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Jia Q, Song Y, Zhang C, Li M, Feng L, Sugimoto K, Zhang X, Liu J, Gao Y. Reasons and experience for patients with amyotrophic lateral sclerosis using traditional Chinese medicine: a CARE-TCM based mixed method study. BMC Complement Med Ther 2024; 24:231. [PMID: 38867220 PMCID: PMC11167840 DOI: 10.1186/s12906-024-04513-2] [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: 10/26/2023] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND AND AIM Traditional Chinese medicine (TCM) is widely used by patients with amyotrophic lateral sclerosis (ALS). However, their reasons and experience in using TCM have received insufficient attention. Therefore, we conducted a mixed method study to gain insights into this issue. MATERIALS AND METHODS This study was conducted on the basis of the China Amyotrophic Lateral Sclerosis Registry of Patients with Traditional Chinese Medicine (CARE-TCM). Data were collected from Dongzhimen Hospital through a mixed method approach, including a questionnaire and a semi-structured interview. Patients with ALS who were using TCM when they were initially registered with CARE-TCM and who had been followed-up for over six months were recruited. The questionnaires' outcomes were statistically outlined, and the interview transcripts were thematically analysed to identify themes and sub-themes. RESULTS Fifty-two and sixteen patients were included in the questionnaire and semi-structured interview groups, respectively. Patients used TCM with the hope of regulating their body holistically to improve nonmotor symptoms and quality of life (QOL). Those who recognised TCM as ineffective tended to discontinue it after a three-month trial period. Although quality was a major concern, herbal medicine (HM) was the most frequently used modality among all participants (n = 52), with the majority (n = 44, 84.6%) continuing to use it. Patients emphasised in-person consultations as a crucial part of TCM treatment. However, the disability caused by disease often made this interaction unattainable. CONCLUSION Nonmotor symptoms and QOL hold substantial importance for patients with ALS using TCM. HM is a more suitable modality than other TCM treatment modalities, but patients are facing challenges in seeking HM treatment. It is necessary to promote the implementation of hierarchical diagnosis and treatment, thus making TCM more accessible. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04885374 (registered on May 13, 2021).
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Affiliation(s)
- Qiuyang Jia
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Yuebo Song
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Chi Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Mingxuan Li
- Gansu provincial Hospital of traditional Chinese medicine, Gansu, China
| | - Luda Feng
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kazuo Sugimoto
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xuebin Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Jia Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.
- Institute for Brain Disorders, Beijing University of Chinese Medicine Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
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Filipe CB, Carreira NR, Reis-Pina P. Optimizing breathlessness management in amyotrophic lateral sclerosis: insights from a comprehensive systematic review. BMC Palliat Care 2024; 23:100. [PMID: 38622643 PMCID: PMC11020819 DOI: 10.1186/s12904-024-01429-z] [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: 01/11/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Breathlessness is a prevalent symptom affecting the quality of life (QOL) of Amyotrophic Lateral Sclerosis (ALS) patients. This systematic review explored the interventions for controlling breathlessness in ALS patients, emphasizing palliative care (PALC), non-invasive ventilation (NIV), opioids, and non-pharmacological strategies. METHODS A comprehensive search of PubMed, Cochrane Library, and Web of Science databases was conducted. Eligibility criteria encompassed adults with ALS or motor neuron disease experiencing breathlessness. Outcomes included QOL and symptom control. Study designs comprised qualitative studies, cohort studies, and randomized controlled trials. RESULTS Eight studies were included, most exhibiting low bias risk, comprising one randomized controlled trial, three cohort studies, two comparative retrospective studies, and two qualitative studies (interviews). Most studies originated from Europe, with one from the United States of America. The participants totaled 3423, with ALS patients constituting 95.6%. PALC consultations significantly improved symptom assessment, advance care planning, and discussions about goals of care. NIV demonstrated efficacy in managing breathlessness, with considerations for device limitations. Opioids were effective, though predominantly studied in non-ALS patients. Non-pharmacological strategies varied in efficacy among patients. CONCLUSION The findings underscore the need for individualized approaches in managing breathlessness in ALS. PALC, NIV, opioids, and non-pharmacological strategies each play a role, with unique considerations. Further research, especially ALS-specific self-management studies, is warranted.
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Affiliation(s)
- Catarina Bico Filipe
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Nuno Reis Carreira
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
- North Lisboa Hospital Centre, Santa Maria Hospital, Lisboa, Portugal
| | - Paulo Reis-Pina
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal.
- Bento Menni Palliative Care Unit, Sintra, Portugal.
