1
|
Kim HS, Woo H, Choi SJ, Baek JG, Ryu JS, Shin HI, Park KS, Beom J. Factors associated with adherence to noninvasive positive pressure ventilation in amyotrophic lateral sclerosis. PLoS One 2024; 19:e0302515. [PMID: 38748695 PMCID: PMC11095767 DOI: 10.1371/journal.pone.0302515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/05/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION This cohort study aimed to investigate the factors associated with noninvasive positive pressure ventilation adherence and assess the long-term effects of noninvasive positive pressure ventilation adherence in patients with amyotrophic lateral sclerosis (ALS). METHODS The medical records of patients with ALS admitted to a tertiary hospital for noninvasive positive pressure ventilation initiation were retrospectively reviewed. Pulmonary function parameters, variables of blood gas analysis, the site of symptom onset, the time from onset and diagnosis to noninvasive positive pressure ventilation application, ALS Functional Rating Scale-Revised, neurophysiological index, and the length of hospital stay were evaluated. The adherence to noninvasive positive pressure ventilation was defined as the use of noninvasive positive pressure ventilation for ≥ 2 h/day or ≥ 4 h/day. The correlations between noninvasive positive pressure ventilation adherence or length of hospital stay and other clinical parameters were analyzed. RESULTS Fifty-one patients with ALS were included in the study. The time from onset and diagnosis to NIPPV application was reduced by 16 months in the adherent group than that in the non-adherent group; however, the parameters of blood gas analysis and pulmonary function tests did not differ significantly between the groups. Furthermore, the neurophysiological index of the abductor digiti minimi muscle was higher by 4.05 in the adherent group than that in the non-adherent group. The adherence to noninvasive positive pressure ventilation prolonged tracheostomy-free survival compared to that of non-adherence. Desaturation events, lower forced vital capacity, last pCO2, bicarbonate, and base excess, and higher differences in pCO2, were associated with an increase in the length of hospital stay. CONCLUSIONS Noninvasive positive pressure ventilation application shortly after symptom onset and ALS diagnosis in patients with CO2 retention and reduced forced vital capacity can be considered for successful adherence. Adherence to noninvasive positive pressure ventilation may result in reduced tracheostomy conversion rates and prolonged tracheostomy-free survival.
Collapse
Affiliation(s)
- Hee Soo Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Hyeonseong Woo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong-Gyu Baek
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| |
Collapse
|
2
|
Kim JS, Park M, Park S, Chae J, Hong YH, Park KS, Sung JJ, Choi SJ. Prognosis of amyotrophic lateral sclerosis patients after tracheostomy invasive ventilation in Korea. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:271-281. [PMID: 38340017 DOI: 10.1080/21678421.2024.2314064] [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: 09/20/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Background: Tracheostomy invasive ventilation (TIV) is applied to a subset of amyotrophic lateral sclerosis (ALS) patients; however, its frequency and impact on prognosis vary across countries. Methods: We conducted a nationwide retrospective cohort study using Korean National Health Insurance claims data. All patients diagnosed with sporadic ALS from 2012 to 2017 were included, with the observation period until 2020. The survival time between the TIV and non-TIV groups was compared using propensity score matching analysis, and prognostic factors were assessed within the TIV group. Results: This study included 3484 ALS patients (mean [standard deviation] age, 62.4 [11.9] years, 60.4% male), among whom 1230 (35.3%) underwent TIV. After 1:1 propensity score matching, the survival duration between the two groups was not significantly different (28 vs. 25 months, p = 0.057). Cox regression indicated that older age (hazard ratios [HRs] for each decade compared to <40 years: 3.89, 3.83, 5.30, 6.78, and 8.40 [≥ 80 years]; p < 0.005 for all) and lower income (HR, 1.28; 95% confidence interval [CI], 1.09-1.52; p = 0.003) negatively impacted survival, while gastrostomy (HR, 0.57; 95% CI, 0.50-0.66; p < 0.001) and supportive care services (HR, 0.43; 95% CI, 0.32-0.59; p < 0.001) were associated with prolonged survival. Conclusions: TIV was administered to more than one-third of Korean ALS patients without significant survival prolongation. Older age, lower income, lack of gastrostomy, and insufficient supportive care were independent poor prognostic factors for survival, underscoring the importance of comprehensive management for ALS patients.
Collapse
Affiliation(s)
- Jong-Su Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minae Park
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Juhee Chae
- Department of Neurology, Jeonbuk National University College of Medicine, Jeonju, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Centre, Seoul, Republic of Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea, and
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Centre for Hospital Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
3
|
Ko JI, Choi SJ, Yoo SH, Cho B, Kim MS, Kim KH, Lee SY. Epidemiology and characteristics of emergency department utilization by patients with amyotrophic lateral sclerosis in Korea from 2016 to 2020: A nationwide study. Muscle Nerve 2023; 68:451-459. [PMID: 37540049 DOI: 10.1002/mus.27952] [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: 05/12/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION/AIMS Patients with amyotrophic lateral sclerosis (ALS) inevitably visit the emergency department (ED) due to their increased risk of respiratory failure and mobility limitations. However, nationwide data on ED visits by patients with ALS are limited. This study investigated the characteristics of patients with ALS-related ED visits. METHODS We conducted a cross-sectional study from 2016 to 2020, utilizing a nationwide ED database. The total number of patients with ALS who visited the ED and their primary reasons for visiting/diagnoses were analyzed. RESULTS In total, 6036 visits to the ED were made by patients with ALS. Of these, 41.8% arrived by ambulance and 27.7% spent >9 h in the ED. Following ED treatment, 57.4% were hospitalized, including 19.3% admitted to the intensive care unit (ICU) and 5.4% who died in the hospital. The primary reasons for ALS-related ED visits were dyspnea (35.2%), feeding tube problems (10.1%), fever (7.8%), and mental status changes (3.6%). The most common diagnoses were pneumonia (14.5%), respiratory failure (5.7%), dyspnea (5.5%), aspiration pneumonia (4.3%), and tracheostomy complications (3.4%). DISCUSSION Reasons for ED visits for patients with ALS include acute respiratory distress, as well as concerns related to tube feeding and tracheostomy. To reduce the risk of patients with ALS requiring ED visits, it is essential to ensure the provision of timely respiratory support and high-quality home-based medical care teams that can support and address patients before their condition deteriorates.
