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Cabona C, Ferraro PM, Scialò C, Bandettini Di Poggio M, Novi G, Gemelli C, Vignolo M, Rao F, Capovilla M, Marogna M, Mandich P, Origone P, Schenone A, Caponnetto C. Clinical epidemiology of amyotrophic lateral sclerosis in Liguria, Italy: a ten year follow up study. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:104-111. [PMID: 37737151 DOI: 10.1080/21678421.2023.2260842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE This article presents an updated analysis of the LIGALS register, a prospective study conducted over a ten-year period (2009-2018) in Liguria, Italy, aimed at evaluating the incidence, prevalence, clinical presentation, and management of amyotrophic lateral sclerosis (ALS). METHODS We calculated the mean annual crude incidence rate of ALS, assessed the point prevalence of ALS on January 1, 2018, and analyzed demographic factors, clinical characteristics, and clinical management strategies. Data analysis included Cox regression analysis to identify predictors of survival. RESULTS The mean annual crude incidence rate of ALS was 3.16/100,000 per year (CI 95%) while the point prevalence of ALS on January 1, 2018, was 9.31/100,000 population (CI 95%). Among the patients, 6.5% were familial ALS, while 93.5% were sporadic cases. Clinical management strategies, including percutaneous endoscopic gastrostomy (PEG) and noninvasive ventilation (NIV), were employed. The study observed a stable frequency of NIV initiation and PEG placement over time, with a growing trend toward earlier PEG positioning. The mean survival from symptom onset was 39 months, whereas from diagnosis, it was 26 months. Cox regression analysis identified several predictors of survival, including gender, age at onset and diagnosis, site of onset, diagnostic category, phenotype, and diagnostic delay. CONCLUSIONS This comprehensive analysis provides valuable insights into the long-term trends in ALS epidemiology and clinical management in Liguria, Italy. It underscores the importance of continued research efforts in understanding and addressing the challenges posed by ALS, particularly in terms of early diagnosis and optimizing clinical interventions to improve patient outcomes.
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Affiliation(s)
| | | | - Carlo Scialò
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | | | - Giovanni Novi
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | | | - Fabrizio Rao
- Centro Clinico NeMO, Ospedale la Colletta, Arenzano, Italy
| | | | - Maura Marogna
- Azienda Sanitaria Locale 3 Genovese, Genova, Italy, and
| | - Paola Mandich
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genova, Italy
| | - Paola Origone
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genova, Italy
| | - Angelo Schenone
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genova, Italy
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Vélez-GóMEZ B, Perna A, Vazquez C, Ketzoian C, Lillo P, Godoy-Reyes G, Sáez D, Zaldivar Vaillant T, Gutiérrez Gil JV, Lara-Fernández GE, Povedano M, Heverin M, McFarlane R, Logroscino G, Hardiman O. LAENALS: epidemiological and clinical features of amyotrophic lateral sclerosis in Latin America. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:119-127. [PMID: 37865869 DOI: 10.1080/21678421.2023.2271517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/05/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE The Latin American Epidemiologic study of ALS (LAENALS) aims to gather data on ALS epidemiology, phenotype, and risk factors in Cuba, Chile, and Uruguay, to understand the impact of genetic and environmental factors on ALS. METHODS A harmonized data collection protocol was generated, and a Latin-American Spanish language Register was constructed. Patient data were collected in Uruguay in 2018, in Chile from 2017 to 2019, and in Cuba between 2017 and 2018. Statistical analysis was performed using SPSS 25.0.0 software. Crude cumulative incidence, standardized incidence, and prevalence were calculated in the population aged 15 years and older. RESULTS During 2017-2019, 90 people with ALS from Uruguay (55.6% men), 219 from Chile (54.6% men), and 49 from Cuba (55.1% men) were included. The cumulative crude incidence in 2018 was 1.73/100,000 persons in Uruguay, 1.08 in Chile and 0.195 in Cuba. Crude prevalence in 2018 was 2.19 per 100,000 persons in Uruguay, 1.39 in Chile and 0.55 in Cuba. Mean age at onset was 61.8 ± 11.96 SD years in Uruguay, 61.9 ± 10.4 SD years in Chile, and 60.21 ± 12.45 SD years in Cuba (p = 0.75). Median survival from onset was 32.43 months (21.93 - 42.36) in Uruguay, 24 months (13.5 - 33.5) in Chile, and 29 months (15 - 42.5) in Cuba (p = 0.006). CONCLUSIONS These preliminary data from LAENALS confirm the lower incidence and prevalence of ALS in counties with admixed populations. The LAENALS database is now open to other Latin American countries for harmonized prospective data collection.
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Affiliation(s)
- Beatriz Vélez-GóMEZ
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Hospital Universitario Torrecárdenas, Almería, Spain
| | | | | | | | - Patricia Lillo
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Unidad de Neurología, Hospital San Jose, SSMN, Santiago, Chile
| | - Gladys Godoy-Reyes
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Servicio de Neurología, Hospital Barros Luco, SSMS, Santiago, Chile
| | - David Sáez
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Servicio de Neurología, Hospital Barros Luco, SSMS, Santiago, Chile
| | | | | | | | - Mónica Povedano
- Unidad de Neuromuscular, Servicio de Neurología, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain, and
| | - Mark Heverin
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Robert McFarlane
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain. Fondazione "Card. G. Panico" Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari "Aldo Moro", Bari, Italy
| | - Orla Hardiman
- Academic Unit of Neurology, Clinical Medicine, Trinity College Dublin, Dublin, Ireland
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3
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Martinelli I, Ghezzi A, Zucchi E, Gianferrari G, Ferri L, Moglia C, Manera U, Solero L, Vasta R, Canosa A, Grassano M, Brunetti M, Mazzini L, De Marchi F, Simonini C, Fini N, Vinceti M, Pinti M, Chiò A, Calvo A, Mandrioli J. Predictors for progression in amyotrophic lateral sclerosis associated to SOD1 mutation: insight from two population-based registries. J Neurol 2023; 270:6081-6092. [PMID: 37668704 DOI: 10.1007/s00415-023-11963-0] [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: 06/07/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Uncovering distinct features and trajectories of amyotrophic lateral sclerosis (ALS) associated with SOD1 mutations (SOD1-ALS) can provide valuable insights for patient' counseling and stratification for trials, and interventions timing. Our study aims to pinpoint distinct clinical characteristics of SOD1-ALS by delving into genotype-phenotype correlations and factors that potentially impact disease progression. METHODS This is a retrospective observational study of a SOD1-ALS cohort from two Italian registers situated in the regions of Emilia-Romagna, Piedmont and Valle d'Aosta. RESULTS Out of 2204 genotyped ALS patients, 2.5% carried SOD1 mutations, with a M:F ratio of 0.83. SOD1-ALS patients were younger, and more frequently reported a family history of ALS and/or FTD. SOD1-ALS had a longer survival compared to patients without ALS-associated gene mutations. However, here was considerable variability in survival across distinct SOD1 mutations, with an average survival of less than a year for the L39V, G42S, G73S, D91N mutations. Among SOD1-ALS, multivariate analysis showed that, alongside established clinical prognostic factors such as advanced age at onset and high progression rate at diagnosis, mutations located in exon 2 or within highly conserved gene positions predicted worse survival. Conversely, among comorbidities, cancer history was independently associated with longer survival. INTERPRETATION Within the context of an overall slower disease, SOD1-ALS exhibits some degree of heterogeneity linked to the considerable genetic diversity arising from the multitude of potential mutations sites and specific clinical prognostic factors, including cancer history. Revealing the factors that modulate the phenotypic heterogeneity of SOD1-ALS could prove advantageous in improving the efficacy of upcoming therapeutic approaches.
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Affiliation(s)
- Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Viale Pietro Giardini, 1355, 41126, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Ghezzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Zucchi
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Viale Pietro Giardini, 1355, 41126, Modena, Italy.
- Neuroscience PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Giulia Gianferrari
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Viale Pietro Giardini, 1355, 41126, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Ferri
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Viale Pietro Giardini, 1355, 41126, Modena, Italy
- Neuroscience PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Moglia
- Department of Neuroscience "Rita Levi Montalcini", ALS Centre, University of Torino, Turin, Italy
| | - Umberto Manera
- Department of Neuroscience "Rita Levi Montalcini", ALS Centre, University of Torino, Turin, Italy
| | - Luca Solero
- Department of Neuroscience "Rita Levi Montalcini", ALS Centre, University of Torino, Turin, Italy
| | - Rosario Vasta
- Department of Neuroscience "Rita Levi Montalcini", ALS Centre, University of Torino, Turin, Italy
| | - Antonio Canosa
- Department of Neuroscience "Rita Levi Montalcini", ALS Centre, University of Torino, Turin, Italy
- SC Neurologia 1U, AOU Città della Salute e della Scienza of Torino, Turin, Italy
| | - Maurizio Grassano
- Department of Neuroscience "Rita Levi Montalcini", ALS Centre, University of Torino, Turin, Italy
- SC Neurologia 1U, AOU Città della Salute e della Scienza of Torino, Turin, Italy
| | - Maura Brunetti
- SC Neurologia 1U, AOU Città della Salute e della Scienza of Torino, Turin, Italy
| | - Letizia Mazzini
- Neurology Unit, ALS Center, AOU Maggiore della Carità and University of Piemonte Orientale, Novara, Italy
| | - Fabiola De Marchi
- Neurology Unit, ALS Center, AOU Maggiore della Carità and University of Piemonte Orientale, Novara, Italy
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Viale Pietro Giardini, 1355, 41126, Modena, Italy
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Viale Pietro Giardini, 1355, 41126, Modena, Italy
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Science of Public Health, Research Centre in Environmental, Genetic and Nutritional Epidemiology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Marcello Pinti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Adriano Chiò
- Department of Neuroscience "Rita Levi Montalcini", ALS Centre, University of Torino, Turin, Italy
- SC Neurologia 1U, AOU Città della Salute e della Scienza of Torino, Turin, Italy
| | - Andrea Calvo
- Department of Neuroscience "Rita Levi Montalcini", ALS Centre, University of Torino, Turin, Italy
- SC Neurologia 1U, AOU Città della Salute e della Scienza of Torino, Turin, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Viale Pietro Giardini, 1355, 41126, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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4
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Zucchi E, Musazzi UM, Fedele G, Martinelli I, Gianferrari G, Simonini C, Fini N, Ghezzi A, Caputo M, Sette E, Vacchiano V, Zinno L, Anceschi P, Canali E, Vinceti M, Ferro S, Mandrioli J. Effect of tauroursodeoxycholic acid on survival and safety in amyotrophic lateral sclerosis: a retrospective population-based cohort study. EClinicalMedicine 2023; 65:102256. [PMID: 37842553 PMCID: PMC10570688 DOI: 10.1016/j.eclinm.2023.102256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Background Oral tauroursodeoxycholic acid (TUDCA) is a commercial drug currently tested in patients with amyotrophic lateral sclerosis (ALS) both singly and combined with sodium phenylbutyrate. This retrospective study aimed to investigate, in a real-world setting, whether TUDCA had an impact on the overall survival of patients with ALS who were treated with this drug compared to those patients who received standard care only. Methods This propensity score-matched study was conducted in the Emilia Romagna Region (Italy), which has had an ALS regional registry since 2009. Out of 627 patients with ALS diagnosed from January 1st, 2015 to June 30th, 2021 and recorded in the registry with available information on death/tracheostomy, 86 patients took TUDCA and were matched in a 1:2 ratio with patients who received only usual care according to age at onset, sex, phenotype, diagnostic latency, ALS Functional Rating Scale-Revised (ALSFRS-R) at first visit, disease progression rate at first visit, and BMI at diagnosis. The primary outcome was survival difference (time from onset of symptoms to tracheostomy/death) between TUDCA exposed and unexposed patients. Findings A total of 86 patients treated with TUDCA were matched to 172 patients who did not receive treatment. TUDCA-exposed patients were stratified based on dosage (less than or equal to 1000 mg/day or greater) and duration (less than or equal to 12 months or longer) of treatment. The median overall survival was 49.6 months (95% CI 41.7-93.5) among those treated with TUDCA and 36.2 months (95% CI 32.7-41.6) in the control group, with a reduced risk of death observed in patients exposed to a higher dosage (defined as ≥ 1000 mg/day) of TUDCA (HR 0.56; 95% CI 0.38-0.83; p = 0.0042) compared to both the control group and those with lower TUDCA dosages (defined as < 1000 mg/day). TUDCA was generally well-tolerated, except for a minority of patients (n = 7, 8.1%) who discontinued treatment due to side effects, primarily gastrointestinal and mild in severity; only 2 adverse events required hospital access but resolved without sequelae. Interpretation In this population-based exploratory study, patients with ALS who were treated with TUDCA may have prolonged survival compared to patients receiving standard care only. Additional prospective randomized studies are needed to confirm the efficacy and safety of this drug. Funding Emilia-Romagna Region.