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Gentile F, Maranzano A, Verde F, Bettoni V, Colombo E, Doretti A, Olivero M, Scheveger F, Colombrita C, Bulgarelli I, Spinelli EG, Torresani E, Messina S, Maderna L, Agosta F, Morelli C, Filippi M, Silani V, Ticozzi N. The value of routine blood work-up in clinical stratification and prognosis of patients with amyotrophic lateral sclerosis. J Neurol 2024; 271:794-803. [PMID: 37801095 PMCID: PMC10827966 DOI: 10.1007/s00415-023-12015-3] [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: 07/19/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND There is an unmet need in amyotrophic lateral sclerosis (ALS) to provide specific biomarkers for the disease. Due to their easy availability, we aimed to investigate whether routine blood parameters provide useful clues for phenotypic classification and disease prognosis. METHODS We analyzed a large inpatient cohort of 836 ALS patients who underwent deep phenotyping with evaluation of the clinical and neurophysiological burden of upper (UMN) and lower (LMN) motor neuron signs. Disability and progression rate were measured through the revised ALS Functional Rating Scale (ALSFRS-R) and its changes during time. Cox regression analysis was performed to assess survival associations. RESULTS Creatinine significantly correlated with LMN damage (r = 0.38), active (r = 0.18) and chronic (r = 0.24) denervation and baseline ALSFRS-R (r = 0.33). Creatine kinase (CK), alanine (ALT) and aspartate (AST) transaminases correlated with active (r = 0.35, r = 0.27, r = 0.24) and chronic (r = 0.37, r = 0.20, r = 0.19) denervation, while albumin and C-reactive protein significantly correlated with LMN score (r = 0.20 and r = 0.17). Disease progression rate showed correlations with chloride (r = -0.19) and potassium levels (r = -0.16). After adjustment for known prognostic factors, total protein [HR 0.70 (95% CI 0.57-0.86)], creatinine [HR 0.86 (95% CI 0.81-0.92)], chloride [HR 0.95 (95% CI 0.92-0.99)], lactate dehydrogenase [HR 0.99 (95% CI 0.99-0.99)], and AST [HR 1.02 (95% CI 1.01-1.02)] were independently associated with survival. CONCLUSIONS Creatinine is a reliable biomarker for ALS, associated with clinical features, disability and survival. Markers of nutrition/inflammation may offer additional prognostic information and partially correlate with clinical features. AST and chloride could further assist in predicting progression rate and survival.
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Affiliation(s)
- Francesco Gentile
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Federico Verde
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Veronica Bettoni
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, Università degli Studi di Pavia, Pavia, Italy
| | - Eleonora Colombo
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Alberto Doretti
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Marco Olivero
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | | | - Claudia Colombrita
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ilaria Bulgarelli
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Edoardo Gioele Spinelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Erminio Torresani
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Messina
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Luca Maderna
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Federica Agosta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Claudia Morelli
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy.
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy.
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Morishima R, Shimizu T, Kimura H, Bokuda K, Saotome T, Nakayama Y, Takahashi K. High doses of opioids usage for amyotrophic lateral sclerosis patients with non-invasive ventilation. Acta Neurol Belg 2024; 124:101-107. [PMID: 37543533 DOI: 10.1007/s13760-023-02344-5] [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: 04/20/2023] [Accepted: 07/19/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION While opioids have been found to be useful in relieving suffering in amyotrophic lateral sclerosis (ALS), there is a lack of evidence concerning how and how much to use them in practice. This study was conducted to clarify how opioids were used for patients with ALS. METHODS We performed a retrospective case-based analysis at a single tertiary neurology center in Tokyo from 2010 to 2018. We enrolled patients with ALS who had died before the end of 2018. We examined the opioid dosage equivalent of morphine hydrochloride and patients' clinical backgrounds, focusing on ventilatory support. RESULTS Morphine was administered in 110 patients with ALS, and 84 were followed up until their death. Of these 84 patients, 57 (69.9%) did not use mechanical ventilation until death (no-MV group), and 21 (22.9%) utilized only non-invasive ventilation (NIV group). Final morphine dosage in the NIV group was significantly higher (mean 65.7 mg [SD 54.6], range 10-200 mg) than in the no-MV group (mean 31.7 mg [SD 26.9], range 0-120 mg; p = 0.015, Welch's t-test). The NIV group needed psychotropic drugs more frequently than the no-MV group (62% [n = 13] vs. 35% [n = 20]). CONCLUSION Patients in the NIV group used opioids for a statistically significantly longer time and at a higher dose than those in the no-MV group. Symptom control with opioids alone may be difficult, and the development of multifaceted evaluation and care is desirable.
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Affiliation(s)
- Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.
- Unit for Intractable Disease Care Unit, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
- Palliative Care Team, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
- Unit for Intractable Disease Care Unit, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Palliative Care Team, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Hideki Kimura
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
- Palliative Care Team, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
- Unit for Intractable Disease Care Unit, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Palliative Care Team, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Takako Saotome
- Department of Rehabilitation Medicine, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
- Palliative Care Team, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Yuki Nakayama
- Unit for Intractable Disease Care Unit, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
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Theme 09 - Clinical Trials and Trial Design. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:209-229. [PMID: 37966326 DOI: 10.1080/21678421.2023.2260201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
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6
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Sulistyo A, Abrahao A, Freitas ME, Ritsma B, Zinman L. Enteral tube feeding for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev 2023; 8:CD004030. [PMID: 37579081 PMCID: PMC10413437 DOI: 10.1002/14651858.cd004030.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Maintaining adequate nutrition is critical for people with amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND). Enteral tube feeding is offered to people experiencing difficulty swallowing (dysphagia) to prevent weight loss and aspiration pneumonia. Among the types of enteral tube feeding, percutaneous endoscopic gastrostomy (PEG) is the typical procedure offered to people with ALS and will be mainly discussed here. OBJECTIVES To examine the effectiveness of percutaneous endoscopic gastrostomy or other enteral tube feeding in people with ALS, compared to oral feeds without enteral tube feeding on: 1. survival; 2. nutritional status; 3. quality of life. To examine the incidence of minor and major complications of percutaneous endoscopic gastrostomy (PEG) and other enteral tube feeding procedures in people with ALS. SEARCH METHODS On 3 January 2020 and 6 February 2021, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE. Embase, ClinicalTrials.gov and WHO ICTRP. We screened the results to identify randomized controlled studies on enteral tube feeding in ALS. We reviewed all references from the search in published articles to identify any additional references. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs, and cross-over trials evaluating the effectiveness and complications of PEG or other enteral tube feeding placement in ALS. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We found no RCTs or quasi-RCTs comparing the effectiveness of enteral tube feeding versus oral feeds without enteral tube feeding. AUTHORS' CONCLUSIONS There are no RCTs or quasi-RCTs to indicate whether enteral tube feeding is effective compared to continuation of oral feeding for any of the outcome measures. Such RCTs are very unlikely to be performed for ethical reasons. RCTs evaluating the effect of different enteral tube insertion techniques and timings of tube placement on survival and quality of life of people with ALS dysphagia are feasible and warranted.