Collapse
Affiliation(s)
- Jung-In Ko
- Department of Emergency Medicine, National Medical Center, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Belong Cho
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine & Hospital, Seoul, Republic of Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine & Hospital, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Balendra R, Jones AR, Al Khleifat A, Chiwera T, Wicks P, Young CA, Shaw PJ, Turner MR, Leigh PN, Al-Chalabi A. Comparison Of King's Clinical Staging In Multinational Amyotrophic Lateral Sclerosis Cohorts. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:71-81. [PMID: 35852375 DOI: 10.1080/21678421.2022.2090847] [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] [Indexed: 01/28/2023]
Abstract
Background: Amyotrophic lateral sclerosis (ALS) shows considerable clinical heterogeneity, which affects clinical trials. A clinical staging system has been proposed for ALS with potential applications in patient care, research, trial design and health economic analyses. The King's system consists of five stages. We have previously shown that progressive clinical stages were reached at predictable proportions through the disease course, but this needs to be validated in other independent samples. Objectives: We aimed to compare King's clinical staging in ALS in four patient groups, located in different regions and countries and using different health care systems from the original study population in South London. Methods: Clinical data were extracted from two European phase 3 randomized controlled trials (MitoTarget and LiCALS) and from two databases predominately from the United States: the PRO-ACT Consortium Database and a database of patients from the PatientsLikeMe website. Clinical stage was estimated using an algorithm, and standardized time to each clinical stage was calculated in deceased patients. Results: 8,796 patients were included, of whom 1,959 had died by the end of follow-up. Stages occurred in the same order as in the original study for all cohorts. Median standardized times to stages (interquartile range) were Stage 2: 0.61 (0.47-0.75), Stage 3: 0.68 (0.56-0.81), Stage 4A: 0.82 (0.71-0.91), Stage 4B: 0.82 (0.69-0.92) and Stage 4 0.80 (0.67-0.91). Discussion: Timings for all stages were similar to those reported in the original study, except Stage 2 which occurred later in the clinical trial databases due to recruitment occurring after diagnosis.
Collapse
Affiliation(s)
- Rubika Balendra
- UK Dementia Research Institute, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Ashley R Jones
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, UK
| | - Ahmad Al Khleifat
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, UK
| | - Theresa Chiwera
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, UK
| | - Paul Wicks
- Wicks Digital Health, Wicks Digital Health, Lichfield, UK
| | - Carolyn A Young
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience (SITraN), Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, OX3 9DU, UK
| | - P Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, University of Sussex, Falmer, East Sussex, BN1 9RY, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, UK
- Department of Neurology, King's College Hospital, London, UK
| |
Collapse
|
5
|
Sung W, Nahm M, Lim SM, Noh MY, Lee S, Hwang SM, Kim YH, Park J, Oh KW, Ki CS, Kim YE, Kim SH. Clinical and genetic characteristics of amyotrophic lateral sclerosis patients with ANXA11 variants. Brain Commun 2022; 4:fcac299. [PMID: 36458208 PMCID: PMC9707645 DOI: 10.1093/braincomms/fcac299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/26/2022] [Accepted: 11/16/2022] [Indexed: 08/12/2023] Open
Abstract
Increasing genetic evidence supports the hypothesis that variants in the annexin A11 gene (ANXA11 ) contribute to amyotrophic lateral sclerosis pathogenesis. Therefore, we studied the clinical aspects of sporadic amyotrophic lateral sclerosis patients carrying ANXA11 variants. We also implemented functional experiments to verify the pathogenicity of the hotspot variants associated with amyotrophic lateral sclerosis-frontotemporal dementia. Korean patients diagnosed with amyotrophic lateral sclerosis (n = 882) underwent genetic evaluations through next-generation sequencing, which identified 16 ANXA11 variants in 26 patients. We analysed their clinical features, such as the age of onset, progression rate, initial symptoms and cognitive status. To evaluate the functional significance of the ANXA11 variants in amyotrophic lateral sclerosis-frontotemporal dementia pathology, we additionally utilized patient fibroblasts carrying frontotemporal dementia-linked ANXA11 variants (p.P36R and p.D40G ) to perform a series of in vitro studies, including calcium imaging, stress granule dynamics and protein translation. The frequency of the pathogenic or likely pathogenic variants of ANXA11 was 0.3% and the frequency of variants classified as variants of unknown significance was 2.6%. The patients with variants in the low-complexity domain presented unique clinical features, including late-onset, a high prevalence of amyotrophic lateral sclerosis-frontotemporal dementia, a fast initial progression rate and a high tendency for bulbar-onset compared with patients carrying variants in the C-terminal repeated annexin homology domains. In addition, functional studies using amyotrophic lateral sclerosis-frontotemporal dementia patient fibroblasts revealed that the ANXA11 variants p.P36R and p.D40G impaired intracellular calcium homeostasis, stress granule disassembly and protein translation. This study suggests that the clinical manifestations of amyotrophic lateral sclerosis and amyotrophic lateral sclerosis-frontotemporal dementia spectrum patients with ANXA11 variants could be distinctively characterized depending upon the location of the variant.