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Affiliation(s)
- Elisabetta Zucchi
- Neuroscience PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Umberto Maria Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, via G. Colombo 71, 20133, Milan, Italy
| | - Guido Fedele
- Associazione Farmaceutici dell'Industria (AFI), Viale Ranzoni 1, 20149, Milano, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Gianferrari
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Andrea Ghezzi
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Caputo
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Veria Vacchiano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lucia Zinno
- Neurology Unit, Department of Neuroscience, University of Parma, Parma, Italy
| | - Pietro Anceschi
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Canali
- Department of Neurology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - 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, USA
| | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, Bologna, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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5
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Solovyev N, Lucio M, Mandrioli J, Forcisi S, Kanawati B, Uhl J, Vinceti M, Schmitt-Kopplin P, Michalke B. Interplay of Metallome and Metabolome in Amyotrophic Lateral Sclerosis: A Study on Cerebrospinal Fluid of Patients Carrying Disease-Related Gene Mutations. ACS Chem Neurosci 2023; 14:3035-3046. [PMID: 37608584 PMCID: PMC10485893 DOI: 10.1021/acschemneuro.3c00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a lethal progressive neurodegenerative disease, characterized by a loss of function of upper and lower motor neurons. This study aimed to explore probable pathological alterations occurring in individuals with ALS compared to neurologically healthy controls through the analysis of cerebrospinal fluid (CSF), a medium, which directly interacts with brain parenchyma. A total of 7 ALS patients with disease-associated mutations (ATXN2, C9ORF72, FUS, SOD1, and TARDBP) and 13 controls were included in the study. Multiple analytical approaches were employed, including metabolomic and metallomics profiling, as well as genetic screening, using CSF samples obtained from the brain compartment. Data analysis involved the application of multivariate statistical methods. Advanced hyphenated selenium and redox metal (iron, copper, and manganese) speciation techniques and nontargeted Fourier transform ion cyclotron resonance mass spectrometry-based metabolomics were used for data acquisition. Nontargeted metabolomics showed reduced steroids, including sex hormones; additionally, copper and manganese species were found to be the most relevant features for ALS patients. This indicates a potential alteration of sex hormone pathways in the ALS-affected brain, as reflected in the CSF.
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Affiliation(s)
- Nikolay Solovyev
- Analytical
BioGeoChemistry Research Unit, Helmholtz
Center Munich—German Research Center for Environmental Health
GmbH, Ingolstädter
Landstr. 1, 85764 Neuherberg, Germany
| | - Marianna Lucio
- Analytical
BioGeoChemistry Research Unit, Helmholtz
Center Munich—German Research Center for Environmental Health
GmbH, Ingolstädter
Landstr. 1, 85764 Neuherberg, Germany
| | - Jessica Mandrioli
- Department
of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Department
of Neurosciences, Azienda Ospedaliero Universitaria
di Modena, 41126 Modena, Italy
| | - Sara Forcisi
- Analytical
BioGeoChemistry Research Unit, Helmholtz
Center Munich—German Research Center for Environmental Health
GmbH, Ingolstädter
Landstr. 1, 85764 Neuherberg, Germany
| | - Basem Kanawati
- Analytical
BioGeoChemistry Research Unit, Helmholtz
Center Munich—German Research Center for Environmental Health
GmbH, Ingolstädter
Landstr. 1, 85764 Neuherberg, Germany
| | - Jenny Uhl
- Analytical
BioGeoChemistry Research Unit, Helmholtz
Center Munich—German Research Center for Environmental Health
GmbH, Ingolstädter
Landstr. 1, 85764 Neuherberg, Germany
| | - Marco Vinceti
- CREAGEN
Research Center of Environmental, Genetic and Nutritional Epidemiology,
Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Philippe Schmitt-Kopplin
- Analytical
BioGeoChemistry Research Unit, Helmholtz
Center Munich—German Research Center for Environmental Health
GmbH, Ingolstädter
Landstr. 1, 85764 Neuherberg, Germany
| | - Bernhard Michalke
- Analytical
BioGeoChemistry Research Unit, Helmholtz
Center Munich—German Research Center for Environmental Health
GmbH, Ingolstädter
Landstr. 1, 85764 Neuherberg, Germany
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6
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Gianferrari G, Martinelli I, Simonini C, Zucchi E, Fini N, Caputo M, Ghezzi A, Gessani A, Canali E, Casmiro M, De Massis P, Curro' Dossi M, De Pasqua S, Liguori R, Longoni M, Medici D, Morresi S, Patuelli A, Pugliatti M, Santangelo M, Sette E, Stragliati F, Terlizzi E, Vacchiano V, Zinno L, Ferro S, Amedei A, Filippini T, Vinceti M, Mandrioli J. Insight into Elderly ALS Patients in the Emilia Romagna Region: Epidemiological and Clinical Features of Late-Onset ALS in a Prospective, Population-Based Study. Life (Basel) 2023; 13:life13040942. [PMID: 37109471 PMCID: PMC10144747 DOI: 10.3390/life13040942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/23/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
Few studies have focused on elderly (>80 years) amyotrophic lateral sclerosis (ALS) patients, who represent a fragile subgroup generally not included in clinical trials and often neglected because they are more difficult to diagnose and manage. We analyzed the clinical and genetic features of very late-onset ALS patients through a prospective, population-based study in the Emilia Romagna Region of Italy. From 2009 to 2019, 222 (13.76%) out of 1613 patients in incident cases were over 80 years old at diagnosis, with a female predominance (F:M = 1.18). Elderly ALS patients represented 12.02% of patients before 2015 and 15.91% from 2015 onwards (p = 0.024). This group presented with bulbar onset in 38.29% of cases and had worse clinical conditions at diagnosis compared to younger patients, with a lower average BMI (23.12 vs. 24.57 Kg/m2), a higher progression rate (1.43 vs. 0.95 points/month), and a shorter length of survival (a median of 20.77 vs. 36 months). For this subgroup, genetic analyses have seldom been carried out (25% vs. 39.11%) and are generally negative. Finally, elderly patients underwent less frequent nutritional- and respiratory-supporting procedures, and multidisciplinary teams were less involved at follow-up, except for specialist palliative care. The genotypic and phenotypic features of elderly ALS patients could help identify the different environmental and genetic risk factors that determine the age at which disease onset occurs. Since multidisciplinary management can improve a patient's prognosis, it should be more extensively applied to this fragile group of patients.
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Affiliation(s)
- Giulia Gianferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Cecilia Simonini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
| | - Elisabetta Zucchi
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
- Neuroscience Ph.D. Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Nicola Fini
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
| | - Maria Caputo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Andrea Ghezzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Annalisa Gessani
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
| | - Elena Canali
- Department of Neurology, IRCCS Arcispedale Santa Maria Nuova, 42123 Reggio Emilia, Italy
| | - Mario Casmiro
- Department of Neurology, Faenza and Ravenna Hospital, 48100 Ravenna, Italy
| | | | | | | | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40126 Bologna, Italy
| | - Marco Longoni
- Department of Neurology, Infermi Hospital, 48018 Rimini, Italy
- Department of Neurology, Bufalini Hospital, 47521 Cesena, Italy
| | - Doriana Medici
- Department of Neurology, Fidenza Hospital, 43036 Parma, Italy
| | | | | | - Maura Pugliatti
- Department of Neurosciences, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurology, St. Anna Hospital, 44124 Ferrara, Italy
| | | | - Elisabetta Sette
- Department of Neurology, St. Anna Hospital, 44124 Ferrara, Italy
| | - Filippo Stragliati
- Department of General and Specialized Medicine, University Hospital of Parma, 43126 Parma, Italy
| | - Emilio Terlizzi
- Department of Neurology, G. Da Saliceto Hospital, 29121 Piacenza, Italy
| | - Veria Vacchiano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40126 Bologna, Italy
| | - Lucia Zinno
- Department of General and Specialized Medicine, University Hospital of Parma, 43126 Parma, Italy
| | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, 40127 Bologna, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Research Centre in Environmental, Genetic and Nutritional Epidemiology-CREAGEN, University of Modena and Reggio Emilia, 41125 Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA 94704, USA
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Research Centre in Environmental, Genetic and Nutritional Epidemiology-CREAGEN, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, MA 02118, USA
| | - Jessica Mandrioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
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Saucier D, Registe PPW, Bélanger M, O'Connell C. Urbanization, air pollution, and water pollution: Identification of potential environmental risk factors associated with amyotrophic lateral sclerosis using systematic reviews. Front Neurol 2023; 14:1108383. [PMID: 36970522 PMCID: PMC10030603 DOI: 10.3389/fneur.2023.1108383] [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: 11/26/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Despite decades of research, causes of ALS remain unclear. To evaluate recent hypotheses of plausible environmental factors, the aim of this study was to synthesize and appraise literature on the potential associations between the surrounding environment, including urbanization, air pollution and water pollution, and ALS. Methods We conducted a series (n = 3) of systematic reviews in PubMed and Scopus to identify epidemiological studies assessing relationships between urbanization, air pollution and water pollution with the development of ALS. Results The combined search strategy led to the inclusion of 44 articles pertaining to at least one exposure of interest. Of the 25 included urbanization studies, four of nine studies on living in rural areas and three of seven studies on living in more highly urbanized/dense areas found positive associations to ALS. There were also three of five studies for exposure to electromagnetic fields and/or proximity to powerlines that found positive associations to ALS. Three case-control studies for each of diesel exhaust and nitrogen dioxide found positive associations with the development of ALS, with the latter showing a dose-response in one study. Three studies for each of high selenium content in drinking water and proximity to lakes prone to cyanobacterial blooms also found positive associations to ALS. Conclusion Whereas markers of air and water pollution appear as potential risk factors for ALS, results are mixed for the role of urbanization.