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Affiliation(s)
- Adrienne Sulistyo
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Maria Eliza Freitas
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Benjamin Ritsma
- Department of Physical Medicine & Rehabilitation, Queen's University, Providence Care Hospital, Kingston , Canada
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Tandra G, Yoone A, Mathew R, Wang M, Hales CM, Mitchell CS. Literature-Based Discovery Predicts Antihistamines Are a Promising Repurposed Adjuvant Therapy for Parkinson's Disease. Int J Mol Sci 2023; 24:12339. [PMID: 37569714 PMCID: PMC10418861 DOI: 10.3390/ijms241512339] [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: 06/30/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Parkinson's disease (PD) is a movement disorder caused by a dopamine deficit in the brain. Current therapies primarily focus on dopamine modulators or replacements, such as levodopa. Although dopamine replacement can help alleviate PD symptoms, therapies targeting the underlying neurodegenerative process are limited. The study objective was to use artificial intelligence to rank the most promising repurposed drug candidates for PD. Natural language processing (NLP) techniques were used to extract text relationships from 33+ million biomedical journal articles from PubMed and map relationships between genes, proteins, drugs, diseases, etc., into a knowledge graph. Cross-domain text mining, hub network analysis, and unsupervised learning rank aggregation were performed in SemNet 2.0 to predict the most relevant drug candidates to levodopa and PD using relevance-based HeteSim scores. The top predicted adjuvant PD therapies included ebastine, an antihistamine for perennial allergic rhinitis; levocetirizine, another antihistamine; vancomycin, a powerful antibiotic; captopril, an angiotensin-converting enzyme (ACE) inhibitor; and neramexane, an N-methyl-D-aspartate (NMDA) receptor agonist. Cross-domain text mining predicted that antihistamines exhibit the capacity to synergistically alleviate Parkinsonian symptoms when used with dopamine modulators like levodopa or levodopa-carbidopa. The relationship patterns among the identified adjuvant candidates suggest that the likely therapeutic mechanism(s) of action of antihistamines for combatting the multi-factorial PD pathology include counteracting oxidative stress, amending the balance of neurotransmitters, and decreasing the proliferation of inflammatory mediators. Finally, cross-domain text mining interestingly predicted a strong relationship between PD and liver disease.
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Affiliation(s)
- Gabriella Tandra
- Laboratory for Pathology Dynamics, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Neural Engineering Center, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Amy Yoone
- Laboratory for Pathology Dynamics, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30332, USA
| | - Rhea Mathew
- Laboratory for Pathology Dynamics, Georgia Institute of Technology, Atlanta, GA 30332, USA
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Minzhi Wang
- Laboratory for Pathology Dynamics, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Neural Engineering Center, Georgia Institute of Technology, Atlanta, GA 30332, USA
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Chadwick M. Hales
- Department of Neurology and Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Cassie S. Mitchell
- Laboratory for Pathology Dynamics, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Neural Engineering Center, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30332, USA
- Machine Learning Center at Georgia Tech, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Morimoto S, Takahashi S, Ito D, Daté Y, Okada K, Kato C, Nakamura S, Ozawa F, Chyi CM, Nishiyama A, Suzuki N, Fujimori K, Kondo T, Takao M, Hirai M, Kabe Y, Suematsu M, Jinzaki M, Aoki M, Fujiki Y, Sato Y, Suzuki N, Nakahara J, Okano H. Phase 1/2a clinical trial in ALS with ropinirole, a drug candidate identified by iPSC drug discovery. Cell Stem Cell 2023; 30:766-780.e9. [PMID: 37267913 DOI: 10.1016/j.stem.2023.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/12/2023] [Accepted: 04/24/2023] [Indexed: 06/04/2023]
Abstract
iPSC-based drug discovery led to a phase 1/2a trial of ropinirole in ALS. 20 participants with sporadic ALS received ropinirole or placebo for 24 weeks in the double-blind period to evaluate safety, tolerability, and therapeutic effects. Adverse events were similar in both groups. During the double-blind period, muscle strength and daily activity were maintained, but a decline in the ALSFRS-R, which assesses the functional status of ALS patients, was not different from that in the placebo group. However, in the open-label extension period, the ropinirole group showed significant suppression of ALSFRS-R decline and an additional 27.9 weeks of disease-progression-free survival. iPSC-derived motor neurons from participants showed dopamine D2 receptor expression and a potential involvement of the SREBP2-cholesterol pathway in therapeutic effects. Lipid peroxide represents a clinical surrogate marker to assess disease progression and drug efficacy. Limitations include small sample sizes and high attrition rates in the open-label extension period, requiring further validation.
