| | - Vladimiro Pietrini
- k Department of Neuroscience , University of Parma , Parma , Italy , and
| | - Paola Oleari
- l Information and Communication Technology Department , Local Health Unit of Reggio Emilia and IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia , Italy
| | - Sergio Teggi
- c Department of Engineering "Enzo Ferrari" , University of Modena and Reggio Emilia , Modena , Italy
| | - Grazia Ghermandi
- c Department of Engineering "Enzo Ferrari" , University of Modena and Reggio Emilia , Modena , Italy
| | - Angela Dimartino
- j Department of Medical , Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania , Catania , Italy
| | - Caterina Ledda
- j Department of Medical , Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania , Catania , Italy
| | - Cristina Mauceri
- j Department of Medical , Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania , Catania , Italy
| | - Salvatore Sciacca
- j Department of Medical , Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania , Catania , Italy
| | - Maria Fiore
- j Department of Medical , Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania , Catania , Italy
| | - Margherita Ferrante
- j Department of Medical , Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania , Catania , Italy
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21
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Demetriou CA, Hadjivasiliou PM, Kleopa KA, Christou YP, Leonidou E, Kyriakides T, Zamba-Papanicolaou E. Epidemiology of Amyotrophic Lateral Sclerosis in the Republic of Cyprus: A 25-Year Retrospective Study. Neuroepidemiology 2017; 48:79-85. [DOI: 10.1159/000477126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/26/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction: Amyotrophic lateral sclerosis (ALS) is a rare, rapidly progressive neurodegenerative disease. Despite wide variability in the incidence and prevalence of ALS, there is evidence of positive temporal trends and an increase in incidence with age. The aim of this study was to conduct a detailed epidemiological investigation of ALS in Cyprus. Methods: All registered Cypriot ALS patients in the Republic of Cyprus from January 1985 until December 2014 were included. Socio-demographic information was extracted from patient files. Results: The study identified 179 ALS patients, of whom 7 had a positive family history. The mean age at onset was 58.6 years and a slight male predominance was observed. Average annual crude incidence was 1.26 cases/100,000 person-years and at the beginning of 2015, prevalence of ALS was 7.9 cases/100,000 population. Both incidence and prevalence displayed an increasing trend, even after age-standardization of incidence rates. Conclusions: Incidence, prevalence and main socio-demographic characteristics of ALS in Cyprus were similar to those of other European countries, without any geographic clustering of the disease. Additionally, an increased incidence through the years was confirmed. However, observations such as a higher male prevalence and a younger mean age of onset compared to published literature require further investigation.
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Tard C, Defebvre L, Moreau C, Devos D, Danel-Brunaud V. Clinical features of amyotrophic lateral sclerosis and their prognostic value. Rev Neurol (Paris) 2017; 173:263-272. [DOI: 10.1016/j.neurol.2017.03.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/27/2017] [Indexed: 12/29/2022]
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23
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Calvo A, Moglia C, Lunetta C, Marinou K, Ticozzi N, Ferrante GD, Scialo C, Sorarù G, Trojsi F, Conte A, Falzone YM, Tortelli R, Russo M, Chiò A, Sansone VA, Mora G, Silani V, Volanti P, Caponnetto C, Querin G, Monsurrò MR, Sabatelli M, Riva N, Logroscino G, Messina S, Fini N, Mandrioli J. Factors predicting survival in ALS: a multicenter Italian study. J Neurol 2016; 264:54-63. [PMID: 27778156 DOI: 10.1007/s00415-016-8313-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
The aim of this multicenter, retrospective study is to investigate the role of clinical characteristics and therapeutic intervention on ALS prognosis. The study included patients diagnosed from January 1, 2009 to December 31, 2013 in 13 Italian referral centers for ALS located in 10 Italian regions. Caring neurologists collected a detailed phenotypic profile and follow-up data until death into an electronic database. One center collected also data from a population-based registry for ALS. 2648 incident cases were collected. The median survival time from onset to death/tracheostomy was 44 months (SE 1.18, CI 42-46). According to univariate analysis, factors related to survival from onset to death/tracheostomy were: age at onset, diagnostic delay, site of onset, phenotype, degree of certainty at diagnosis according to revised El Escorial criteria (R-EEC), presence/absence of dementia, BMI at diagnosis, patients' provenance. In the multivariate analysis, age at onset, diagnostic delay, phenotypes but not site of onset, presence/absence of dementia, BMI, riluzole use, R-EEC criteria were independent prognostic factors of survival in ALS. We compared patients from an ALS Registry with patients from tertiary centers; the latter ones were younger, less frequently bulbar, but more frequently familial and definite at diagnosis. Our large, multicenter study demonstrated the role of some clinical and demographic factors on ALS survival, and showed some interesting differences between referral centers' patients and the general ALS population. These results can be helpful for clinical practice, in clinical trial design and to validate new tools to predict disease progression.