Collapse
Affiliation(s)
- Wonjae Sung
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Minyeop Nahm
- Dementia Research Group, Korea Brain Research Institute, Daegu, Republic of Korea
| | - Su Min Lim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Min-Young Noh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Sanggon Lee
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Sung-Min Hwang
- Gachon Pain Center and Department of Physiology, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Yong Ho Kim
- Gachon Pain Center and Department of Physiology, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | | | - Young-Eun Kim
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| |
Collapse
|
6
|
Park CHK, Choi SJ, Kim YJ, Hong YH, Sung JJ. National prescription patterns of antidepressants among patients with amyotrophic lateral sclerosis: an analysis of the Korean National Health Insurance database. Muscle Nerve 2022; 66:312-318. [PMID: 35707968 DOI: 10.1002/mus.27663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS The current status of antidepressant use in patients with amyotrophic lateral sclerosis (ALS), such as the prevalence and factors associated with it, has not been systematically investigated. We aimed to analyze the prevalence and patterns of antidepressant prescriptions in patients with ALS and depression, and to identify factors associated with antidepressant prescriptions following the diagnosis of ALS. METHODS The data of patients with ALS and the prescription of antidepressants were retrieved from the Korean National Health Insurance claims data. A multivariate logistic regression model was used to identify factors associated with antidepressant prescriptions. RESULTS In total, 533 of 2,955 patients had depressive disorders, and 426 were prescribed antidepressants. Selective serotonin reuptake inhibitors and tricyclic antidepressants were the most frequently prescribed drugs. Adjusted odds ratios (ORs) were 1.379 for the prescription of antidepressants in females. For various age groups, compared with those aged 80 years and older, adjusted ORs were 1.889 for those in their 70s, 2.319 for those in their 60s, 2.872 for those in their 50s, 2.854 for those in their 40s, and 3.363 for those under 40 years of age. Adjusted ORs were 1.662 for patients with a history of a psychiatric disorder and 1.861 for those with a history of psychiatric pharmacotherapy (all p < 0.05). DISCUSSION Most patients with ALS who had depression received antidepressant prescriptions. In young females with a previous psychiatric disorder or pharmacotherapy, an in-depth evaluation for a depressive disorder should be performed. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- C Hyung Keun Park
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Inha University Hospital, Incheon, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
7
|
Choi SJ, Park CHK, Hong YH, Sung JJ. Previous psychiatric disorders in the multistep hypothesis of amyotrophic lateral sclerosis: a South Korean population study. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:601-607. [PMID: 35164606 DOI: 10.1080/21678421.2022.2035765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective: There is accumulating evidence about an association between amyotrophic lateral sclerosis (ALS) and psychiatric disorders. We aimed to investigate the prevalence of previous psychiatric disorders before ALS onset and evaluate the contribution of psychiatric disorders to the number of steps toward developing ALS.Methods: We analyzed the National Health Insurance claims data from 2011 to 2017 and calculated the incidence of ALS. We created a multistep model using the linear least squares method with regression of the log incidence against the log age.Results: The mean annual incidence of ALS was 0.95/100,000 and frequency of familial ALS (fALS) was 5.89%. The proportions of patients who had psychiatric disorders before ALS diagnosis were 36.8% and 47.0% in fALS and sporadic ALS (sALS), respectively (p = 0.009). In both fALS and sALS, depressive disorders and anxiety and stress disorders were relatively frequent, whereas psychotic disorders and bipolar disorders were rare. Further, the slope estimates for regression analyses were 3.50 (R2 = 0.94) and 3.56 (R2 = 0.99) for fALS and sALS, respectively, suggesting a 4-5-step process to ALS onset. However, slope estimates did not differ between sALS patients with pre-symptomatic psychiatric disorders and those without.Conclusions: The incidence of ALS is relatively low in Korea and fewer steps are required to develop ALS compared to Western populations (all 6 steps). Although the prevalence of previous depression or anxiety is seemingly high, the multistep model provides no evidence that these conditions modify the risk of developing ALS in our cohort.