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Affiliation(s)
- Satoru Morimoto
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan; Department of Neurology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Shinichi Takahashi
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan; Department of Neurology, Keio University School of Medicine, Tokyo 160-8582, Japan; Department of Neurology and Stroke, Saitama Medical University International Medical Center, Saitama 350-1298, Japan
| | - Daisuke Ito
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan; Department of Neurology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yugaku Daté
- Department of Neurology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kensuke Okada
- Department of Neurology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Chris Kato
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Shiho Nakamura
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Fumiko Ozawa
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Chai Muh Chyi
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan; Keio University Global Research Institute, Tokyo 108-8345, Japan
| | - Ayumi Nishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan
| | - Naoki Suzuki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan
| | - Koki Fujimori
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tosho Kondo
- Research Center of Neurology, ONO Pharmaceutical Co., Ltd., Osaka 541-8564, Japan
| | - Masaki Takao
- Department of Clinical Laboratory, National Center of Neurology and Psychiatry (NCNP), Tokyo 187-0031, Japan; Department of Neurology, Mihara Memorial Hospital, Isesaki, Gunmma 372-0006, Japan
| | - Miwa Hirai
- Department of Biochemistry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yasuaki Kabe
- Department of Biochemistry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Makoto Suematsu
- Department of Biochemistry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan
| | - Yuto Fujiki
- Keio University Hospital Clinical and Translational Research Center, Tokyo 160-8582, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan.
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Lee AJB, Kittel TE, Kim RB, Bach TN, Zhang T, Mitchell CS. Comparing therapeutic modulators of the SOD1 G93A Amyotrophic Lateral Sclerosis mouse pathophysiology. Front Neurosci 2023; 16:1111763. [PMID: 36741054 PMCID: PMC9893287 DOI: 10.3389/fnins.2022.1111763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Amyotrophic Lateral Sclerosis (ALS) is a paralyzing, multifactorial neurodegenerative disease with limited therapeutics and no known cure. The study goal was to determine which pathophysiological treatment targets appear most beneficial. Methods A big data approach was used to analyze high copy SOD1 G93A experimental data. The secondary data set comprised 227 published studies and 4,296 data points. Treatments were classified by pathophysiological target: apoptosis, axonal transport, cellular chemistry, energetics, neuron excitability, inflammation, oxidative stress, proteomics, or systemic function. Outcome assessment modalities included onset delay, health status (rotarod performance, body weight, grip strength), and survival duration. Pairwise statistical analysis (two-tailed t-test with Bonferroni correction) of normalized fold change (treatment/control) assessed significant differences in treatment efficacy. Cohen's d quantified pathophysiological treatment category effect size compared to "all" (e.g., all pathophysiological treatment categories combined). Results Inflammation treatments were best at delaying onset (d = 0.42, p > 0.05). Oxidative stress treatments were significantly better for prolonging survival duration (d = 0.18, p < 0.05). Excitability treatments were significantly better for prolonging overall health status (d = 0.22, p < 0.05). However, the absolute best pathophysiological treatment category for prolonging health status varied with disease progression: oxidative stress was best for pre-onset health (d = 0.18, p > 0.05); excitability was best for prolonging function near onset (d = 0.34, p < 0.05); inflammation was best for prolonging post-onset function (d = 0.24, p > 0.05); and apoptosis was best for prolonging end-stage function (d = 0.49, p > 0.05). Finally, combination treatments simultaneously targeting multiple pathophysiological categories (e.g., polytherapy) performed significantly (p < 0.05) better than monotherapies at end-stage. Discussion In summary, the most effective pathophysiological treatments change as function of assessment modality and disease progression. Shifting pathophysiological treatment category efficacy with disease progression supports the homeostatic instability theory of ALS disease progression.
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Affiliation(s)
- Albert J. B. Lee
- Laboratory for Pathology Dynamics, Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, United States
- Center for Machine Learning, Georgia Institute of Technology, Atlanta, GA, United States
| | - Tyler E. Kittel
- Laboratory for Pathology Dynamics, Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, United States
| | - Renaid B. Kim
- Laboratory for Pathology Dynamics, Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, United States
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Thao-Nguyen Bach
- Laboratory for Pathology Dynamics, Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, United States
- University of Texas at Dallas, Dallas, TX, United States
| | - Tian Zhang
- Laboratory for Pathology Dynamics, Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, United States
| | - Cassie S. Mitchell
- Laboratory for Pathology Dynamics, Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, United States
- Center for Machine Learning, Georgia Institute of Technology, Atlanta, GA, United States
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10
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Peng S, Chang W, Tian Y, Yang Y, Li S, Ni J, Zhu W. Herbal medicine and acupuncture relieved progressive bulbar palsy for more than 3 years: A case report. Medicine (Baltimore) 2022; 101:e31446. [PMID: 36397351 PMCID: PMC9666122 DOI: 10.1097/md.0000000000031446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Progressive bulbar palsy (PBP) is a type of motor neuron disease (MND). The main symptoms include dysarthria, dysphagia, tongue muscle atrophy and fasciculations. This disease is generally severe and develops rapidly. Due to the lack of effective treatment, many patients with MND in China turn to traditional Chinese medicine treatment for help. We successfully relieved dysphagia and sialorrhea in a patient with PBP for 3 years with herbal medicine and acupuncture. PATIENT CONCERNS The patient was a 68-years-old woman with PBP and suffered from severe dysphagia and sialorrhea. DIAGNOSES Progressive bulbar palsy. INTERVENTIONS Chinese herbal medicine and acupuncture. OUTCOMES After 4 months of herbal medicine and acupuncture treatment, dysphagia and sialorrhea were relieved considerably. The patient's condition has been stable for more than 3 years and continues to be treated with Chinese herbal medicine and acupuncture. LESSONS Our case suggests that alternative therapies such as herbal medicine and acupuncture may be effective in alleviating the symptoms of MND/PBP. However, standardized clinical studies are still required to verify the effectiveness and safety.