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Affiliation(s)
- Daniel Saucier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de formation médicale du Nouveau-Brunswick, Moncton, NB, Canada
- *Correspondence: Daniel Saucier
| | - Pierre Philippe Wilson Registe
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de formation médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Mathieu Bélanger
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de formation médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Colleen O'Connell
- Stan Cassidy Center for Rehabilitation, Fredericton, NB, Canada
- Department of Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
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Faghri F, Brunn F, Dadu A, Zucchi E, Martinelli I, Mazzini L, Vasta R, Canosa A, Moglia C, Calvo A, Nalls MA, Campbell RH, Mandrioli J, Traynor BJ, Chiò A. Identifying and predicting amyotrophic lateral sclerosis clinical subgroups: a population-based machine-learning study. Lancet Digit Health 2022; 4:e359-e369. [PMID: 35341712 PMCID: PMC9038712 DOI: 10.1016/s2589-7500(21)00274-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 10/17/2021] [Accepted: 11/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is known to represent a collection of overlapping syndromes. Various classification systems based on empirical observations have been proposed, but it is unclear to what extent they reflect ALS population substructures. We aimed to use machine-learning techniques to identify the number and nature of ALS subtypes to obtain a better understanding of this heterogeneity, enhance our understanding of the disease, and improve clinical care. METHODS In this retrospective study, we applied unsupervised Uniform Manifold Approximation and Projection [UMAP]) modelling, semi-supervised (neural network UMAP) modelling, and supervised (ensemble learning based on LightGBM) modelling to a population-based discovery cohort of patients who were diagnosed with ALS while living in the Piedmont and Valle d'Aosta regions of Italy, for whom detailed clinical data, such as age at symptom onset, were available. We excluded patients with missing Revised ALS Functional Rating Scale (ALSFRS-R) feature values from the unsupervised and semi-supervised steps. We replicated our findings in an independent population-based cohort of patients who were diagnosed with ALS while living in the Emilia Romagna region of Italy. FINDINGS Between Jan 1, 1995, and Dec 31, 2015, 2858 patients were entered in the discovery cohort. After excluding 497 (17%) patients with missing ALSFRS-R feature values, data for 42 clinical features across 2361 (83%) patients were available for the unsupervised and semi-supervised analysis. We found that semi-supervised machine learning produced the optimum clustering of the patients with ALS. These clusters roughly corresponded to the six clinical subtypes defined by the Chiò classification system (ie, bulbar, respiratory, flail arm, classical, pyramidal, and flail leg ALS). Between Jan 1, 2009, and March 1, 2018, 1097 patients were entered in the replication cohort. After excluding 108 (10%) patients with missing ALSFRS-R feature values, data for 42 clinical features across 989 patients were available for the unsupervised and semi-supervised analysis. All 1097 patients were included in the supervised analysis. The same clusters were identified in the replication cohort. By contrast, other ALS classification schemes, such as the El Escorial categories, Milano-Torino clinical staging, and King's clinical stages, did not adequately label the clusters. Supervised learning identified 11 clinical parameters that predicted ALS clinical subtypes with high accuracy (area under the curve 0·982 [95% CI 0·980-0·983]). INTERPRETATION Our data-driven study provides insight into the ALS population substructure and confirms that the Chiò classification system successfully identifies ALS subtypes. Additional validation is required to determine the accuracy and clinical use of these algorithms in assigning clinical subtypes. Nevertheless, our algorithms offer a broad insight into the clinical heterogeneity of ALS and help to determine the actual subtypes of disease that exist within this fatal neurodegenerative syndrome. The systematic identification of ALS subtypes will improve clinical care and clinical trial design. FUNDING US National Institute on Aging, US National Institutes of Health, Italian Ministry of Health, European Commission, University of Torino Rita Levi Montalcini Department of Neurosciences, Emilia Romagna Regional Health Authority, and Italian Ministry of Education, University, and Research. TRANSLATIONS For the Italian and German translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Faraz Faghri
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, US National Institute on Aging, Bethesda, MD, USA; Center for Alzheimer's and Related Dementias, US National Institute on Aging, Bethesda, MD, USA; Data Tecnica International, Glen Echo, MD, USA; Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fabian Brunn
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Anant Dadu
- Center for Alzheimer's and Related Dementias, US National Institute on Aging, Bethesda, MD, USA; Data Tecnica International, Glen Echo, MD, USA; Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Elisabetta Zucchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria Martinelli
- Neurology Unit, Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Letizia Mazzini
- ALS Centre, Department of Neurology, Maggiore della Carità University Hospital, Novara, Italy
| | - Rosario Vasta
- Rita Levi Montalcini, Department of Neuroscience, University of Turin, Turin, Italy
| | - Antonio Canosa
- Rita Levi Montalcini, Department of Neuroscience, University of Turin, Turin, Italy
| | - Cristina Moglia
- Rita Levi Montalcini, Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Calvo
- Rita Levi Montalcini, Department of Neuroscience, University of Turin, Turin, Italy
| | - Michael A Nalls
- Center for Alzheimer's and Related Dementias, US National Institute on Aging, Bethesda, MD, USA; Data Tecnica International, Glen Echo, MD, USA
| | - Roy H Campbell
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Jessica Mandrioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, Department of Neurosciences, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Bryan J Traynor
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, US National Institute on Aging, Bethesda, MD, USA; Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA; Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Adriano Chiò
- Rita Levi Montalcini, Department of Neuroscience, University of Turin, Turin, Italy; Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy; Neurology 1 and ALS Centre, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
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9
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Ilaria M, Elisabetta Z, Viviana P, Cinzia G, Bryan J T, Giulia G, Adriano C, Jessica M. G507D mutation in FUS gene causes familial amyotrophic lateral sclerosis with a specific genotype-phenotype correlation. Neurobiol Aging 2022; 118:124-128. [DOI: 10.1016/j.neurobiolaging.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/17/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
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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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11
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Tavazzi E, Daberdaku S, Zandonà A, Vasta R, Nefussy B, Lunetta C, Mora G, Mandrioli J, Grisan E, Tarlarini C, Calvo A, Moglia C, Drory V, Gotkine M, Chiò A, Di Camillo B. Predicting functional impairment trajectories in amyotrophic lateral sclerosis: a probabilistic, multifactorial model of disease progression. J Neurol 2022; 269:3858-3878. [PMID: 35266043 PMCID: PMC9217910 DOI: 10.1007/s00415-022-11022-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 12/02/2022]
Abstract
Objective To employ Artificial Intelligence to model, predict and simulate the amyotrophic lateral sclerosis (ALS) progression over time in terms of variable interactions, functional impairments, and survival. Methods We employed demographic and clinical variables, including functional scores and the utilisation of support interventions, of 3940 ALS patients from four Italian and two Israeli registers to develop a new approach based on Dynamic Bayesian Networks (DBNs) that models the ALS evolution over time, in two distinct scenarios of variable availability. The method allows to simulate patients’ disease trajectories and predict the probability of functional impairment and survival at different time points. Results DBNs explicitly represent the relationships between the variables and the pathways along which they influence the disease progression. Several notable inter-dependencies were identified and validated by comparison with literature. Moreover, the implemented tool allows the assessment of the effect of different markers on the disease course, reproducing the probabilistically expected clinical progressions. The tool shows high concordance in terms of predicted and real prognosis, assessed as time to functional impairments and survival (integral of the AU-ROC in the first 36 months between 0.80–0.93 and 0.84–0.89 for the two scenarios, respectively). Conclusions Provided only with measurements commonly collected during the first visit, our models can predict time to the loss of independence in walking, breathing, swallowing, communicating, and survival and it can be used to generate in silico patient cohorts with specific characteristics. Our tool provides a comprehensive framework to support physicians in treatment planning and clinical decision-making. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11022-0.
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Affiliation(s)
- Erica Tavazzi
- Department of Information Engineering, University of Padova, Padua, Italy
| | | | - Alessandro Zandonà
- Department of Information Engineering, University of Padova, Padua, Italy
| | - Rosario Vasta
- Department of Neuroscience, University of Torino, "Rita Levi Montalcini", Turin, Italy
| | | | | | - Gabriele Mora
- Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | | | - Enrico Grisan
- Department of Information Engineering, University of Padova, Padua, Italy
- School of Engineering, London South Bank University, London, UK
| | | | - Andrea Calvo
- Department of Neuroscience, University of Torino, "Rita Levi Montalcini", Turin, Italy
| | - Cristina Moglia
- Department of Neuroscience, University of Torino, "Rita Levi Montalcini", Turin, Italy
| | - Vivian Drory
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Marc Gotkine
- Hadassah University Hospital Medical Center, Jerusalem, Israel
| | - Adriano Chiò
- Department of Neuroscience, University of Torino, "Rita Levi Montalcini", Turin, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, Padua, Italy.
- Department of Comparative Biomedicine and Food Science, University of Padova, Via Gradenigo 6/B, 35131, Padua, Italy.
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12
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Liu W, Li X, Sun Y, Yu X, Wang Y, Liu N, Deng M. Genotype-phenotype correlations in a chinese population with familial amyotrophic lateral sclerosis. Neurol Res 2021; 44:206-216. [PMID: 34431456 DOI: 10.1080/01616412.2021.1968706] [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: 10/20/2022]
Abstract
Objective: This study aimed to determine the distribution of the most commonly mutated genes (SOD1, TARDBP, FUS/TLS, and C9ORF72) associated with familial amyotrophic lateral sclerosis (FALS) and the association between genotype and phenotype in 242 Chinese patients.Methods: A total of 58 families were screened for ALS-associated mutations in SOD1,TARDBP, FUS, and C9ORF72 hexanucleotide repeat expansion. These mutations were analyzed to evaluate the relationship between genotype and phenotype in Chinese FALS patients.Results: Partial clinical data were obtained for 242 relatives of the 58 analyzed families, with a male-to-female ratio of 1.2:1 and a mean age of disease onset of 45.9±12.0 (13-80) years. 26 mutations associated with pathogenesis were identified in 32 probands from 58 different families. Mutations in SOD1, FUS, TARDBP, and C9ORF72 accounted for 32.8%, 12.1%, 8.6%, and 1.7% of FALS, respectively. FALS patients showed longer survival times; however, bulbar-onset ALS and the male-to-female ratio for them were lower than those reported previously. The site of onset, age of onset, and lifespan differed in FALS patients with SOD1, TARDBP, and FUS mutations.Discussion: In this study, patients with SOD1 mutations exhibited heterogeneous survival times that showed a bimodal distribution, while patients with FUS mutations showed rapid disease progression. Our results showed the relative contributions of the different types of mutations associated with ALS and provided phenotype-genotype correlations with clinical features in Chinese patients.