Collapse
Affiliation(s)
- Seok-Jin Choi
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Inha University Hospital, Incheon, Republic of Korea
| | - C Hyung Keun Park
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
8
|
Edgar S, Abdul-Aziz NA, Loh EC, Capelle D, Goh KJ, Latif LA, Shahrizaila N, Ahmad-Annuar A. A survey on patients' disease perception and the impact of the COVID-19 pandemic on persons living with amyotrophic lateral sclerosis in Malaysia. Neurodegener Dis Manag 2021; 11:307-314. [PMID: 34284643 PMCID: PMC8320654 DOI: 10.2217/nmt-2021-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate the patients' perception of their disease, its management and the impact of the COVID-19 pandemic on persons living with amyotrophic lateral sclerosis (ALS) in Malaysia. Patients & methods: An online survey comprising 42 questions was conducted on ALS patients during the peak of the COVID-19 pandemic. Results: Responses were received from 37/60 (62%) participants with ALS directly or through their caregivers. During the COVID-19 pandemic, two-thirds of patients were negatively impacted by the sudden disruption to their hospital appointments, rehabilitation sessions and reduced social interactions. Conclusion: This study provided insight into patients' perception of their care and management of ALS in Malaysia which will facilitate in implementing changes that can improve care to persons living with this devastating illness.
Collapse
Affiliation(s)
- Suzanna Edgar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.,Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Nur Adilah Abdul-Aziz
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Ee Chin Loh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - David Capelle
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Khean-Jin Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Lydia Abdul Latif
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Nortina Shahrizaila
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| |
Collapse
|
9
|
Choi PJ, Murn M, Turner R, Bedlack R. Continuing Non-Invasive Ventilation During Amyotrophic Lateral Sclerosis-Related Hospice Care Is Medically, Administratively, and Financially Feasible. Am J Hosp Palliat Care 2020; 38:1238-1241. [PMID: 33327734 DOI: 10.1177/1049909120982291] [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: 11/16/2022] Open
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) is a terminal neuromuscular disease with patients dying within 3-5 years of diagnosis. Most patients choose to forego invasive life sustaining measures. Timing of hospice referral can be challenging given the advancement of non-invasive ventilation (NIV) technology. OBJECTIVE To describe the characteristics of patients enrolled in hospice from an ALS clinic at 1 academic medical center and to perform a cost analysis for patients who remained on ventilator support. METHODS Retrospective cross-sectional study of patients enrolled in hospice over a 2-year period. Clinical characteristics included ALS Functional Rating Scale Revised (ALSFRS-R) score, Forced Vital Capacity (FVC), use of NIV and mechanical insufflation-exsufflation (MIE), riluzole use, and length of stay in hospice. A cost analysis was performed for patients enrolled in Duke Home Care and Hospice. RESULTS 85 of 104 patients who died were enrolled in hospice. Median days enrolled in hospice was 84. Patients who continued on NIV had similar hospice length of stay as those on no respiratory support (88 versus 80 days, p = 0.83). Bulbar patients had a trend toward shorter length of stay in hospice than limb onset patients (71 versus 101 days, p = 0.49). Cost analysis showed that hospice maintained a mean net operating revenue of $3234.50 per patient who continued on NIV. CONCLUSIONS Hospice referrals for ALS patients on NIV can be challenging. This study shows that even with continued NIV use, most ALS patients die within the expected 6 months on home hospice, and care remains cost effective for hospice agencies.
Collapse
Affiliation(s)
- Philip J Choi
- Division of Pulmonary and Critical Care, Department of Internal Medicine, 1259University of Michigan, Ann Arbor, MI, USA
| | - Michael Murn
- Division of Pulmonary and Critical Care, Department of Internal Medicine, 5798Columbia University, New York, NY, USA
| | - Roberta Turner
- Department of Internal Medicine, 3065Duke University Medical Center, Section of Palliative Medicine, Durham, NC, USA
| | - Richard Bedlack
- Department of Neurology, 3065Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
10
|
Abdul Aziz NA, Toh TH, Goh KJ, Loh EC, Capelle DP, Abdul Latif L, Leow AHR, Yim CCW, Zainal Abidin MF, Ruslan SR, Shahrizaila N. Natural history and clinical features of ALS in Malaysia. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:108-116. [DOI: 10.1080/21678421.2020.1832121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nur Adilah Abdul Aziz
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tsun-Haw Toh
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean-Jin Goh
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee-Chin Loh
- Palliative Care Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Palliative Care Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lydia Abdul Latif
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Alex Hwong-Ruey Leow
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Carolyn Chue-Wai Yim
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Fitry Zainal Abidin
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shairil Rahayu Ruslan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
11
|
Xu L, Chen L, Wang S, Feng J, Liu L, Liu G, Wang J, Zhan S, Gao P, Fan D. Incidence and prevalence of amyotrophic lateral sclerosis in urban China: a national population-based study. J Neurol Neurosurg Psychiatry 2020; 91:520-525. [PMID: 32139654 DOI: 10.1136/jnnp-2019-322317] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disease and information on disease burden of ALS in mainland China was limited. We aimed to estimate the prevalence and incidence of ALS in China. METHODS We used 2012-2016 data from China's Urban Employee Basic Medical Insurance and Urban Residence Basic Medical Insurance, covering approximately 0.43 billion individuals. ALS cases were identified by the primary diagnosis (International Classification of Diseases code or text of diagnosis) in the insurance database. RESULTS The crude prevalence and incidence in 2016 were 2.91 per 100 000 person-years (95% CI 2.31 to 3.58) and 1.65 (95% CI 1.33 to 2.01), respectively. The standardised prevalence and incidence based on 2010 Chinese census data were 2.97 (95% CI 2.91 to 3.03) and 1.62 (95% CI 1.58 to 1.67), respectively. The annual prevalence between 2013 and 2016 remained relatively constant, ranging from 2.91 (95% CI 2.31 to 3.58) in 2016 to 3.29 (95% CI 2.51 to 4.17) in 2014 (linear regression: β=-0.129, p=0.104). Both rates peaked in the group aged 75-79 years. CONCLUSIONS The prevalence and incidence of ALS in mainland China were lower than those in developed countries, and maintained a relatively stable trend. The age at onset and age at diagnosis for ALS patients were younger than those in developed countries. Further research is expected to clarify the potential pathophysiological mechanism of ALS.