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Affiliation(s)
- Siyang Peng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Weiqian Chang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Yukun Tian
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Yajing Yang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Shaohong Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Jinxia Ni
- Dongzhimen Hospital of Beijing University of Chinese Medicine, Dongcheng District, Beijing, China
| | - Wenzeng Zhu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
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11
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Aust E, Linse K, Graupner ST, Joos M, Liebscher D, Grosskreutz J, Prudlo J, Meyer T, Günther R, Pannasch S, Hermann A. Quality of life and mental health in the locked-in-state-differences between patients with amyotrophic lateral sclerosis and their next of kin. J Neurol 2022; 269:5910-5925. [PMID: 35790562 PMCID: PMC9553779 DOI: 10.1007/s00415-022-11238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022]
Abstract
For both patients with amyotrophic lateral sclerosis (ALS) and their next of kin (NOK), the maintenance of quality of life (QoL) and mental health is particularly important. First studies suggest significant discrepancies between QoL reports by patients and NOK, but little is known for advanced ALS stages. To address this issue, we screened 52 ALS patients in incomplete locked-in state (iLIS). Final results were obtained for 15 couples of iLIS patients and NOK. We assessed patients' and NOK's subjective QoL, depression and anxiety and NOK's caregiver burden. Gaze controlled questionnaires allowed direct assessment of patients. Patients and NOK self-reported comparable, mostly moderate to high levels of QoL. Of note, NOK indicated stronger anxiety symptoms. Higher anxiety levels in NOK were associated with stronger caregiver burden and reduced QoL. No significant misjudgment of patient's QoL by the NOK was evident, while patients overestimated NOK's global QoL. However, NOK with severe caregiver burden and depression symptoms gave poorer estimations of patients' QoL. This relationship is relevant, considering NOK's impact on life critical treatment decisions. While the daily time NOK and patient spend together was positively correlated with NOK's QoL and mental health, this was not reversely found for the patients. Our results suggest that NOK adapt less successfully to the disease and concomitant experience of loss and point to an urgent need for specialized psychosocial support. The findings emphasize the importance of direct psychological wellbeing assessment of both patients and NOK in clinical practice, enabled by eye-tracking technology for patients in iLIS.
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Affiliation(s)
- Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Sven-Thomas Graupner
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | - Daniel Liebscher
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | | | - Johannes Prudlo
- Department of Neurology, University of Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Thomas Meyer
- Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Sebastian Pannasch
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Andreas Hermann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany.
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, Rostock, Germany.
- Translational Neurodegeneration Section "Albrecht Kossel," Department of Neurology, University Medical Center Rostock, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany.
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12
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Hu N, Ji H. Medications on hypertension, hyperlipidemia, diabetes, and risk of amyotrophic lateral sclerosis: a systematic review and meta-analysis. Neurol Sci 2022; 43:5189-5199. [DOI: 10.1007/s10072-022-06131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/11/2022] [Indexed: 02/06/2023]
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13
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Relationship between Dietary Total Antioxidant Capacity and the Prognosis of Amyotrophic Lateral Sclerosis. Nutrients 2022; 14:nu14163264. [PMID: 36014769 PMCID: PMC9414183 DOI: 10.3390/nu14163264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
Antioxidant intake has been suggested to be associated with the prognosis of amyotrophic lateral sclerosis (ALS). This study aimed to investigate whether dietary total antioxidant capacity (DTAC) and that of major food groups are related to disease progression rate (ΔFS) and survival time in ALS patients. A total of 301 participants diagnosed with sporadic ALS according to the revised El Escorial criteria were recruited from March 2011 and followed up to the event occurrence, or the end of October 2021. Events included percutaneous endoscopic gastrostomy, tracheostomy, and death. DTAC was estimated using task automation and an algorithm based on 24 h dietary recall. ΔFS was negatively correlated with the vegetable and legume DTAC, and event-free survival was different among the tertiles of vegetables and legumes DTAC. Consistently, the risk of events was negatively associated with DTAC from vegetables and legumes. These results suggest that the intake of antioxidants, especially those derived from vegetables and legumes, has a beneficial effect on delaying disease progression and prolonging survival in patients with ALS. Further studies with large prospective cohorts and clinical trials are needed to determine whether the consumption of foods with high DTAC improves the prognosis of ALS.