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Affiliation(s)
- WenChao Liu
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - XiaoGang Li
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yan Sun
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - XiaoTong Yu
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - Yan Wang
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - Na Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Min Deng
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
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Violi F, Solovyev N, Vinceti M, Mandrioli J, Lucio M, Michalke B. The study of levels from redox-active elements in cerebrospinal fluid of amyotrophic lateral sclerosis patients carrying disease-related gene mutations shows potential copper dyshomeostasis. Metallomics 2021; 12:668-681. [PMID: 32373852 DOI: 10.1039/d0mt00051e] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Amyotrophic lateral sclerosis is a progressive neurodegenerative disease characterized by a loss of function of motor neurons. The etiology of this disorder is still largely unknown. Gene-environment interaction arises as a possible key factor in the development of amyotrophic lateral sclerosis. We assessed the levels of trace metals, copper (Cu), iron (Fe), and manganese (Mn), of 9 amyotrophic lateral sclerosis cases and 40 controls by measuring their content in cerebrospinal fluid. The following trace element species were quantified using ion chromatography-inductively coupled plasma mass spectrometry: univalent copper (Cu-I), divalent Cu (Cu-II), divalent Fe (Fe-II), trivalent Fe (Fe-III), divalent Mn (Mn-II), trivalent Mn (Mn-III), and also unidentified Mn species (Mn-unknown) were present in some samples. When computing the relative risks for amyotrophic lateral sclerosis through an unconditional logistic regression model, we observed a weak and imprecise positive association for iron (Fe III, adjusted odds ratio 1.48, 95% CI 0.46-4.76) and manganese (total-Mn and Mn-II; adjusted odds ratio 1.11, 95% CI 0.74-1.67, and 1.13, 95% CI 0.79-1.61, respectively). Increased risk for copper was found both in the crude analysis (odds ratio 1.14, 95% CI 0.99-1.31) and in multivariable analysis after adjusting for sex, age, and year of storage (1.09, 95% CI 0.90-1.32). Our results suggest a possible positive association between Cu and genetic amyotrophic lateral sclerosis, while they give little indication of involvement of Fe and Mn in disease, though some correlations found also for these elements deserve further investigation.
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Affiliation(s)
- Federica Violi
- CREAGEN Research Center of Environmental, Genetic and Nutritional Epidemiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 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: 70] [Impact Index Per Article: 23.3] [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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15
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Niccolai E, Di Pilato V, Nannini G, Baldi S, Russo E, Zucchi E, Martinelli I, Menicatti M, Bartolucci G, Mandrioli J, Amedei A. The Gut Microbiota-Immunity Axis in ALS: A Role in Deciphering Disease Heterogeneity? Biomedicines 2021; 9:biomedicines9070753. [PMID: 34209688 PMCID: PMC8301418 DOI: 10.3390/biomedicines9070753] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder with an unknown etiology and no effective treatment, and is characterized by large phenotypic heterogeneity, including variable sites, ages of symptom onset and rates of disease progression. Increasing data support the role of the microbiota-immunity axis in the pathogenesis of neurodegenerative diseases. In the present study, we compared the inflammatory and microbiota profile of ALS patients with different clinical characteristics, with healthy family caregivers. Measuring a panel of 30 inflammatory cytokines in serum and fecal samples, we observed a distinct cytokine profile both at the systemic and intestinal level in patients compared to controls and even in patients with different clinical phenotypes and progression rates. The 16S targeted metagenome analysis revealed slight differences in patients compared to controls as well as in patients with slow progression, marked by the reduction of butyrate-producing bacteria and a decrease of the Firmicutes/Bacteroidetes ratio in ALS. Finally, the short chain fatty acid analysis did not show a different distribution among the groups. If confirmed in a larger number of patients, the inflammatory cytokine profile and the microbial composition could be appropriate biomarker candidates for deciphering ALS heterogeneity.
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Affiliation(s)
- Elena Niccolai
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (G.N.); (S.B.); (E.R.)
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy;
| | - Giulia Nannini
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (G.N.); (S.B.); (E.R.)
| | - Simone Baldi
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (G.N.); (S.B.); (E.R.)
| | - Edda Russo
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (G.N.); (S.B.); (E.R.)
| | - Elisabetta Zucchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Ilaria Martinelli
- Neurology Unit, Department of Neuroscience, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy;
| | - Marta Menicatti
- Department of Neurosciences, Psychology, Drug Research and Child Health Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, 50139 Florence, Italy; (M.M.); (G.B.)
| | - Gianluca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, 50139 Florence, Italy; (M.M.); (G.B.)
| | - Jessica Mandrioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
- Neurology Unit, Department of Neuroscience, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy;
- Correspondence: (J.M.); (A.A.); Tel.: +39-0593961700 (J.M.); +39-0552758330 (A.A.)
| | - Amedeo Amedei
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (G.N.); (S.B.); (E.R.)
- Correspondence: (J.M.); (A.A.); Tel.: +39-0593961700 (J.M.); +39-0552758330 (A.A.)
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16
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Residential exposure to electromagnetic fields and risk of amyotrophic lateral sclerosis: a dose-response meta-analysis. Sci Rep 2021; 11:11939. [PMID: 34099747 PMCID: PMC8185090 DOI: 10.1038/s41598-021-91349-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/25/2021] [Indexed: 11/08/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is neurodegenerative disease characterized by a fatal prognosis and still unknown etiology. Some environmental risk factors have been suggested, including exposure to magnetic fields. Studies have suggested positive associations in occupationally-exposed populations, but the link with residential exposure is still debated as is the shape of such relation. Due to recent availability of advanced biostatistical tools for dose–response meta-analysis, we carried out a systematic review in order to assess the dose–response association between ALS and residential exposure to magnetic fields. We performed an online literature searching through April 30, 2021. Studies were included if they assessed residential exposure to electromagnetic fields, based either on distance from overhead power lines or on magnetic field modelling techniques, and if they reported risk estimates for ALS. We identified six eligible studies, four using distance-based and one modelling-based exposure assessment, and one both methods. Both distance-based and particularly modelling-based exposure estimates appeared to be associated with a decreased ALS risk in the highest exposure category, although estimates were very imprecise (summary RRs 0.87, 95% CI 0.63–1.20, and 0.27, 95% CI 0.05–1.36). Dose–response meta-analysis also showed little association between distance from power lines and ALS, with no evidence of any threshold. Overall, we found scant evidence of a positive association between residential magnetic fields exposure and ALS, although the available data were too limited to conduct a dose–response analysis for the modelled magnetic field estimates or to perform stratified analyses.
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17
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Filippini T, Mandrioli J, Malagoli C, Costanzini S, Cherubini A, Maffeis G, Vinceti M. Risk of Amyotrophic Lateral Sclerosis and Exposure to Particulate Matter from Vehicular Traffic: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030973. [PMID: 33499343 PMCID: PMC7908475 DOI: 10.3390/ijerph18030973] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/26/2022]
Abstract
(1) Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with still unknown etiology. Some occupational and environmental risk factors have been suggested, including long-term air pollutant exposure. We carried out a pilot case-control study in order to evaluate ALS risk due to particulate matter with a diameter of ≤10 µm (PM10) as a proxy of vehicular traffic exposure. (2) Methods: We recruited ALS patients and controls referred to the Modena Neurology ALS Care Center between 1994 and 2015. Using a geographical information system, we modeled PM10 concentrations due to traffic emissions at the geocoded residence address at the date of case diagnosis. We computed the odds ratio (OR) and 95% confidence interval (CI) of ALS according to increasing PM10 exposure, using an unconditional logistic regression model adjusted for age and sex. (3) Results: For the 132 study participants (52 cases and 80 controls), the average of annual median and maximum PM10 concentrations were 5.2 and 38.6 µg/m3, respectively. Using fixed cutpoints at 5, 10, and 20 of the annual median PM10 levels, and compared with exposure <5 µg/m3, we found no excess ALS risk at 5-10 µg/m3 (OR 0.87, 95% CI 0.39-1.96), 10-20 µg/m3 (0.94, 95% CI 0.24-3.70), and ≥20 µg/m3 (0.87, 95% CI 0.05-15.01). Based on maximum PM10 concentrations, we found a statistically unstable excess ALS risk for subjects exposed at 10-20 µg/m3 (OR 4.27, 95% CI 0.69-26.51) compared with those exposed <10 µg/m3. However, risk decreased at 20-50 µg/m3 (OR 1.49, 95% CI 0.39-5.75) and ≥50 µg/m3 (1.16, 95% CI 0.28-4.82). ALS risk in increasing tertiles of exposure showed a similar null association, while comparison between the highest and the three lowest quartiles lumped together showed little evidence for an excess risk at PM10 concentrations (OR 1.13, 95% CI 0.50-2.55). After restricting the analysis to subjects with stable residence, we found substantially similar results. (4) Conclusions: In this pilot study, we found limited evidence of an increased ALS risk due to long-term exposure at high PM10 concentration, though the high statistical imprecision of the risk estimates, due to the small sample size, particularly in some exposure categories, limited our capacity to detect small increases in risk, and further larger studies are needed to assess this relation.
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Affiliation(s)
- Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Carlotta Malagoli
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
| | - Sofia Costanzini
- DIEF Department of Engineering “Enzo Ferrari,” University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | | | | | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Correspondence:
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18
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Borg R, Farrugia Wismayer M, Bonavia K, Farrugia Wismayer A, Vella M, van Vugt JJFA, Kenna BJ, Kenna KP, Vassallo N, Veldink JH, Cauchi RJ. Genetic analysis of ALS cases in the isolated island population of Malta. Eur J Hum Genet 2021; 29:604-614. [PMID: 33414559 PMCID: PMC8115635 DOI: 10.1038/s41431-020-00767-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Genetic isolates are compelling tools for mapping genes of inherited disorders. The archipelago of Malta, a sovereign microstate in the south of Europe is home to a geographically and culturally isolated population. Here, we investigate the epidemiology and genetic profile of Maltese patients with amyotrophic lateral sclerosis (ALS), identified throughout a 2-year window. Cases were largely male (66.7%) with a predominant spinal onset of symptoms (70.8%). Disease onset occurred around mid-age (median age: 64 years, men; 59.5 years, female); 12.5% had familial ALS (fALS). Annual incidence rate was 2.48 (95% CI 1.59–3.68) per 100,000 person-years. Male-to-female incidence ratio was 1.93:1. Prevalence was 3.44 (95% CI 2.01–5.52) cases per 100,000 inhabitants on 31st December 2018. Whole-genome sequencing allowed us to determine rare DNA variants that change the protein-coding sequence of ALS-associated genes. Interestingly, the Maltese ALS patient cohort was found to be negative for deleterious variants in C9orf72, SOD1, TARDBP or FUS genes, which are the most commonly mutated ALS genes globally. Nonetheless, ALS-associated repeat expansions were identified in ATXN2 and NIPA1. Variants predicted to be damaging were also detected in ALS2, DAO, DCTN1, ERBB4, SETX, SCFD1 and SPG11. A total of 40% of patients with sporadic ALS had a rare and deleterious variant or repeat expansion in an ALS-associated gene, whilst the genetic cause of two thirds of fALS cases could not be pinpointed to known ALS genes or risk loci. This warrants further studies to elucidate novel genes that cause ALS in this unique population isolate.