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Affiliation(s)
- Andrea Calvo
- "Rita Levi Montalcini" Department of Neuroscience, ALS Center, University of Torino, Turin, Italy
| | - Cristina Moglia
- "Rita Levi Montalcini" Department of Neuroscience, ALS Center, University of Torino, Turin, Italy
| | - Christian Lunetta
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Milan, Italy.,NEMO Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina, Italy
| | - Kalliopi Marinou
- Department of Neurorehabilitation ALS Center Scientific Institute of Milan, Salvatore Maugeri Foundation IRCCS, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation 'Dino Ferrari' Center, University of Milan, Milan, Italy
| | - Gianluca Drago Ferrante
- Neurorehabilitation Unit/ALS Center, Salvatore Maugeri Foundation, IRCCS, Mistretta, Messina, Italy
| | - Carlo Scialo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Gianni Sorarù
- Department of Neurosciences Neuromuscular Center, University of Padova, Padua, Italy
| | - Francesca Trojsi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Amelia Conte
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation: Pol. A. Gemelli Foundation, Rome, Italy
| | - Yuri M Falzone
- Department of Neurology Division of Neuroscience Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Rosanna Tortelli
- Department of Clinical Research in Neurology, University of Bari "A. Moro", at Pia Fondazione "Card. G. Panico" Tricase, Lecce, Italy
| | - Massimo Russo
- Department of Clinical and Experimental Medicine, University of Messina and Nemo Sud Clinical Center for Neuromuscular Diseases, Aurora Foundation, Messina, Italy
| | - Adriano Chiò
- "Rita Levi Montalcini" Department of Neuroscience, ALS Center, University of Torino, Turin, Italy
| | - Valeria Ada Sansone
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Milan, Italy.,Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Gabriele Mora
- Department of Neurorehabilitation ALS Center Scientific Institute of Milan, Salvatore Maugeri Foundation IRCCS, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation 'Dino Ferrari' Center, University of Milan, Milan, Italy
| | - Paolo Volanti
- Neurorehabilitation Unit/ALS Center, Salvatore Maugeri Foundation, IRCCS, Mistretta, Messina, Italy
| | - Claudia Caponnetto
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Giorgia Querin
- Department of Neurosciences Neuromuscular Center, University of Padova, Padua, Italy
| | - Maria Rosaria Monsurrò
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Mario Sabatelli
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation: Pol. A. Gemelli Foundation, Rome, Italy.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Nilo Riva
- Department of Neurology Division of Neuroscience Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, University of Bari "A. Moro", at Pia Fondazione "Card. G. Panico" Tricase, Lecce, Italy
| | - Sonia Messina
- NEMO Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina, Italy.,Department of Clinical and Experimental Medicine, University of Messina and Nemo Sud Clinical Center for Neuromuscular Diseases, Aurora Foundation, Messina, Italy
| | - Nicola Fini
- Department of Neuroscience, S. Agostino-Estense Hospital and University of Modena and Reggio Emilia, Via Pietro Giardini n. 1355, 41100, Modena, Italy
| | - Jessica Mandrioli
- Department of Neuroscience, S. Agostino-Estense Hospital and University of Modena and Reggio Emilia, Via Pietro Giardini n. 1355, 41100, Modena, Italy.