Collapse
Affiliation(s)
- Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing 100191, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jingnan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Guozhen Liu
- Peking University Health Information Technology Co. Ltd, 52 North Fourth Ring West Road, Haidian District, Beijing 100080, China
| | - Jinxi Wang
- Beijing Healthcom Data Technology Co. Ltd, 18 Fengtai North Road, Fengtai District, Beijing 100071, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China .,Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing 100191, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing 100191, China
| |
Collapse
|
12
|
Prognostic factors of key outcomes for motor neuron disease in a multiracial Asian population. J Clin Neurosci 2020; 72:63-67. [DOI: 10.1016/j.jocn.2020.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/05/2020] [Indexed: 11/21/2022]
|
13
|
Demetriou CA, Hadjivasiliou PM, Kleopa KA, Christou YP, Leonidou E, Kyriakides T, Zamba-Papanicolaou E. Retrospective longitudinal study of ALS in Cyprus: Clinical characteristics, management and survival. PLoS One 2019; 14:e0220246. [PMID: 31490941 PMCID: PMC6730913 DOI: 10.1371/journal.pone.0220246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/11/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS) is a rare, progressive neurodegenerative disease. There is heterogeneity of clinical phenotypes while a clinical characterization of ALS in Cyprus is still lacking. The aim of this 30-year retrospective study of ALS in Cyprus is to determine the demographic characteristics of patients, the clinical features of the disease, the uptake of supportive therapies and factors influencing survival. Methods All ALS patients seen at the Cyprus Institute of Neurology and Genetics from January 1985 until July 2015 were included. Medical records of eligible patients were used for data extraction and compilation of an ALS database. Clinical features were compared between gender categories using univariate tests, while survival was assessed using Kaplan-Meier curves. Cox proportional hazards models were used to identify prognostic factors for survival. Results One hundred and seventy-nine ALS patients were included in the study, of whom 7 had a positive family history. Most clinical characteristics of ALS did not differ from what is observed in other European countries. However, some clinical characteristics were unique to our population, such as an increased acceptability and utilisation of supportive treatments such as gastrostomy. Conclusions Overall, clinical characteristics of patients with ALS in the Republic of Cyprus do not differ from other European counties. Our study demonstrates a high acceptance and utilisation of supportive interventions enhancing survival, in the context of a multidisciplinary approach offered in the single tertiary centre that services the whole Cypriot ALS population. The findings of this paper are of value to the health professionals treating ALS in Cyprus.
Collapse
Affiliation(s)
- Christiana A. Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Petros M. Hadjivasiliou
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kleopas A. Kleopa
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- Neurology Clinic E, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Yiolanda P. Christou
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Eleni Leonidou
- Neurology Clinic C, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Theodoros Kyriakides
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- Neurology Clinic A, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Eleni Zamba-Papanicolaou
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- * E-mail:
| |
Collapse
|
14
|
Jun KY, Park J, Oh KW, Kim EM, Bae JS, Kim I, Kim SH. Epidemiology of ALS in Korea using nationwide big data. J Neurol Neurosurg Psychiatry 2019; 90:395-403. [PMID: 30409890 PMCID: PMC6581156 DOI: 10.1136/jnnp-2018-318974] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to determine the incidence, prevalence and survival time of Korean patients with amyotrophic lateral sclerosis (ALS) using National Health Insurance Service (NHIS) data. METHODS Using NHIS data, the Korean nationwide health dataset, we identified patients with motor neuron diseases who were first diagnosed with a KCD-6 code (G12.20-G12.28; modified from ICD-10 codes) between 2011 and 2015. ALS (G12.21 code) epidemiological characteristics, including annual incidence, prevalence, mortality rates and survival time, were analysed and compared with sociodemographic variables. RESULTS New patients with ALS (n=3049) were enrolled over 5 years. The mean annual incidence was 1.20/100 000, and the sex ratio was 1.60 (male:female). The mean age at the time of diagnosis was 61.4 years. The prevalence rate was 3.43/100 000 in 2015. In this period, riluzole was prescribed to 53.6% of patients with ALS. Furthermore, 20.3% of patients with ALS underwent tracheostomy. When analysed for age and socioeconomic status, ALS prevalence rate was 10.71 in the aged group (≥60) in 2015 and was lowest in the middle-income group compared with that in the high-income and low-income groups. The estimated mean survival time in this population was 50.0 months, and the 3-year and 5-year mortality rates were 52.1% and 63.7%, respectively. CONCLUSIONS This study is the first nationwide survey for epidemiological characteristics of ALS in Korea using national data. The use of these data substantially advances the understanding of Korean and Asian ALS epidemiology and its relationship with socioeconomic status, age and sex.