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Affiliation(s)
- Rebecca Borg
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Maia Farrugia Wismayer
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Karl Bonavia
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
| | - Andrew Farrugia Wismayer
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta
| | - Malcolm Vella
- Department of Neuroscience, Mater Dei Hospital, Msida, Malta
| | - Joke J F A van Vugt
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brendan J Kenna
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kevin P Kenna
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Neville Vassallo
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jan H Veldink
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruben J Cauchi
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences Building, University of Malta, Msida, Malta. .,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
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19
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Filippini T, Tesauro M, Fiore M, Malagoli C, Consonni M, Violi F, Iacuzio L, Arcolin E, Oliveri Conti G, Cristaldi A, Zuccarello P, Zucchi E, Mazzini L, Pisano F, Gagliardi I, Patti F, Mandrioli J, Ferrante M, Vinceti M. Environmental and Occupational Risk Factors of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082882. [PMID: 32331298 PMCID: PMC7216189 DOI: 10.3390/ijerph17082882] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease with still unknown etiology. We aimed at investigating the association between environmental and occupational factors with ALS risk. Methods: We performed a population-based case-control study in four Italian provinces (Catania, Modena, Novara, and Reggio Emilia) by administration of tailored questionnaires to ALS cases (n = 95) and randomly selected population referents (n = 135). We estimated ALS risk by calculating the odds ratio (OR) with its 95% confidence interval (CI) using an unconditional logistic regression model. Results: We found a positive association with disease risk for history of occupation in the agricultural sector (OR = 2.09, 95% CI 0.79-7.54), especially for longer than 10 years (OR = 2.72, 95% 1.02-7.20). Overall occupational exposure to solvents also suggested a positive association, especially for thinners (OR = 2.27, 95% CI 1.14-4.54) and paint removers (OR = 2.01, 95% CI 0.90-4.48). Both occupational and environmental exposure to electromagnetic fields show a slightly increased risk with OR = 1.69 (95% CI 0.70-4.09) and 2.41 (95% CI 1.13-5.12), respectively. Occupational but not environmental exposure to pesticides (OR = 1.22, 95% CI 0.63-2.37), particularly fungicides, and exposure to metals (OR = 4.20, 95% CI 1.88-9.38), particularly lead, mercury, and selenium, showed an imprecise but positive association. Finally, there was an indication of increased risk for living in proximity to water bodies. Conclusions: Despite the caution that needs to be used due to some study limitations, such as the low number of exposed subjects and the possibility of recall bias, these results suggest the potential role of some environmental and occupational factors in ALS etiology.
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Affiliation(s)
- Tommaso Filippini
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Correspondence:
| | - Marina Tesauro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Maria Fiore
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Carlotta Malagoli
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
| | - Michela Consonni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Federica Violi
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Laura Iacuzio
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Department of Public Health, Local Health Unit, 41121 Modena, Italy
| | - Elisa Arcolin
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
| | - Gea Oliveri Conti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Antonio Cristaldi
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Pietro Zuccarello
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Elisabetta Zucchi
- Neurology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Letizia Mazzini
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Fabrizio Pisano
- Neurological Rehabilitation Division, Policlinico San Marco di Zingonia, 24046 Zingonia (BG), Italy;
| | - Ileana Gagliardi
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marco Vinceti
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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20
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Filippini T, Fiore M, Tesauro M, Malagoli C, Consonni M, Violi F, Arcolin E, Iacuzio L, Oliveri Conti G, Cristaldi A, Zuccarello P, Zucchi E, Mazzini L, Pisano F, Gagliardi I, Patti F, Mandrioli J, Ferrante M, Vinceti M. Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030857. [PMID: 32019087 PMCID: PMC7037077 DOI: 10.3390/ijerph17030857] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/26/2022]
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease of the motor neurons. The etiology of ALS remains largely unknown, particularly with reference to the potential environmental determinants. Methods: We performed a population-based case-control study in four provinces from both Northern and Southern Italy in order to assess non-genetic ALS risk factors by collecting through tailored questionnaires information about clinical and lifestyle factors. We estimated ALS risk by calculating odds ratio (OR) with its 95% confidence interval (CI) using unconditional logistic regression models adjusted for sex, age and educational attainment. Results: We recruited 230 participants (95 cases and 135 controls). We found a possible positive association of ALS risk with trauma, particularly head trauma (OR = 2.61, 95% CI 1.19–5.72), electric shock (OR = 2.09, 95% CI 0.62–7.06), and some sports, although at a competitive level only. In addition, our results suggest an increased risk for subjects reporting use of private wells for drinking water (OR = 1.38, 95% CI 0.73–2.27) and for use of herbicides during gardening (OR = 1.95, 95% CI 0.88–2.27). Conversely, there was a suggestion of an inverse association with overall fish consumption (OR = 0.27, 95% CI 0.12–0.60), but with no dose-response relation. Consumption of some dietary supplements, namely those containing amino acids and, in the Southern Italy population, vitamins and minerals such as selenium, seemed associated with a statistically imprecise increased risk. Conclusions: Our results suggest a potential etiologic role a number of clinical and lifestyle factors with ALS risk. However, caution is needed due to some study limitations. These include the small sample size and the low number of exposed subjects, which affect statistical precision of risk estimates, the potential for exposure misclassification, and the uncertainties about mechanisms underpinning the possible association between these factors and disease risk.
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Affiliation(s)
- Tommaso Filippini
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Maria Fiore
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marina Tesauro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Carlotta Malagoli
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
| | - Michela Consonni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Federica Violi
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Elisa Arcolin
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
| | - Laura Iacuzio
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Department of Public Health, Local Health Unit, 41121 Modena, Italy
| | - Gea Oliveri Conti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Antonio Cristaldi
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Pietro Zuccarello
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Elisabetta Zucchi
- Neurology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Letizia Mazzini
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Fabrizio Pisano
- Neurological Rehabilitation Division, Policlinico San Marco di Zingonia, 24046 Zingonia (BG), Italy;
| | - Ileana Gagliardi
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marco Vinceti
- CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.); (F.V.); (E.A.); (L.I.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Correspondence:
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Vinceti M, Filippini T, Malagoli C, Violi F, Mandrioli J, Consonni D, Rothman KJ, Wise LA. Amyotrophic lateral sclerosis incidence following exposure to inorganic selenium in drinking water: A long-term follow-up. ENVIRONMENTAL RESEARCH 2019; 179:108742. [PMID: 31629180 DOI: 10.1016/j.envres.2019.108742] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 06/10/2023]
Abstract
Some studies have reported an association between overexposure to selenium and risk of amyotrophic lateral sclerosis (ALS), a rare degenerative disease of motor neurons. From 1986 through 2015, we followed a cohort in Northern Italy that had been inadvertently consuming tap water with unusually high concentrations of inorganic hexavalent selenium from 1974 to 1985. We had previously documented an excess incidence of ALS in this cohort during 1986-1994. Here, we report extended follow-up of the cohort for an additional 21 years, encompassing 50,100 person-years of the exposed cohort and 2,233,963 person-years of the unexposed municipal cohort. We identified 7 and 112 incident ALS cases in the exposed and unexposed cohorts, respectively, yielding crude incidence rates of 14 and 5 cases per 100,000 person-years. A Poisson regression analysis, adjusting for age, sex and calendar year, produced an overall incidence rate ratio (IRR) for ALS of 2.8 (95% confidence interval (CI) 1.3, 6), with a substantially stronger IRR in 1986-1994 (8.2, 95% CI 2.7, 24.7) than in 1995-2015 (1.5, 95% CI 0.5, 4.7), and among women (5.1, 95% CI 1.8, 14.3) than men (1.7, 95% CI 0.5, 5.4). Overall, these results indicate an association between high exposure to inorganic selenium, a recognized neurotoxicant, and ALS incidence, with declining rates after cessation of exposure and stronger effects among women.
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Affiliation(s)
- Marco Vinceti
- CREAGEN - Research Center of Environmental, Genetic and Nutritional Epidemiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Medical School, Via Campi 287, 41125, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, United States.
| | - Tommaso Filippini
- CREAGEN - Research Center of Environmental, Genetic and Nutritional Epidemiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Medical School, Via Campi 287, 41125, Modena, Italy
| | - Carlotta Malagoli
- CREAGEN - Research Center of Environmental, Genetic and Nutritional Epidemiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Medical School, Via Campi 287, 41125, Modena, Italy
| | - Federica Violi
- CREAGEN - Research Center of Environmental, Genetic and Nutritional Epidemiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Medical School, Via Campi 287, 41125, Modena, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, St. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, United States
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, United States
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Palese F, Sartori A, Logroscino G, Pisa FE. Predictors of diagnostic delay in amyotrophic lateral sclerosis: a cohort study based on administrative and electronic medical records data. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:176-185. [PMID: 30656971 DOI: 10.1080/21678421.2018.1550517] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: To characterize the timing and pathway of amyotrophic lateral sclerosis (ALS) diagnosis and to identify predictors of delayed diagnosis in a retrospective cohort. Methods: The cohort included all patients with incident ALS between 2010 and 2014 in Friuli-Venezia Giulia (FVG) region, Italy, admitted to two University Hospitals. Information on demographics, clinical presentation, and healthcare use was obtained from health databases and electronic medical records (EMRs). Total diagnostic time (TDT), the interval between ALS symptoms onset and diagnosis, was compared between patient groups through Wilcoxon-Mann-Whitney test. The adjusted odds ratio (aOR), with 95% confidence interval (95% CI), of having a TDT ≥12 months was estimated using unconditional logistic regression. Results: Among 134 patients, median TDT (interquartile range [IQR]) was 11.5 months (7.1-18.3), shorter in those aged <60 years vs. ≥60 years (8.1; 5.1-11.1 vs. 12.4; 7.4-21.5; p = 0.0064), first referred to a neurologist vs. other specialist (10.2; 6.1-16.3 vs. 13.2; 8.1-24.5; p = 0.0386) and without neurologic comorbidities (11.1; 7.1-16.5 vs. 19.7; 8.8-33.7; p = 0.0243). TDT was ≥12 months in 64 (48.5%) patients and was predicted by male sex (aOR: 2.47; 95% CI: 1.06-5.75), age at onset ≥60 years (11.46; 3.13-41.9), spinal onset (2.04; 1.00-5.93), and prior therapies or first referral to a non-neurologist (3.15; 1.36-7.29). Conclusions: In this cohort, delayed diagnosis was common, particularly in older patients and in those with neurological comorbidities. Timely referral to a neurologist may improve diagnostic timing.