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Mathis S, Couratier P, Julian A, Vallat JM, Corcia P, Le Masson G. Management and therapeutic perspectives in amyotrophic lateral sclerosis. Expert Rev Neurother 2016; 17:263-276. [DOI: 10.1080/14737175.2016.1227705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Stéphane Mathis
- Department of Neurology, Neuro-Muscular Unit and ALS Center, CHU de Bordeaux, groupe hospitalier Pellegrin, Bordeaux, France
| | - Philippe Couratier
- Department of Neurology, ALS center, Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, Limoges, France
| | - Adrien Julian
- Department of Neurology, CHU Poitiers, University of Poitiers, Poitiers, France
| | - Jean-Michel Vallat
- Department and Laboratory of Neurology, Centre de Référence ‘neuropathies périphériques rares’, University Hospital of Limoges, Limoges, France
| | - Philippe Corcia
- Department of Neurology, ALS center, Centre de compétence SLA-fédération Tours-Limoges, CHU de Tours, Tours, France
| | - Gwendal Le Masson
- Department of Neurology, Neuro-Muscular Unit and ALS Center, CHU de Bordeaux, groupe hospitalier Pellegrin, Bordeaux, France
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Tobin K, Gilthorpe MS, Rooney J, Heverin M, Vajda A, Staines A, Hardiman O. Age-period-cohort analysis of trends in amyotrophic lateral sclerosis incidence. J Neurol 2016; 263:1919-26. [PMID: 27372451 DOI: 10.1007/s00415-016-8215-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/13/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease with an unknown cause. Studies have reported that the incidence rate of ALS might be changing. As ALS is an age related disease, crude incidence could increase as population structure changes and overall life expectancy improves. Age-period-cohort (APC) models are frequently used to investigate trends in demographic rates such as incidence. Age-specific incidence rate for ALS from 1996 to 2014 were taken from a population-based ALS register in Ireland. To circumvent the well-known identifiability issue in APC models, we apply the method of Partial Least Squares Regression to separate the effects of Age, Period and Cohort on ALS incidence over time. This APC analysis shows no cohort effect and the initial signs of a period effect; increasing incidence of ALS in the most recently diagnosed group. As further years of data accrue to the Irish register it will become clear if this effect emerges as a strong trend in the incidence of ALS in Ireland and replication of these analyses in other populations will show if our findings on temporal patterns in ALS incidence are shared elsewhere.
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Affiliation(s)
- Katy Tobin
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland. .,Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland.