Collapse
Affiliation(s)
- Kyo Yeon Jun
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea.,Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
| | - Eun Mi Kim
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Inah Kim
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea .,Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea .,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
| |
Collapse
|
15
|
Ang K, Lim MY, Srinivasan S. Ethical and legal issues of tracheostomy ventilation in patients with amyotrophic lateral sclerosis. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819828753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Doctors owe a legal duty of care to patients, of which legal standard of care, especially on advice, evolves over time. With the modified Montgomery test, informed consent involves a process of best interests decision-making accompanied by disclosure of relevant information in a comprehensible fashion, to the patient. Ethical issues confronting treatment decision and advice are also manifold and have to be confronted. For example, in amyotrophic lateral sclerosis (ALS), an incurable disease, death is usually due to respiratory failure. Tracheostomy ventilation (TV) may be the only alternative to death, yet patients on TV may be subject to the relentless progression of ALS resulting in a locked-in state. Through a case vignette of invasive ventilation for ALS, we examine the ethical and legal issues regarding choice of assisted ventilation in these patients, especially for TV, to ensure reasoned and defensible methodology in patient care. We also include a tracheostomy counselling info kit applicable for use prior to tracheostomy insertion.
Collapse
Affiliation(s)
- Kexin Ang
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | |
Collapse
|
16
|
Niedermeyer S, Murn M, Choi PJ. Respiratory Failure in Amyotrophic Lateral Sclerosis. Chest 2018; 155:401-408. [PMID: 29990478 DOI: 10.1016/j.chest.2018.06.035] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis is a progressive neuromuscular disease characterized by both lower motor neuron and upper motor neuron dysfunction. Although clinical presentations can vary, there is no cure for ALS, and the disease is universally terminal, with most patients dying of respiratory complications. Patients die, on average, within 3 to 5 years of diagnosis, unless they choose to undergo tracheostomy, in which case, they may live, on average, 2 additional years. Up to 95% of patients with ALS in the United States choose not to undergo tracheostomy; management of respiratory failure is therefore aimed at both prolonging survival as well as improving quality of life. Standard of care for patients with ALS includes treatment from multidisciplinary teams, but many patients do not have consistent access to a pulmonary physician who regularly sees patients with this disease. The goal of this review was to serve as an overview of respiratory considerations in the management of ALS. This article discusses noninvasive ventilation in the management of respiratory muscle weakness, mechanical insufflation/exsufflation devices for airway clearance, and treatment of aspiration, including timing of placement of a percutaneous endoscopic gastrostomy tube, as well as secretion management. In addition, it is important for physicians to consider end-of-life issues such as advanced directives, hospice referral, and ventilator withdrawal.
Collapse
Affiliation(s)
- Shannon Niedermeyer
- Duke University Hospital, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Michael Murn
- Duke University Hospital, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Philip J Choi
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, University of Michigan Medical Center, Ann Arbor, MI.
| |
Collapse
|
17
|
Deng X, Hao Y, Xiao B, Tan EK, Lo YL. Risk factors for respiratory failure of motor neuron disease in a multiracial Asian population. J Clin Neurosci 2017; 39:137-141. [PMID: 28089419 DOI: 10.1016/j.jocn.2016.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Motor neuron disease (MND) is a devastating degenerative disorder. Amyotrophic Lateral Sclerosis (ALS) is the most common and severe form of MND. Respiratory failure arising from ventilator musculature atrophy is the most common cause of death for ALS patients. Exploring the factors correlated with respiratory failure can contribute to disease management. PURPOSE To characterize the clinical features of MND and determine the factors that may affect respiratory failure of MND patients. METHODS The case records of all MND patients seen in Singapore General Hospital (SGH) between January 2004 and December 2014 were examined. Demographic, clinical information were collected by reviewing case records. Mortality data, if not available from records, were obtained via phone call interview of family members. Demographic data and clinical treatments were compared between Respiratory support group and Non-respiratory support group. RESULTS There were 73 patients included in our study. 49 (67.1%) patients died during follow-up. The mean age of onset was 58±11.1years. With regard to treatment, 63% needed feeding support, and 42.5% required ventilation aid. The median overall survival was 36months from symptom onset. Chi-square tests showed there was significantly higher percentage of respiratory support needed in Chinese than in other races (P=0.016). Compared with non-feeding support patients, patients with feeding support were more likely to require assisted ventilation (P=0.001). CONCLUSIONS We report for the first time that the need of feeding support is significantly associated with assisted ventilation. Chinese MND patients may be more inclined to require respiratory support.
Collapse
Affiliation(s)
- Xiao Deng
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore 169608, Singapore
| | - Ying Hao
- Health Service Research Unit, Division of Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Bin Xiao
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore 169608, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore 169608, Singapore; Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Yew-Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore 169608, Singapore; Duke-NUS Graduate Medical School, Singapore 169857, Singapore.