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Affiliation(s)
| | - Arianna Sartori
- b Department of Medical, Surgical and Health Sciences, Neurology Clinic , Azienda Sanitaria Universitaria Integrata di Trieste , Trieste , Italy
| | - Giancarlo Logroscino
- c Neurodegenerative Diseases Unit, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari , Bari , Italy.,d Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico", Tricase, Lecce , Italy
| | - Federica Edith Pisa
- e Leibniz Institute for Prevention Research and Epidemiology-BIPS , Bremen , Germany
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23
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Palese F, Sartori A, Verriello L, Ros S, Passadore P, Manganotti P, Barbone F, Pisa FE. Epidemiology of amyotrophic lateral sclerosis in Friuli-Venezia Giulia, North-Eastern Italy, 2002-2014: a retrospective population-based study. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:90-99. [PMID: 30430867 DOI: 10.1080/21678421.2018.1511732] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the epidemiology of Amyotrophic Lateral Sclerosis (ALS) in Friuli-Venezia Giulia (FVG) region, Italy, over a 13-year period (2002-2014), estimating ALS (a) incidence, prevalence, and clinical features; (b) mortality, also comparing Udine municipality to the rest of FVG. METHODS We conducted a retrospective population-based study. ALS incident cases were ascertained using multiple sources and validated through expert review. We calculated crude and standardized incidence rate (IR), point prevalence and mortality rate (MR), each with 95% confidence interval. Standardized incidence (SIR) and mortality (SMR) ratio were calculated to compare Udine to FVG. RESULTS Among 444 incident cases (50.0% men, median age 68.5 years), onset was bulbar in 30.2%, spinal in 59.9%, mixed in 9.9%; 3.6% had familial ALS. Crude and 2000 European population standardized IR was respectively 2.81 (2.56-3.09) and 2.09 (1.89-2.29) per 100,000 person-years. Standardized male-to-female incidence ratio was 1.05. IR peaked at age 65-74 years (men: 9.93, 8.04-12.32; women: 7.74, 6.18-9.67) and decreased thereafter. Prevalence was 8.36 (6.74-9.97) cases per 100,000 inhabitants on 30 June 2009 and 7.98 (6.40-9.56) on 30 June 2014. SIR was 1.20 and SMR 1.11. CONCLUSIONS When assessed over a long period, incidence of ALS was in the range of Italian and European population-based registries and showed a consistent pattern by age and sex. IR and MR were only slightly higher in Udine vs. FVG.
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Affiliation(s)
| | - Arianna Sartori
- b Neurologic Clinic, Department of Medical, Surgical and Health Sciences , Azienda Sanitaria Universitaria Integrata di Trieste, University Hospital of Trieste , Trieste , Italy
| | - Lorenzo Verriello
- c Neurologic Clinic, Department of Neurological Sciences , Azienda Sanitaria Universitaria Integrata di Udine , Udine , Italy
| | - Silvia Ros
- d Neurologic Clinic , Hospital of Gorizia , Gorizia , Italy
| | - Paolo Passadore
- e Neurologic Clinic , Hospital of Pordenone , Pordenone , Italy
| | - Paolo Manganotti
- b Neurologic Clinic, Department of Medical, Surgical and Health Sciences , Azienda Sanitaria Universitaria Integrata di Trieste, University Hospital of Trieste , Trieste , Italy
| | - Fabio Barbone
- a Medical Area Department , University of Udine , Udine , Italy
| | - Federica Edith Pisa
- a Medical Area Department , University of Udine , Udine , Italy.,f Leibniz Institute for Prevention Research and Epidemiology - BIPS , Bremen , Germany.,g Institute of Hygiene and Clinical Epidemiology , University Hospital of Udine , Udine , Italy
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24
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Age-specific ALS incidence: a dose-response meta-analysis. Eur J Epidemiol 2018; 33:621-634. [PMID: 29687175 DOI: 10.1007/s10654-018-0392-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/02/2018] [Indexed: 12/12/2022]
Abstract
To evaluate the association between worldwide ALS incidence rates and age, using a dose-response meta-analysis. We reviewed Medline and Embase up to July 2016 and included all population-based studies of newly-diagnosed cases, using multiple sources for case ascertainment. A dose-response meta-analysis was performed. A meta-regression investigated potential sources of heterogeneity. Of 3254 articles identified in the literature, we included 41 incidence studies covering 42 geographical areas. Overall, the fit between observed and predicted age-specific rates was very good. The expected variation of ALS incidence with age was characterized, in each study, by a progressive increase in the incidence from the 40s leading to a peak in the 60s or 70s, followed by a sharp decrease. Cochran's Q test suggested a significant heterogeneity between studies. Overall, estimated patterns of ALS age-specific incidence (at which the peak was reached) were similar among subcontinents of Europe and North America: peak of ALS incidence ranged in these areas between 6.98 and 8.17/100,000 PYFU, which referred to age in the range 71.6-77.4 years. The relationship between age and ALS incidence appeared different for Eastern Asia which was characterized by a peak of ALS incidence at 2.20/100,000 PYFU around 75 years of age. This study confirms the consistency of the age-specific ALS incidence pattern within different subcontinents. Age-specific incidence appears lower in Eastern Asia as compared to Europe and North America.
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25
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Logroscino G, Marin B, Piccininni M, Arcuti S, Chiò A, Hardiman O, Rooney J, Zoccolella S, Couratier P, Preux PM, Beghi E. Referral bias in ALS epidemiological studies. PLoS One 2018; 13:e0195821. [PMID: 29659621 PMCID: PMC5901916 DOI: 10.1371/journal.pone.0195821] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 03/31/2018] [Indexed: 02/06/2023] Open
Abstract
Background Despite concerns about the representativeness of patients from ALS tertiary centers as compared to the ALS general population, the extent of referral bias in clinical studies remains largely unknown. Using data from EURALS consortium we aimed to assess nature, extent and impact of referral bias. Methods Four European ALS population-based registries located in Ireland, Piedmont, Puglia, Italy, and Limousin, France, covering 50 million person-years, participated. Demographic and clinic characteristics of ALS patients diagnosed in tertiary referral centers were contrasted with the whole ALS populations enrolled in registries in the same geographical areas. Results Patients referred to ALS centers were younger (with difference ranging from 1.1 years to 2.4 years), less likely to present a bulbar onset, with a higher proportion of familial antecedents and a longer survival (ranging from 11% to 15%) when compared to the entire ALS population in the same geographic area. Conclusions A trend for referral bias is present in cohorts drawn from ALS referral centers. The magnitude of the possible referral bias in a particular tertiary center can be estimated through a comparison with ALS patients drawn from registry in the same geographic area. Studies based on clinical cohorts should be cautiously interpreted. The presence of a registry in the same area may improve the complete ascertainment in the referral center.
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Grants
- Health Research Programme Clinical Fellowship Programme
- Health Research Board Clinician Scientist Programme
- Novarits, Biogen Idec, Sanofi Aventis, Merck-Serono, Allergen, Ono Pharmaceuticals, Novartis, Cytokinetics, Sanofi Aventis
- Euro-MOTOR FP7/2007-2013
- Motor Neurone Disease Association, ALS Association, National Institute for Health Research, European Commission, Medical Research Council and Economic and Social Research Council, Italian Ministry of Health (Ricerca Finalizzata), University of Turin, and Fondazione Vialli e Mauro onlus.
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Affiliation(s)
- Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, at “Pia Fondazione Cardinale G. Panico“, Tricase, Lecce, Italy
- * E-mail:
| | - Benoit Marin
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, at “Pia Fondazione Cardinale G. Panico“, Tricase, Lecce, Italy
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
- Laboratorio di Malattie Neurologiche, Dipartimento di Neuroscienze, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Marco Piccininni
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, at “Pia Fondazione Cardinale G. Panico“, Tricase, Lecce, Italy
| | - Simona Arcuti
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, at “Pia Fondazione Cardinale G. Panico“, Tricase, Lecce, Italy
| | - Adriano Chiò
- ALS Center, Department of Neuroscience, University of Turin, Turin, Italy
- Neuroscience Institute of Turin (NIT), Turin, Italy
- Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy
| | - Orla Hardiman
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin, Dublin, Ireland
| | - James Rooney
- Academic Unit of Neurology Trinity Biomedical Sciences Institute Trinity College Dublin, Dublin, Ireland
| | - Stefano Zoccolella
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Philippe Couratier
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- CHU Limoges, Service de Neurologie, Centre expert SLA, Limoges, France
| | - Pierre-Marie Preux
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, at “Pia Fondazione Cardinale G. Panico“, Tricase, Lecce, Italy
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Ettore Beghi
- Laboratorio di Malattie Neurologiche, Dipartimento di Neuroscienze, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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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: 124] [Impact Index Per Article: 20.7] [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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Riluzole and other prognostic factors in ALS: a population-based registry study in Italy. J Neurol 2018; 265:817-827. [PMID: 29404735 DOI: 10.1007/s00415-018-8778-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE In this prospective population-based registry study on ALS survival, we investigated the role of riluzole treatment, together with other clinical factors, on the prognosis in incident ALS cases in Emilia Romagna Region (ERR), Italy. METHODS A registry for ALS has been collecting all incident cases in ERR since 2009. Detailed clinical data from all patients diagnosed with ALS between 1.1.2009 and 31.12.2014 have been analyzed for this study, with last follow up date set at 31.12.2015. RESULTS During the 6 years of the study, there were 681 incident cases with a median tracheostomy-free survival of 40 months (95% CI 36-44) from onset and of 26 months (95% CI 24-30) from diagnosis; 573 patients (84.14%) were treated with riluzole, 207 (30.39%) patients underwent gastrostomy, 246 (36.12%) non invasive ventilation, and 103 (15.15%) invasive ventilation. Patients who took treatment for ≥ 75% of disease duration from diagnosis had a median survival of 29 months compared to 18 months in patients with < 75% treatment duration. In multivariable analysis, factors independently influencing survival were age at onset (HR 1.04, 95% CI 1.02-1.05, p < 0.001), dementia (HR 1.56, 95% CI 1.05-2.32, p = 0.027), degree of diagnostic certainty (HR 0.88, 95% CI 0.78-0.98, p = 0.021), gastrostomy (HR 1.46, 95% CI 1.14-1.88, p = 0.003), NIV (HR 1.43, 95% CI 1.12-1.82, p = 0.004), and weight loss at diagnosis (HR 1.05, 95% CI 1.03-1.07, p < 0.001), diagnostic delay (HR 0.98, 95% CI 0.97-0.99, p = 0.004), and % treatment duration (HR 0.98, 95% CI 0.98-0.99, p < 0.001). CONCLUSIONS Independently from other prognostic factors, patients who received riluzole for a longer period of time survived longer, but further population based studies are needed to verify if long-tem use of riluzole prolongs survival.