| | - Mark S Gilthorpe
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - James Rooney
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Anthony Staines
- School of Nursing and Health Sciences, Dublin City University, Dublin 9, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
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Aragones JM, Altimiras J, Roura-Poch P, Homs E, Bajo L, Povedano M, Cortés-Vicente E, Illa I, Al-Chalabi A, Rojas-García R. Amyotrophic lateral sclerosis: A higher than expected incidence in people over 80 years of age. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:522-527. [DOI: 10.1080/21678421.2016.1187175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Jacint Altimiras
- Department of Epidemiology, Vic University Hospital, Vic, Barcelona,
| | - Pere Roura-Poch
- Department of Epidemiology, Vic University Hospital, Vic, Barcelona,
| | - Elvira Homs
- Department of Pharmacy, Vic University Hospital, Vic, Barcelona,
| | - Lorena Bajo
- Department of Geriatry, Hospital de la Santa Creu, Vic, Barcelona,
| | - Monica Povedano
- Department of Neurology, Neuromuscular Diseases Unit, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona,
| | - Elena Cortés-Vicente
- Department of Neurology, Neuromuscular Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain, and
| | - Isabel Illa
- Department of Neurology, Neuromuscular Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain, and
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, Department of Clinical Neuroscience, London, UK
| | - Ricard Rojas-García
- Department of Neurology, Neuromuscular Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain, and
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Fantini R, Mandrioli J, Zona S, Antenora F, Iattoni A, Monelli M, Fini N, Tonelli R, Clini E, Marchioni A. Ultrasound assessment of diaphragmatic function in patients with amyotrophic lateral sclerosis. Respirology 2016; 21:932-8. [PMID: 26994409 DOI: 10.1111/resp.12759] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/29/2015] [Accepted: 11/29/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Evaluation of diaphragm function in Amyotrophic Lateral Sclerosis (ALS) is critical in determining when to commence non-invasive mechanical ventilation (NIV). Currently, forced vital capacity (FVC) and sniff nasal inspiratory pressure (SNIP) are volitional measures for this evaluation, but require collaboration and are poorly specific. The primary aim of this study was to assess whether diaphragmatic thickness measured by ultrasound (US) correlates with lung function impairment in ALS patients. The secondary aim was then to compare US diaphragm thickness index (ΔTdi) with a new parameter (ΔTmax index). METHODS 41 patients with ALS and 30 healthy subjects were enrolled in the study. All subjects underwent spirometry, SNIP and diaphragm US evaluation, while arterial blood gases were measured in some patients only. US assessed diaphragm thickness (Tdi) at tidal volume (Vt) or total lung capacity (TLC), and their ratio (ΔTmax) were recorded. Changes (Δ) in Tdi indices during tidal volume (ΔTdiVt) and maximal inspiration (ΔTdiTLC) were also assessed. RESULTS ΔTdiTLC (p <0.001) and ΔTmax (p = 0.007), but not ΔTdiVt, differed between patients and controls. Significant correlation (p < 0.05) was found between ΔTdiTLC, ΔTmax and FVC. The ROC curve analysis for comparison of individual testing showed better accuracy with Δtmax than with ΔtdiTLC for FVC (AUC 0.76 and 0.27) and SNIP (AUC 0.71 and 0.25). CONCLUSION Diaphragm thickness assessed by ultrasound significantly correlates with global respiratory alterations in patients with ALS. ΔTmax represents a new US index of early diaphragmatic dysfunction, better related with the routinely performed lung function tests.
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Affiliation(s)
- Riccardo Fantini
- Respiratory Disease Clinic, Policlinico Modena, University of Modena and Reggio Emilia
| | - Jessica Mandrioli
- Department of Neuroscience, St Agostino-Estense Hospital, University of Modena and Reggio Emilia
| | - Stefano Zona
- Infectious Diseases Clinic, Policlinico Modena, University of Modena and Reggio Emilia
| | - Federico Antenora
- Respiratory Disease Clinic, Policlinico Modena, University of Modena and Reggio Emilia
| | - Andrea Iattoni
- Respiratory Disease Clinic, Policlinico Modena, University of Modena and Reggio Emilia
| | - Marco Monelli
- Respiratory Disease Clinic, Policlinico Modena, University of Modena and Reggio Emilia
| | - Nicola Fini
- Department of Neuroscience, St Agostino-Estense Hospital, University of Modena and Reggio Emilia
| | - Roberto Tonelli
- Respiratory Disease Clinic, Policlinico Modena, University of Modena and Reggio Emilia
| | - Enrico Clini
- Respiratory Disease Clinic, Policlinico Modena, University of Modena and Reggio Emilia
| | - Alessandro Marchioni