| |
Collapse
|
18
|
Oh J, An JW, Oh KW, Oh SI, Kim JA, Kim SH, Lee JS. [Depression and caregiving burden in families of patients with amyotrophic lateral sclerosis]. J Korean Acad Nurs 2016; 45:202-10. [PMID: 25947182 DOI: 10.4040/jkan.2015.45.2.202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to describe depression, caregiving burden and the correlation of the two variables in the families of patients with amyotrophic lateral sclerosis (ALS) and to clarify factors predicting caregiving burden. METHODS A descriptive and cross-sectional study was conducted with 139 family members who provided care to patients with ALS. The characteristics of patients and families, Korean-Beck Depression Inventory (K-BDI), Korean version of Zarit Burden Interview (K-ZBI) and Korean-Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (K-ALSFRS-R) were used as study measures. RESULTS The mean score for K-BDI was 19.39 out of 63 suggesting sub-clinical depression and 38.2% of the family members exhibited depression. The mean score for K-ZBI was 66.03 out of 88. The predictors for K-ZBI were K-BDI, age of family member, length of time spent per day in caring, relationship to patient and K-ALSFRS-R. CONCLUSION The results of this study suggest that levels of depression and caregiving burden are high among family members caring for patients with ALS. As depression is associated with caregiving burden, screening and emotional supports should be provided to reduce the burden of care for these family. Support programs to alleviate the care burden are also needed, considering family demographics, time per day in caring giving and K-ALSFRS-R.
Collapse
Affiliation(s)
- Juyeon Oh
- College of Nursing, Hanyang University; Hanyang Cell Therapy Center, Hanyang University Seoul Hospital, Seoul, Korea
| | - Ji Won An
- Department of Nursing, Far East University, Eumseong, Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University; Hanyang Cell Therapy Center, Hanyang University Seoul Hospital, Seoul, Korea
| | - Seong-Il Oh
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung A Kim
- College of Nursing, Hanyang University, Seoul, Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University; Hanyang Cell Therapy Center, Hanyang University Seoul Hospital, Seoul, Korea
| | | |
Collapse
|
19
|
Shahrizaila N, Sobue G, Kuwabara S, Kim SH, Birks C, Fan DS, Bae JS, Hu CJ, Gourie-Devi M, Noto Y, Shibuya K, Goh KJ, Kaji R, Tsai CP, Cui L, Talman P, Henderson RD, Vucic S, Kiernan MC. Amyotrophic lateral sclerosis and motor neuron syndromes in Asia. J Neurol Neurosurg Psychiatry 2016; 87:821-30. [PMID: 27093948 DOI: 10.1136/jnnp-2015-312751] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022]
Abstract
While the past 2 decades have witnessed an increasing understanding of amyotrophic lateral sclerosis (ALS) arising from East Asia, particularly Japan, South Korea, Taiwan and China, knowledge of ALS throughout the whole of Asia remains limited. Asia represents >50% of the world population, making it host to the largest patient cohort of ALS. Furthermore, Asia represents a diverse population in terms of ethnic, social and cultural backgrounds. In this review, an overview is presented that covers what is currently known of ALS in Asia from basic epidemiology and genetic influences, through to disease characteristics including atypical phenotypes which manifest a predilection for Asians. With the recent establishment of the Pan-Asian Consortium for Treatment and Research in ALS to facilitate collaborations between clinicians and researchers across the region, it is anticipated that Asia and the Pacific will contribute to unravelling the uncertainties in ALS.
Collapse
Affiliation(s)
- N Shahrizaila
- Faculty of Medicine, Neurology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - G Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S H Kim
- Department of Neurology, Hanyang University Medical Center, Seoul, South Korea
| | - Carol Birks
- International Alliance of ALS/MND Associations, Sydney, New South Wales, Australia
| | - D S Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - J S Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - C J Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - M Gourie-Devi
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, Delhi, India
| | - Y Noto
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Shibuya
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K J Goh
- Faculty of Medicine, Neurology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Kaji
- Department of Clinical Neuroscience, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - C P Tsai
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - L Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - P Talman
- Neurology Unit, Calvary Health Care, Bethlehem Hospital, Caulfield, Victoria, Australia
| | - R D Henderson
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - S Vucic
- The Brain Dynamics Centre, Westmead Millennium Institute, Westmead, NSW and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - M C Kiernan
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
20
|
Kimura F. [Tracheostomy and invasive mechanical ventilation in amyotrophic lateral sclerosis: decision-making factors and survival analysis]. Rinsho Shinkeigaku 2016; 56:241-247. [PMID: 27025993 DOI: 10.5692/clinicalneurol.cn-000837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Invasive and/or non-invasive mechanical ventilation are most important options of respiratory management in amyotrophic lateral sclerosis. METHODS We evaluated the frequency, clinical characteristics, decision-making factors about ventilation and survival analysis of 190 people with amyotrophic lateral sclerosis patients from 1990 until 2013. RESULTS Thirty-one percentage of patients underwent tracheostomy invasive ventilation with the rate increasing more than the past 20 years. The ratio of tracheostomy invasive ventilation in patients >65 years old was significantly increased after 2000 (25%) as compared to before (10%). After 2010, the standard use of non-invasive ventilation showed a tendency to reduce the frequency of tracheostomy invasive ventilation. Mechanical ventilation prolonged median survival (75 months in tracheostomy invasive ventilation, 43 months in non-invasive ventilation vs natural course, 32 months). The life-extending effects by tracheostomy invasive ventilation were longer in younger patients ≤65 years old at the time of ventilation support than in older patients. Presence of partners and care at home were associated with better survival. Following factors related to the decision to perform tracheostomy invasive ventilation: patients ≤65 years old: greater use of non-invasive ventilation: presence of a spouse: faster tracheostomy: higher progression rate; and preserved motor functions. No patients who underwent tracheostomy invasive ventilation died from a decision to withdraw mechanical ventilation. CONCLUSION The present study provides factors related to decision-making process and survival after tracheostomy and help clinicians and family members to expand the knowledge about ventilation.