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14
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Song Y, Li M, Sugimoto K, Han Y, Liu J, Ma B, Song H, Zhang C, Gao Y. China amyotrophic lateral sclerosis registry of patients with Traditional Chinese Medicine (CARE-TCM): Rationale and design. JOURNAL OF ETHNOPHARMACOLOGY 2022; 284:114774. [PMID: 34699945 DOI: 10.1016/j.jep.2021.114774] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/06/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional Chinese medicine (TCM) has become popular interventional treatment for amyotrophic lateral sclerosis (ALS). However, lack of knowledge about the general characteristics and long-term clinical outcomes hampers the development of herbal drugs for ALS. AIM OF THE STUDY The China Amyotrophic Lateral Sclerosis Registry of Patients with Traditional Chinese Medicine (CARE-TCM) provides an opportunity to better understand which TCM interventions patients with ALS are receiving, what the characteristics of patients with ALS are, and how these interventions impact clinical measures. MATERIALS AND METHODS This study includes a voluntary nationwide registry, and data will be collected prospectively using an electronic data system. Detailed data collection will be performed every 3 months for 5 years. Baseline characteristics and 5-year survival will be collected. This registry was initiated in March 2021. The number of participating medical centers will be about 30 hospitals, and the target procedure number will be 2000. We will also compare the results with those of other registries in China and other countries. DISCUSSION The CARE-TCM registry will first provide real-world data regarding TCM and ALS in China, focusing on the clinical characteristics of ALS patients with TCM, disease phenotypes that respond best to TCM, and correlating clinical response with other parameters. The CARE-TCM can be very helpful to improve the efficiency and quality of TCM clinical trial design. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04885374 (registered on May 8, 2021).
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Affiliation(s)
- Yuebo Song
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Mingxuan Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Kazuo Sugimoto
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Yi Han
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China.
| | - Jia Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Bin Ma
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China.
| | - Hujie Song
- Xi'an Encephalopathy Hospital of Traditional Chinese Medicine, China.
| | - Chi Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
| | - Ying Gao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, China.
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15
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Yamakawa M, Dwyer S, Song X, Statland J. Demographics, clinical characteristics, and prognostic factors of amyotrophic lateral sclerosis in Midwest. Muscle Nerve 2022; 65:217-224. [PMID: 34708421 PMCID: PMC8849587 DOI: 10.1002/mus.27450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION/AIMS The Midwest has the highest regional prevalence of self-reported amyotrophic lateral sclerosis (ALS) in the United States, but with limited epidemiological studies. We aimed to explore the characteristics of patients with ALS in the Midwest. METHODS This was a retrospective cohort study of participants with ALS deceased between January, 2010, and September, 2020, registered with the ALS Association Mid-America Chapter. Demographics and clinical variables included gender, race/ethnicity, military status, site of onset, interventions (gastrostomy, non-invasive ventilation, tracheostomy), and visits to ALS Association-registered clinics. Disease characteristics were compared to the National ALS Registry, and survival analysis was performed followed by sample augmentation with historical data to estimate survival with hypothetical censoring. RESULTS The database included 1447 participants with a mean age at diagnosis of 65.7 ± 11.9 y (>60 y at diagnosis: 72%). The median survival from symptom onset was 28.0 mo (95% confidence limit: 26.3, 29.7); sample augmentation increased this to 41.0 mo (38.5, 43.5). Bulbar onset disease and older age at diagnosis were associated with shorter survival. Participants not followed in ALS-Association registered clinics were more frequently male, had familial onset and tracheostomy. Veterans (N = 298) were older at diagnosis but had similar survival after adjustment for age. DISCUSSIONS Our cohort had an older age at onset and more frequent bulbar onset than the National ALS Registry, perhaps reflecting ascertainment biases in each registry. Prospective cohort studies with more clinical and functional data are needed to better characterize ALS in Midwest, veterans, and non-clinic populations, and to optimize care.
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Affiliation(s)
- Mai Yamakawa
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA
| | - Sally Dwyer
- The ALS Association Mid-America Chapter, Mission, KS, USA
| | - Xing Song
- University of Missouri, Health Management and Informatics, School of Medicine, Columbia, MO, USA
| | - Jeffrey Statland
- University of Kansas Medical Center, Department of Neurology, Kansas City, KS, USA
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16
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Caga J, Devenney E, Huynh W, Zoing MC, Ahmed RM, Kiernan MC. Illness Cognitions in ALS: New Insights Into Clinical Management of Behavioural Symptoms. Front Neurol 2021; 12:740693. [PMID: 34630311 PMCID: PMC8498576 DOI: 10.3389/fneur.2021.740693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Timely management of frontotemporal dysfunction associated with amyotrophic lateral sclerosis (ALS) has important prognostic and therapeutic implications. However, there remains a paucity of research on best practise recommendations to guide the development of interventions for cognitive and behavioural symptoms as part of ALS care. Accordingly, a focus on illness perceptions may provide a preliminary framework for managing cognitive and behavioural symptoms. The aim of the present study was to explore the nature of illness perceptions among ALS patients with cognitive and behavioural symptoms. A total of 39 patients were recruited from a specialised ALS clinic. Factor analysis showed three independent and clinically interpretable factors corresponding to “cognitive and emotion related ALS perceptions,” “cognitive- specific ALS perceptions” and “ALS coherence”. Of these factors, greater perceived cognitive and emotional impacts of ALS were associated with an approximate 4-fold increased risk of behavioural changes (p < 0.05). Greater perceived cognitive and emotional impacts of ALS was also associated with more rapid disease progression (p < 0.001). As such, timely provision of intervention addressing perceptions about the impact of ALS on functioning as well as associated emotional distress may optimise clinical management of cognitive and behavioural symptoms of ALS.