- Respiratory Disease Clinic, Policlinico Modena, University of Modena and Reggio Emilia
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Marin B, Logroscino G, Boumédiene F, Labrunie A, Couratier P, Babron MC, Leutenegger AL, Preux PM, Beghi E. Clinical and demographic factors and outcome of amyotrophic lateral sclerosis in relation to population ancestral origin. Eur J Epidemiol 2015; 31:229-45. [DOI: 10.1007/s10654-015-0090-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/05/2015] [Indexed: 01/08/2023]
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Pupillo E, Bianchi E, Messina P, Chiveri L, Lunetta C, Corbo M, Filosto M, Lorusso L, Marin B, Mandrioli J, Riva N, Sasanelli F, Tremolizzo L, Beghi E. Extrapyramidal and cognitive signs in amyotrophic lateral sclerosis: A population based cross-sectional study. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:324-30. [DOI: 10.3109/21678421.2015.1040028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Fini N, Georgoulopoulou E, Vinceti M, Monelli M, Pinelli G, Vacondio P, Giovannini M, Dallari R, Marudi A, Mandrioli J. Noninvasive and invasive ventilation and enteral nutrition for ALS in Italy. Muscle Nerve 2014; 50:508-16. [PMID: 24448736 DOI: 10.1002/mus.24187] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 01/10/2014] [Accepted: 01/16/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We performed a population-based study to assess amyotrophic lateral sclerosis (ALS) survival after noninvasive ventilation (NIV), invasive ventilation (IV), and enteral nutrition (EN). METHODS We included patients diagnosed from 2000 to 2009 in Modena, where a prospective registry and a Motor Neuron Diseases Centre have been active since 2000. RESULTS Of the 193 incident cases, 47.7% received NIV, 24.3% received tracheostomy, and 49.2% received EN. A total of 10.4% of the patients refused NIV, 31.6% refused IV, and 8.7% refused EN. The median survival times after NIV, IV, and EN were 15, 19, and 9 months, respectively. Of the tracheostomized patients, 79.7% were discharged from the hospital; 73.0% were discharged to home. The median survival times for tracheostomized patients who were cared for at home and in nursing homes were 43 and 2 months, respectively. The multivariate analysis demonstrated that the place of discharge was the only independent prognostic factor after IV (P<0.01). CONCLUSIONS Service organizations may promote adherence to NIV, IV, EN, and influence postprocedure survival. These data may be useful in defining health plans regarding advanced ALS care and in patient counseling.
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Affiliation(s)
- Nicola Fini
- Department of Neuroscience, S. Agostino-Estense Hospital and University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126, Modena, Italy
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Mandrioli J, Biguzzi S, Guidi C, Venturini E, Sette E, Terlizzi E, Ravasio A, Casmiro M, Salvi F, Liguori R, Rizzi R, Pietrini V, Chierici E, Santangelo M, Granieri E, Mussuto V, Borghi A, Rinaldi R, Fini N, Georgoulopoulou E, De Pasqua S, Vinceti M, Bonvicini F, Ferro S, D'Alessandro R. Epidemiology of amyotrophic lateral sclerosis in Emilia Romagna Region (Italy): A population based study. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:262-8. [PMID: 24863640 DOI: 10.3109/21678421.2013.865752] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to describe incidence and clinical features of ALS from a prospective population-based study in Emilia Romagna Region (ERR). From 2009 onwards, a prospective registry recorded all incident cases of ALS among residents in the ERR (population, 4.4 million inhabitants), involving 17 neurological departments. For each patient, detailed demographic and clinical information was collected by caring physicians. Results showed that from 1 January 2009 to 31 December 2011, 347 patients received a new diagnosis of ALS with a crude incidence rate of 2.63/100,000/year. There was micro-geographic heterogeneity throughout ERR, with higher incidence rates in the low density population (3.27/100,000) (p < 0.01). ALS patients have been more frequently employed in agriculture than the general ERR population (8.64% vs. 4.6%, p < 0.01). Clinical features were similar to those described in previous population based studies. In conclusion, we report incidence rates similar to those reported by European registries, reflecting good accuracy of our prospective study. We confirmed previous studies reporting higher incidence rates in rural areas and among agricultural workers. Although genetics has been gaining increasing importance in ALS aetiology, some epidemiological data are still unexplained. Identifying geographical areas or populations with high incidence rates can be a starting point for identifying environmental risk factors. Further studies having this specific aim can shed light on these topics.