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28
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Changes in routine laboratory tests and survival in amyotrophic lateral sclerosis. Neurol Sci 2017; 38:2177-2182. [DOI: 10.1007/s10072-017-3138-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/26/2017] [Indexed: 12/22/2022]
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29
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Vinceti M, Filippini T, Violi F, Rothman KJ, Costanzini S, Malagoli C, Wise LA, Odone A, Signorelli C, Iacuzio L, Arcolin E, Mandrioli J, Fini N, Patti F, Lo Fermo S, Pietrini V, Teggi S, Ghermandi G, Scillieri R, Ledda C, Mauceri C, Sciacca S, Fiore M, Ferrante M. Pesticide exposure assessed through agricultural crop proximity and risk of amyotrophic lateral sclerosis. Environ Health 2017; 16:91. [PMID: 28851431 PMCID: PMC5576246 DOI: 10.1186/s12940-017-0297-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 08/14/2017] [Indexed: 05/31/2023]
Abstract
BACKGROUND Epidemiologic studies have raised the possibility that some pesticide compounds induce the neurodegenerative disease amyotrophic lateral sclerosis (ALS), though the available evidence is not entirely consistent. METHODS We conducted a population-based case-control study in two Italian populations to assess the extent to which residence in the vicinity of agricultural crops associated with the application of neurotoxic pesticides is a risk factor for ALS, using crop acreage in proximity to the residence as an index of exposure. RESULTS Based on 703 cases and 2737 controls, we computed an ALS odds ratio of 0.92 (95% confidence interval 0.78-1.09) for those in proximity to agricultural land. Results were not substantially different when using alternative exposure categories or when analyzing specific crop types, with the exception of a higher risk related to exposure to citrus orchards and olive groves in Southern Italy, though based on few exposed subjects (N = 89 and 8, respectively). There was little evidence of any dose-response relation between crop proximity and ALS risk, and using long-term residence instead of current residence did not substantially change our estimates. CONCLUSIONS Though our index of exposure is indirect and subject to considerable misclassification, our results offer little support for the hypothesis that neurotoxic pesticide exposure increases ALS risk.
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Affiliation(s)
- Marco Vinceti
- Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 287 Via Campi, 41125 Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Tommaso Filippini
- Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 287 Via Campi, 41125 Modena, Italy
| | - Federica Violi
- Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 287 Via Campi, 41125 Modena, Italy
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
- Research Triangle Institute, Research Triangle Park, 3040 E Cornwallis Road, Durham, NC 27709 USA
| | - Sofia Costanzini
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, 10 Via Vivarelli, 41125 Modena, Italy
| | - Carlotta Malagoli
- Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 287 Via Campi, 41125 Modena, Italy
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Anna Odone
- Department of Biomedical, Biotechnological, and Translational Sciences, University of Parma, 14 Via Gramsci, 43126 Parma, Italy
| | - Carlo Signorelli
- Department of Biomedical, Biotechnological, and Translational Sciences, University of Parma, 14 Via Gramsci, 43126 Parma, Italy
- School of Medicine, University Vita-Salute San Raffaele, 58 Via Olgettina Milano, 20132 Milan, Italy
| | - Laura Iacuzio
- Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 287 Via Campi, 41125 Modena, Italy
| | - Elisa Arcolin
- Environmental, Genetic, and Nutritional Epidemiology Research Center - CREAGEN, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 287 Via Campi, 41125 Modena, Italy
| | - Jessica Mandrioli
- Department of Neuroscience, S. Agostino-Estense Hospital, and University of Modena and Reggio Emilia, 1355 Via Pietro Giardini, 41126 Modena, Italy
| | - Nicola Fini
- Department of Neuroscience, S. Agostino-Estense Hospital, and University of Modena and Reggio Emilia, 1355 Via Pietro Giardini, 41126 Modena, Italy
| | - Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 87 Via S. Sofia, 95123 Catania, Italy
| | - Salvatore Lo Fermo
- Neurologic Unit, AOU Policlinico - Vittorio Emanuele, University of Catania, 628 Via Plebiscito, 95124 Catania, Italy
| | - Vladimiro Pietrini
- Department of Neuroscience, Neurology Unit, University of Parma, 14 Via Gramsci, 43126 Parma, Italy
| | - Sergio Teggi
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, 10 Via Vivarelli, 41125 Modena, Italy
| | - Grazia Ghermandi
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, 10 Via Vivarelli, 41125 Modena, Italy
| | - Renato Scillieri
- Department of Prevention, Catania Local Health Unit, 5 Via Santa Maria la Grande, 95124 Catania, Italy
| | - Caterina Ledda
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 87 Via S. Sofia, 95123 Catania, Italy
| | - Cristina Mauceri
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 87 Via S. Sofia, 95123 Catania, Italy
| | - Salvatore Sciacca
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 87 Via S. Sofia, 95123 Catania, Italy
| | - Maria Fiore
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 87 Via S. Sofia, 95123 Catania, Italy
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 87 Via S. Sofia, 95123 Catania, Italy
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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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Govoni V, Della Coletta E, Cesnik E, Casetta I, Granieri E. Can the age at onset give a clue to the pathogenesis of ALS? Acta Neurol Belg 2017; 117:221-227. [PMID: 27761793 DOI: 10.1007/s13760-016-0704-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/27/2016] [Indexed: 12/11/2022]
Abstract
Pathogenesis could play an important role in the mid- to late-life onset of symptoms in amyotrophic lateral sclerosis (ALS). An analysis of the age at onset of ALS among the incident cases occurring in the population in the Health District of Ferrara, Italy, in the period 1064-2009 was carried out. Two subsequent 23-year time intervals (1964-1986 and 1987-2009) were considered. The mean age at onset (MAAO) was estimated in relation to gender, onset type and area of residence (urban or extra-urban) at disease onset among the incident cases which occurred in the two subsequent time intervals. An uneven increase in the MAAO over time was observed as it was significant only among the female cases (from 56.7 95 % CI 51.6-61.7 years to 65.4 95 % CI 61.8-69.0 years), the overall bulbar onset cases (from 58.0 95 % CI 54.0-62.1 years to 69.3 95 % CI 66.2-72.4 years), the overall cases occurring in the extra-urban population (from 54.5 95 % CI 49.0-60.1 years to 65.1 95 % CI 60.4-69.8 years) and the bulbar onset cases occurring in the extra-urban population (from 57.1 95 % CI 53.5-60.7 years to 69.6 95 % CI 66.3-73.7 years). Although the increasing age of the population combined with improvements in ALS diagnosis among the elderly may have played a part, these uneven findings among the incident cases occurring in a well-defined homogeneous population with a stable ALS incidence would seem to suggest the involvement of risk factors associated with the extra-urban environment.
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Affiliation(s)
- Vittorio Govoni
- Neurological Clinic, biomedical and specialized surgery sciences department of the University of Ferrara, Ferrara, Italy.
- Sant' Anna Hospital, Clinica Neurologica, Via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Elena Della Coletta
- Neurological Clinic, biomedical and specialized surgery sciences department of the University of Ferrara, Ferrara, Italy
| | - Edward Cesnik
- Neurology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Ilaria Casetta
- Neurological Clinic, biomedical and specialized surgery sciences department of the University of Ferrara, Ferrara, Italy
| | - Enrico Granieri
- Neurological Clinic, biomedical and specialized surgery sciences department of the University of Ferrara, Ferrara, Italy
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32
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Tesauro M, Consonni M, Filippini T, Mazzini L, Pisano F, Chiò A, Esposito A, Vinceti M. Incidence of amyotrophic lateral sclerosis in the province of Novara, Italy, and possible role of environmental pollution. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:284-290. [PMID: 28152620 DOI: 10.1080/21678421.2017.1281961] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE AND METHODS Based on nationwide death certificates, a cluster of amyotrophic lateral sclerosis (ALS) has been reported in the area of Briga (Novara province, northern Italy), known for its severe environmental contamination. We further investigated this finding, by following up with the collection of recent incidence ALS data in 2002-2012 of Novara province, also to assess the possible long-term effects of environmental pollution in that area. RESULTS In the whole Novara province we identified 106 ALS cases, of which 35 were from the Briga area. Incidence rates of Novara province were 3.98, 5.14 and 2.97 for the total population, males and females, respectively, compared with the Briga area where they were 4.65, 4.27 and 4.98, respectively. The ratio of observed-to-expected ALS cases in the Briga area, using incidence of the rest of Novara province as a reference, was 1.17 (95% CI 0.81-1.62), with a value of 0.83 (95% CI 0.47-1.37) in males and 1.68 (95% CI 1.03-2.60) in females. CONCLUSIONS Overall, our study did not confirm previous findings of an excess ALS incidence in an area characterised by severe environmental heavy metal pollution, and it suggests the need to interpret with caution clusters identified through mortality data.
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Affiliation(s)
- Marina Tesauro
- a Department of Biomedical, Surgical and Dental Sciences , University of Milan , Italy
| | - Michela Consonni
- a Department of Biomedical, Surgical and Dental Sciences , University of Milan , Italy
| | - Tommaso Filippini
- b Environmental, Genetic, and Nutritional Epidemiology Research Center-CREAGEN, Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy
| | - Letizia Mazzini
- c Department of Neurology , ALS Center, Azienda Ospedaliero Universitaria Maggiore della Carità , Novara , Italy
| | - Fabrizio Pisano
- d ICS Maugeri , Scientific Institute of Veruno (NO) , Veruno , Italy
| | - Adriano Chiò
- e Rita Levi Montalcini Department of Neuroscience , ALS Center, University of Turin , Turin , Italy , and
| | - Aniello Esposito
- f Hygiene and Public Health Service , ASL Novara , Novara , Italy
| | - Marco Vinceti
- b Environmental, Genetic, and Nutritional Epidemiology Research Center-CREAGEN, Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy
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Fasano A, Fini N, Ferraro D, Ferri L, Vinceti M, Mandrioli J. Percutaneous endoscopic gastrostomy, body weight loss and survival in amyotrophic lateral sclerosis: a population-based registry study. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:233-242. [DOI: 10.1080/21678421.2016.1270325] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Fasano
- Department of Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy, and
| | - Nicola Fini
- Department of Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy, and
| | - Diana Ferraro
- Department of Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy, and
| | - Laura Ferri
- Department of Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy, and
| | - Marco Vinceti
- CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy, and
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Amyotrophic lateral sclerosis and myasthenia gravis: association or chance occurrence? Neurol Sci 2016; 38:441-444. [PMID: 27913903 DOI: 10.1007/s10072-016-2787-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/28/2016] [Indexed: 12/14/2022]
Abstract
Very few cases of patients with myasthenia gravis (MG) who later developed amyotrophic lateral sclerosis (ALS) have been described, although some studies showed that significantly more cases than expected have ALS associated with a prior diagnosis of autoimmune diseases. Our aim was to investigate whether the association of ALS and MG was higher than expected in a population-based study and to describe the clinical features characterizing these patients. In Emilia Romagna Region of Italy, a prospective registry has been collecting all incident ALS cases since 1.1.2009. For each patient, detailed clinical information is collected by caring physicians, including comorbidities. From 1.1.2009 to 31.12.2014, 671 patients were diagnosed with ALS; five patients (0.75%) were also affected by MG. Considering Western Countries incidence rates the occurrence of both the diseases should be a really exceptional event (7.5/109), compared to our findings (1.87/107) (p < 0.01). Patients with ALS and MG had more frequently a bulbar onset and a fast progressive course. These cases of ALS after MG raise the possibility of potential shared immunological dysfunctions, which may be expression of common pathogenic mechanisms, as well as of shared disease-course modulating events.