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Affiliation(s)
- Jashelle Caga
- Brain & Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Emma Devenney
- Brain & Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - William Huynh
- Brain & Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Prince of Wales Clinical School, University of NSW, Sydney, NSW, Australia
| | - Margaret C Zoing
- Brain & Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Rebekah M Ahmed
- Brain & Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Brain & Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
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17
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Peseschkian T, Cordts I, Günther R, Stolte B, Zeller D, Schröter C, Weyen U, Regensburger M, Wolf J, Schneider I, Hermann A, Metelmann M, Kohl Z, Linker RA, Koch JC, Büchner B, Weiland U, Schönfelder E, Heinrich F, Osmanovic A, Klopstock T, Dorst J, Ludolph AC, Boentert M, Hagenacker T, Deschauer M, Lingor P, Petri S, Schreiber-Katz O. A Nation-Wide, Multi-Center Study on the Quality of Life of ALS Patients in Germany. Brain Sci 2021; 11:372. [PMID: 33799476 PMCID: PMC7998410 DOI: 10.3390/brainsci11030372] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022] Open
Abstract
Improving quality of life (QoL) is central to amyotrophic lateral sclerosis (ALS) treatment. This Germany-wide, multicenter cross-sectional study analyses the impact of different symptom-specific treatments and ALS variants on QoL. Health-related QoL (HRQoL) in 325 ALS patients was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire 5 (ALSAQ-5) and EuroQol Five Dimension Five Level Scale (EQ-5D-5L), together with disease severity (captured by the revised ALS Functional Rating Scale (ALSFRS-R)) and the current care and therapies used by our cohort. At inclusion, the mean ALSAQ-5 total score was 56.93 (max. 100, best = 0) with a better QoL associated with a less severe disease status (β = -1.96 per increase of one point in the ALSFRS-R score, p < 0.001). "Limb-onset" ALS (lALS) was associated with a better QoL than "bulbar-onset" ALS (bALS) (mean ALSAQ-5 total score 55.46 versus 60.99, p = 0.040). Moreover, with the ALSFRS-R as a covariate, using a mobility aid (β = -7.60, p = 0.001), being tracheostomized (β = -14.80, p = 0.004) and using non-invasive ventilation (β = -5.71, p = 0.030) were associated with an improved QoL, compared to those at the same disease stage who did not use these aids. In contrast, antidepressant intake (β = 5.95, p = 0.007), and increasing age (β = 0.18, p = 0.023) were predictors of worse QoL. Our results showed that the ALSAQ-5 was better-suited for ALS patients than the EQ-5D-5L. Further, the early and symptom-specific clinical management and supply of assistive devices can significantly improve the individual HRQoL of ALS patients. Appropriate QoL questionnaires are needed to monitor the impact of treatment to provide the best possible and individualized care.
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Affiliation(s)
- Tara Peseschkian
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Isabell Cordts
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, 01307 Dresden, Germany;
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Benjamin Stolte
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany;
| | - Carsten Schröter
- Hoher Meißner Clinic, Neurology, 37242 Bad Sooden-Allendorf, Germany;
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, 44789 Bochum, Germany;
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Joachim Wolf
- Department of Neurology, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany;
| | - Ilka Schneider
- Department of Neurology, Martin-Luther University Halle/Saale, 06120 Halle, Germany;
- Department of Neurology, Klinikum Sankt Georg, 04129 Leipzig, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany;
- German Center for Neurodegenerative Diseases Rostock/Greifswald, 18147 Rostock, Germany
| | - Moritz Metelmann
- Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Zacharias Kohl
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Ralf A. Linker
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany; (Z.K.); (R.A.L.)
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, 37075 Göttingen, Germany;
| | - Boriana Büchner
- Friedrich-Baur Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (B.B.); (T.K.)
| | - Ulrike Weiland
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
| | - Erik Schönfelder
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Felix Heinrich
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Thomas Klopstock
- Friedrich-Baur Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany; (B.B.); (T.K.)
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (U.W.); (J.D.); (A.C.L.)
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Matthias Boentert
- Department of Neurology with the Institute of Translational Neurology, University Hospital Münster, 48149 Münster, Germany;
- Department of Medicine, UKM Marienhospital, 48565 Steinfurt, Germany
| | - Tim Hagenacker
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany; (B.S.); (T.H.)
| | - Marcus Deschauer
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (I.C.); (M.D.); (P.L.)
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.P.); (E.S.); (F.H.); (A.O.); (S.P.)