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Chiò A, Logroscino G, Traynor BJ, Collins J, Simeone JC, Goldstein LA, White LA. Global epidemiology of amyotrophic lateral sclerosis: a systematic review of the published literature. Neuroepidemiology 2013; 41:118-30. [PMID: 23860588 DOI: 10.1159/000351153] [Citation(s) in RCA: 537] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/03/2013] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is relatively rare, yet the economic and social burden is substantial. Having accurate incidence and prevalence estimates would facilitate efficient allocation of healthcare resources. OBJECTIVE To provide a comprehensive and critical review of the epidemiological literature on ALS. METHODS MEDLINE and EMBASE (1995-2011) databases of population-based studies on ALS incidence and prevalence reporting quantitative data were analyzed. Data extracted included study location and time, design and data sources, case ascertainment methods and incidence and/or prevalence rates. Medians and interquartile ranges (IQRs) were calculated, and ALS case estimates were derived using 2010 population estimates. RESULTS In all, 37 articles met the inclusion criteria. In Europe, the median incidence rate (/100,000 population) was 2.08 (IQR 1.47-2.43), corresponding to an estimated 15,355 (10,852-17,938) cases. Median prevalence (/100,000 population) was 5.40 (IQR 4.06-7.89), or 39,863 (29,971-58,244) prevalent cases. CONCLUSIONS Disparity in rates among ALS incidence and prevalence studies may be due to differences in study design or true variations in population demographics such as age and geography, including environmental factors and genetic predisposition. Additional large-scale studies that use standardized case ascertainment methods are needed to more accurately assess the true global burden of ALS.
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Affiliation(s)
- A Chiò
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy.
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Vinceti M, Solovyev N, Mandrioli J, Crespi CM, Bonvicini F, Arcolin E, Georgoulopoulou E, Michalke B. Cerebrospinal fluid of newly diagnosed amyotrophic lateral sclerosis patients exhibits abnormal levels of selenium species including elevated selenite. Neurotoxicology 2013; 38:25-32. [PMID: 23732511 DOI: 10.1016/j.neuro.2013.05.016] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/17/2013] [Accepted: 05/23/2013] [Indexed: 12/11/2022]
Abstract
Exposure to selenium, and particularly to its inorganic forms, has been hypothesized as a risk factor for amyotrophic lateral sclerosis (ALS), a fast progressing motor neuron disease with poorly understood etiology. However, no information is known about levels of inorganic and some organic selenium species in the central nervous system of ALS patients, and recent observations suggest that peripheral biomarkers of exposure are unable to predict these levels for several Se species including the inorganic forms. Using a hospital-referred case-control series and advanced selenium speciation methods, we compared the chemical species of selenium in cerebrospinal fluid from 38 ALS patients to those of 38 reference neurological patients matched on age and gender. We found that higher concentrations of inorganic selenium in the form of selenite and of human serum albumin-bound selenium were associated with increased ALS risk (relative risks 3.9 (95% confidence interval 1.2-11.0) and 1.7 (1.0-2.9) for 0.1μg/L increase). Conversely, lower concentrations of selenoprotein P-bound selenium were associated with increased risk (relative risk 0.2 for 1μg/L increase, 95% confidence interval 0.04-0.8). The associations were stronger among cases age 50 years or older, who are postulated to have lower rates of genetic disease origin. These results suggest that excess selenite and human serum albumin bound-selenium and low levels of selenoprotein P-bound selenium in the central nervous system, which may be related, may play a role in ALS etiology.