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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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Scialò C, Novi G, Bandettini di Poggio M, Canosa A, Sormani MP, Mandich P, Origone P, Truffelli R, Mancardi GL, Caponnetto C. Clinical epidemiology of amyotrophic lateral sclerosis in Liguria, Italy: An update of LIGALS register. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:535-542. [DOI: 10.1080/21678421.2016.1197942] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Carlo Scialò
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova,
| | - Giovanni Novi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova,
| | - Monica Bandettini di Poggio
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova,
| | - Antonio Canosa
- ALS Centre ‘Rita Levi Montalcini’ Department of Neuroscience, University of Torino, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova,
| | - Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genova, IRCCS AOU San Martino-IST, Genova, and
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova,
| | - Paola Origone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova,
| | - Romina Truffelli
- Fondazioni Serena ONLUS, ‘La Colletta’ Hospital, Service of Rehabilitation of Neuromuscular Diseases, Arenzano, Genova, Italy
| | - Giovanni Luigi Mancardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova,
| | - Claudia Caponnetto
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, IRCCS AOU San Martino-IST, Genova,
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Ferraro D, Consonni D, Fini N, Fasano A, Del Giovane C, Mandrioli J. Amyotrophic lateral sclerosis: a comparison of two staging systems in a population-based study. Eur J Neurol 2016; 23:1426-32. [DOI: 10.1111/ene.13053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/21/2016] [Indexed: 12/13/2022]
Affiliation(s)
- D. Ferraro
- Department of Biomedical Metabolic and Neurosciences; Nuovo Ospedale Civile S. Agostino Estense; University of Modena and Reggio Emilia; Modena
| | - D. Consonni
- Epidemiology Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan
| | - N. Fini
- Department of Biomedical Metabolic and Neurosciences; Nuovo Ospedale Civile S. Agostino Estense; University of Modena and Reggio Emilia; Modena
| | - A. Fasano
- Department of Biomedical Metabolic and Neurosciences; Nuovo Ospedale Civile S. Agostino Estense; University of Modena and Reggio Emilia; Modena
| | - C. Del Giovane
- Department of Diagnostic and Clinical Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
| | - J. Mandrioli
- Department of Biomedical Metabolic and Neurosciences; Nuovo Ospedale Civile S. Agostino Estense; University of Modena and Reggio Emilia; Modena
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Stratification of ALS patients' survival: a population-based study. J Neurol 2015; 263:100-11. [PMID: 26518423 DOI: 10.1007/s00415-015-7940-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/09/2015] [Accepted: 10/10/2015] [Indexed: 10/22/2022]
Abstract
The natural history of amyotrophic lateral sclerosis (ALS) and patient risk stratification are areas of considerable research interest. We aimed (1) to describe the survival of a representative cohort of French ALS patients, and (2) to identify covariates associated with various patterns of survival using a risk classification analysis. ALS patients recruited in the FRALim register (2000-2013) were included. Time-to-death analyses were performed using Kaplan-Meier method and Cox model. A recursive partitioning and amalgamation (RECPAM) algorithm analysis identified subgroups of patients with different patterns of survival. Among 322 patients, median survival times were 26.2 and 15.6 months from time of onset and of diagnosis, respectively. Four groups of patients were identified, depending on their baseline characteristics and survival (1) ALSFRS-R slope >0.46/month and definite or probable ALS (median survival time (MST) 10.6 months); (2) ALSFRS-R slope >0.46/month and possible or probable laboratory-supported ALS (MST: 18.1 months); (3) ALSFRS-R slope ≤0.46/month and definite or probable ALS (MST: 22.5 months), and (4) ALSFRS-R slope ≤0.46/month and possible or probable laboratory-supported ALS (MST: 37.6 months). Median survival time is among the shortest ever reported by a worldwide population-based study. This is probably related to the age structure of the patients (the oldest identified to date), driven by the underlying population (30 % of subjects older than 60 years). Further research in the field of risk stratification could help physicians better anticipate prognosis of ALS patients, and help improve the design of randomized controlled trials.
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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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Mandrioli J, Biguzzi S, Guidi C, Sette E, Terlizzi E, Ravasio A, Casmiro M, Salvi F, Liguori R, Rizzi R, Pietrini V, Borghi A, Rinaldi R, Fini N, Chierici E, Santangelo M, Granieri E, Mussuto V, De Pasqua S, Georgoulopoulou E, Fasano A, Ferro S, D'Alessandro R. Heterogeneity in ALSFRS-R decline and survival: a population-based study in Italy. Neurol Sci 2015. [PMID: 26205535 DOI: 10.1007/s10072-015-2343-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Very few studies examined trend over time of the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and factors influencing it; previous studies, then, included only patients attending tertiary ALS Centres. We studied ALSFRS-R decline, factors influencing this trend and survival in a population-based setting. From 2009 onwards, a prospective registry records all incident ALS cases among residents in Emilia Romagna (population: 4.4 million). For each patient, demographic and clinical details (including ALSFRS-R) are collected by caring physicians at each follow-up. Analysis was performed on 402 incident cases (1279 ALSFRS-R assessments). The average decline of the ALSFRS-R was 0.60 points/month during the first year after diagnosis and 0.34 points/month in the second year. ALSFRS-R decline was heterogeneous among subgroups. Repeated measures mixed model showed that ALSFRS-R score decline was influenced by age at onset (p < 0.01), phenotype (p = 0.01), body mass index (BMI) (p < 0.01), progression rate at diagnosis (ΔFS) (p < 0.01), El Escorial Criteria-Revised (p < 0.01), and FVC% at diagnosis (p < 0.01). Among these factors, at multivariate analysis, only age, site of onset and ΔFS independently influenced survival. In this first population-based study on ALSFRS-R trend, we confirm that ALSFRS-R decline is not homogeneous among ALS patients and during the disease. Factors influencing ALSFRS-R decline may not match with those affecting survival. These disease modifiers should be taken into consideration for trials design and in clinical practice during discussions with patients on prognosis.
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Affiliation(s)
- Jessica Mandrioli
- Department of Neuroscience, St. Agostino-Estense Hospital, Via Pietro Giardini n. 1355, 41100, Modena, Italy.
| | - Sara Biguzzi
- Department of Neurology, Bufalini Hospital, Cesena, Italy
| | - Carlo Guidi
- Department of Neurology, Forlì Hospital, Forlì, Italy
| | | | - Emilio Terlizzi
- Department of Neurology, G. Da Saliceto Hospital, Piacenza, Italy
| | | | - Mario Casmiro
- Department of Neurology, Faenza and Ravenna Hospital, Ravenna, Italy
| | - Fabrizio Salvi
- Neurology Unit, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Romana Rizzi
- Department of Neurology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Vladimiro Pietrini
- Department of Neuroscience, Neurology Unit, University of Parma, Parma, Italy
| | - Annamaria Borghi
- Neurology Unit, Maggiore Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rita Rinaldi
- Department of Neuroscience, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Nicola Fini
- Department of Neuroscience, St. Agostino-Estense Hospital, Via Pietro Giardini n. 1355, 41100, Modena, Italy
| | | | | | - Enrico Granieri
- Department of Neuroscience, University of Ferrara, Ferrara, Italy
| | | | - Silvia De Pasqua
- Department of Biomedical and Neuromotor Sciences, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Eleni Georgoulopoulou
- Department of Neuroscience, St. Agostino-Estense Hospital, Via Pietro Giardini n. 1355, 41100, Modena, Italy
| | - Antonio Fasano
- Department of Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore Ferro
- Department of Hospital Services, Emilia Romagna Regional Health Authority, Bologna, Italy
| | - Roberto D'Alessandro
- Neuroepidemiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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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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Franchignoni F, Mandrioli J, Giordano A, Ferro S. A further Rasch study confirms that ALSFRS-R does not conform to fundamental measurement requirements. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:331-7. [PMID: 25916346 DOI: 10.3109/21678421.2015.1026829] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Our objective was to verify and expand previous evidence of psychometric inadequacies in the ALSFRS-R, in a different sample of subjects suffering from ALS. Since 2009, a prospective registry records all incident cases of ALS in Emilia Romagna Region, Italy (4.4 million inhabitants) referred to its 17 neurological departments. For each patient, demographic and clinical information is collected by the physician in charge, including compilation of the ALSFRS-R at each clinical follow-up. Results showed that a confirmatory factor analysis on the three-factor model previously found (bulbar, motor, respiratory function) showed a good fit. Rasch analysis on the whole scale showed the need to collapse some rating categories, confirmed the multidimensionality of the ALSFRS-R, and demonstrated the presence of differential item functioning between patients with spinal versus bulbar onset. Moreover, some items included in the three ALSFRS-R subscales showed a problematic fit to the respective construct they were intended to measure. In conclusion, the interpretation of a total raw score of ALSFRS-R is hampered by ambiguities due to the different metric properties of the three domains the scale aggregates, and their content and structure. This study confirms that a refinement of ALSFRS-R is warranted, pointing to the need to revise its whole structure, and providing detailed guidelines for its revision.
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Affiliation(s)
- Franco Franchignoni
- a Unit of Occupational Rehabilitation and Ergonomics, Salvatore Maugeri Foundation, Scientific Institute of Veruno (NO) , Italy
| | - Jessica Mandrioli
- b Department of Neuroscience , St. Agostino-Estense Hospital , Modena , Italy
| | - Andrea Giordano
- c Unit of Bioengineering, Salvatore Maugeri Foundation, Scientific Institute of Veruno (NO) , Italy
| | - Salvatore Ferro
- d Department of Hospital Services , Emilia Romagna Regional Health Authority , Bologna , Italy
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