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18
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Steinbach R, Prell T, Gaur N, Stubendorff B, Roediger A, Ilse B, Witte OW, Grosskreutz J. Triage of Amyotrophic Lateral Sclerosis Patients during the COVID-19 Pandemic: An Application of the D50 Model. J Clin Med 2020; 9:jcm9092873. [PMID: 32899481 PMCID: PMC7565659 DOI: 10.3390/jcm9092873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease, the management of which requires the continuous provision of multidisciplinary therapies. Owing to the novel coronavirus disease (COVID-19) pandemic, regular contact with ALS patients at our center was severely restricted and patient care was at risk by delay of supportive therapies. We established a triage system based on the D50 disease progression model and were thus able to identify a prospective cohort with high disease aggressiveness (D50 < 30). Thirty-seven patients with highly aggressive disease were actively offered follow-up, either via telephone or on-site, depending on their disease-specific needs and abilities. We describe here the procedures, obstacles, and results of these prescient efforts during the restrictions caused by COVID-19 in the period between March and June 2020. In conclusion, four patients with highly aggressive disease were initiated with non-invasive ventilation and two received a gastrostomy. We could show that a comparable amount of advanced care was induced in a retrospective cohort within a similar time period one year prior to the COVID-19 outbreak. Our workflow to identify high-risk patients via D50 model metrics can be easily implemented and integrated within existing centers. It helped to maintain a high quality of advanced care planning for our ALS patients.
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Affiliation(s)
- Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Correspondence: ; Tel.: +49-3641-9323-587
| | - Tino Prell
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
| | - Nayana Gaur
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Beatrice Stubendorff
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Annekathrin Roediger
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Benjamin Ilse
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Otto W. Witte
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
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Soo SK, Rudich PD, Traa A, Harris-Gauthier N, Shields HJ, Van Raamsdonk JM. Compounds that extend longevity are protective in neurodegenerative diseases and provide a novel treatment strategy for these devastating disorders. Mech Ageing Dev 2020; 190:111297. [PMID: 32610099 PMCID: PMC7484136 DOI: 10.1016/j.mad.2020.111297] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
While aging is the greatest risk factor for the development of neurodegenerative disease, the role of aging in these diseases is poorly understood. In the inherited forms of these diseases, the disease-causing mutation is present from birth but symptoms appear decades later. This indicates that these mutations are well tolerated in younger individuals but not in older adults. Based on this observation, we hypothesized that changes taking place during normal aging make the cells in the brain (and elsewhere) susceptible to the disease-causing mutations. If so, then delaying some of these age-related changes may be beneficial in the treatment of neurodegenerative disease. In this review, we examine the effects of five compounds that have been shown to extend longevity (metformin, rapamycin, resveratrol, N-acetyl-l-cysteine, curcumin) in four of the most common neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis). While not all investigations observe a beneficial effect of these compounds, there are multiple studies that show a protective effect of each of these lifespan-extending compounds in animal models of neurodegenerative disease. Combined with genetic studies, this suggests the possibility that targeting the aging process may be an effective strategy to treat neurodegenerative disease.
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Affiliation(s)
- Sonja K Soo
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, H4A 3J1, Canada; Metabolic Disorders and Complications Program, and Brain Repair and Integrative Neuroscience Program, Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada
| | - Paige D Rudich
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, H4A 3J1, Canada; Metabolic Disorders and Complications Program, and Brain Repair and Integrative Neuroscience Program, Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada
| | - Annika Traa
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, H4A 3J1, Canada; Metabolic Disorders and Complications Program, and Brain Repair and Integrative Neuroscience Program, Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada
| | - Namasthée Harris-Gauthier
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, H4A 3J1, Canada; Metabolic Disorders and Complications Program, and Brain Repair and Integrative Neuroscience Program, Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada
| | - Hazel J Shields
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, H4A 3J1, Canada; Metabolic Disorders and Complications Program, and Brain Repair and Integrative Neuroscience Program, Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada
| | - Jeremy M Van Raamsdonk
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, H4A 3J1, Canada; Metabolic Disorders and Complications Program, and Brain Repair and Integrative Neuroscience Program, Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, QC, H4A 3J1, Canada; Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA.
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20
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Prell T, Grosskreutz J. Use of vitamins by participants in amyotrophic lateral sclerosis clinical trials. PLoS One 2020; 15:e0237175. [PMID: 32790757 PMCID: PMC7425848 DOI: 10.1371/journal.pone.0237175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
Patients' vitamin intake is often not documented and is therefore not considered sufficiently in studies of prescribed medication in patients with amyotrophic lateral sclerosis (ALS). We aimed to determine the prevalence of vitamin use by participants in ALS clinical trials. Data about demographics, disease severity (ALS Functional Rating Scale) and concomitant medication were obtained from the Pooled Resource Open-Access ALS Clinical Trials Database, which contains records from more than 6000 ALS patients who participated in 23 phase II/III clinical trials. Information about vitamin intake for all study subjects was coded into major categories. Clinical data of vitamin users and nonusers were compared, and regression analysis was used to explore the associations among clinical parameters, vitamin use and two measures of disease progression. From the 40.996 available medication records from 6274 subjects, 7338 (17.9%) concerned vitamins. One or more vitamins were used by 3331 subjects (53.1%). Most common was vitamin E, vitamin C and multivitamins. Patients who did and did not take vitamins did not differ in terms of disease progression and ALS Functional Rating Scale score. Patients who took vitamins were younger, were more often female, had a shorter time between onset and diagnosis, had shorter disease duration and more frequently had limb-onset types. Disease progression rate and disease aggressiveness were not associated with vitamin use. Despite unclear evidence, the use of vitamins in ALS is common. However, rapid progression was not observed to be associated with vitamin use.
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Affiliation(s)
- Tino Prell
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany
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