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Affiliation(s)
- Marco Vinceti
- CREAGEN - Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
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Georgoulopoulou E, Fini N, Vinceti M, Monelli M, Vacondio P, Bianconi G, Sola P, Nichelli P, Mandrioli J. The impact of clinical factors, riluzole and therapeutic interventions on ALS survival: a population based study in Modena, Italy. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:338-45. [PMID: 23373475 DOI: 10.3109/21678421.2013.763281] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prognostic role of riluzole, enteral nutrition (EN), non-invasive ventilation (NIV) and interdisciplinary care in ALS is still debated. A population based study has been performed focusing on ALS survival, with particular attention to prognostic factors and therapeutic intervention. All patients diagnosed with ALS between 2000 and 2009 and residing in Modena, Italy, have been registered. A centre for motor neuron disease (MND) has been active in our province since 2000, in addition to a prospective registry collecting all incident cases. One hundred and ninety-three incident cases have been collected during the 10 years of the study. Results demonstrated that median survival was 41 months (the overall three-year and five-year survival rates being 54.36% and 28.81%, respectively). Based on univariate analysis, factors related to survival were: age at diagnosis, gender, site of onset, phenotype, riluzole treatment and tracheostomy. In the Cox multivariable model, the factors independently related to a longer survival were age (p < 0.01), site of onset (p = 0.02) and riluzole treatment (p < 0.01), with a median gain in survival of 29 months (patients aged < 55 years compared with patients ≥ 55 years), 20 months (spinal versus bulbar onset), and 12 months (riluzole, yes vs. no), respectively. In conclusion, the study has confirmed the prognostic role of clinical features, but has surprisingly demonstrated that riluzole prolonged life significantly longer than NIV and EN. This observational study described the effects of ALS management in a setting that may approximate routine clinical practice more closely than randomized controlled trial (RCT); effects of uncontrolled potential confounders, however, cannot be excluded.
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Affiliation(s)
- Eleni Georgoulopoulou
- Department of Neuroscience, S. Agostino-Estense Hospital and University of Modena and Reggio Emilia, Modena, Italy
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Bandettini di Poggio M, Sormani MP, Truffelli R, Mandich P, Origone P, Verdiani S, Mantero V, Scialò C, Schenone A, Mancardi GL, Caponnetto C. Clinical epidemiology of ALS in Liguria, Italy. Amyotroph Lateral Scler Frontotemporal Degener 2012; 14:52-7. [PMID: 23030513 DOI: 10.3109/17482968.2012.729062] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to assess the incidence and trends of amyotrophic lateral sclerosis (ALS) in Liguria, a north-west region of Italy, utilizing a prospective design. Liguria (1,615,064 residents in 2010) is the site of a multicentre-multisource prospective population based registry called LIGALS (Liguria Amyotrophic Lateral Sclerosis Registry). All incident ALS cases during the period 2009-2010 were enrolled and followed up. Cases were identified using several concurrent sources. ALS diagnosis was based on the revised El Escorial criteria. One hundred and four cases were enrolled, generating an annual crude incidence of 3.22/100,000 (95% CI 2.66-3.90), with a male/female ratio of 1.34. The annual standardized incidence, age and gender adjusted to the 2001 Italian population, was 2.51. At last observation on 1 March 2012, 45% of patients registered in the LIGALS had died, with a median survival of 45 months from symptoms onset. According to capture-recapture estimation, three patients were unobserved. For both genders, demographic and clinical features were collected. In conclusion, comparing these data to those of epidemiological studies with a similar prospective design, the occurrence of ALS is similar. The observed crude incidence was higher compared to other Italian studies, due in part to a very careful case ascertainment and in part to a high percentage of the elderly in Liguria.
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Affiliation(s)
- Monica Bandettini di Poggio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.
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Blasco H, Guennoc AM, Veyrat-Durebex C, Gordon PH, Andres CR, Camu W, Corcia P. Amyotrophic lateral sclerosis: A hormonal condition? ACTA ACUST UNITED AC 2012; 13:585-8. [DOI: 10.3109/17482968.2012.706303] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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