Collapse
Affiliation(s)
- Fumiharu Kimura
- Division of Neurology, Department of Internal Medicine (I), Osaka Medical College
| |
Collapse
|
21
|
Oh SI, Baek S, Park JS, Piao L, Oh KW, Kim SH. Prognostic Role of Serum Levels of Uric Acid in Amyotrophic Lateral Sclerosis. J Clin Neurol 2015; 11:376-82. [PMID: 26424237 PMCID: PMC4596112 DOI: 10.3988/jcn.2015.11.4.376] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/25/2015] [Accepted: 05/28/2015] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose It has been suggested that oxidative stress is one of the pathomechanisms underlying amyotrophic lateral sclerosis (ALS), and thus antioxidants such as uric acid (UA) that could reduce oxidative stress might be beneficial in the prevention or treatment of this disease. The objective of this study was to prospectively investigate serum UA levels in Korean ALS patients and to relate them to disease progression. Methods ALS patients and healthy controls who were individually well-matched for sex, age, and body mass index (BMI) underwent blood testing for serum UA levels, and analyzed whether UA levels were correlated with the disease status of the patients, as defined by the ALS Functional Rating Scale-Revised (ALSFRS-R). Results The study included 136 ALS patients and 136 matched controls. The UA level was lower in the ALS patients (4.50±1.17 mg/dL, mean±SD) than in the controls (5.51±1.22 mg/dL; p<0.001). Among the ALS patients, the level of UA acid was inversely correlated with the rate of disease progression (decrease in ALSFRS-R score). Kaplan-Meier analysis revealed that a better survival rate was more strongly correlated with top-tertile levels of serum UA than with bottom-tertile levels (log-rank test: p=0.035). Conclusions ALS patients had lower serum UA levels than did healthy individuals. UA levels in ALS were negatively correlated with the rate of disease progression and positively associated with survival, suggesting that UA levels contribute to the progression of ALS. UA levels could be considered a biomarker of disease progression in the early phase in ALS patients.
Collapse
Affiliation(s)
- Seong Il Oh
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Soojeong Baek
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Seok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Liying Piao
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea.,Department of Neurology, College of Medicine, Yanbian University Hospital, Yanji, China
| | - Ki Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea.
| |
Collapse
|
22
|
Oh J, An JW, Oh SI, Oh KW, Kim JA, Lee JS, Kim SH. Socioeconomic costs of amyotrophic lateral sclerosis according to staging system. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:202-8. [PMID: 25646865 DOI: 10.3109/21678421.2014.999791] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to compare the cost of illness of amyotrophic lateral sclerosis (ALS) in the Korean population based on the staging system for ALS from the perspective of both patients and the government. Direct medical costs, care-related costs, and loss of productivity in patients with ALS were measured based on medical records and face-to-face interviews. The patients were divided into groups according to the staging system for ALS, and the cost of illness was analysed. A total of 151 patients with ALS were enrolled in the study. The mean monthly cost of ALS was US $7902 per patient and increased according to the disease stage (stage 2, US $5181; stage 3, US $7089; stage 4, US $10,557). Of direct medical costs (US $3436), 44.8% of the cost burden was carried by patients, and the remaining costs were paid by the government. In conclusion, although the current coverage rate of the National Health Insurance (NHI) system for rare and intractable diseases including ALS is 90%, the rate of direct medical costs paid by patients and out-of-pocket costs remain high. Moreover, coverage rates and cost of illness are closely related with disease severity.
Collapse
Affiliation(s)
- Juyeon Oh
- Cell Therapy Center for Intractable Disorders, Hanyang University Hospital , Seoul , Korea
| | | | | | | | | | | | | |
Collapse
|
23
|
Tracheostomy and invasive ventilation in Japanese ALS patients: decision-making and survival analysis: 1990-2010. J Neurol Sci 2014; 344:158-64. [PMID: 25017882 DOI: 10.1016/j.jns.2014.06.047] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/13/2014] [Accepted: 06/23/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the factors related to the choice of a tracheostomy and invasive ventilation in amyotrophic lateral sclerosis patients and to determine survival time after a tracheostomy at a single institute in Japan between 1990 and 2010. METHODS Data for survival time until death or tracheostomy were obtained from 160 patients. Fifty-two patients (33%) underwent tracheostomy/mechanical ventilation. RESULTS Tracheostomy and invasive ventilation prolonged median survival time (74 months), as did non-invasive ventilation (48 months) when compared to a non-ventilation-supported control group (32 months; p<0.001 each). The ratio of tracheostomy/mechanical ventilation in patients >65 years old significantly increased after 1999 (27%) compared to earlier years (10%, p=0.002). Cox proportional modeling confirmed an age of ≤65 years as advantageous for long-term survival after a tracheostomy. In univariate logistic regression analysis, factors related to the decision to perform a tracheostomy included an age of ≤65 years, greater use of non-invasive ventilation, the presence of a spouse, interval and speed from disease onset to diagnosis/tracheostomy and preservation of motor function. In multivariate logistic regression analysis, age, shorter duration from disease onset until tracheostomy and the presence of a spouse were independently associated with the decision to perform a tracheostomy. Kaplan-Meier plots revealed longer survival times in patients who resided at home after a tracheostomy compared to patients who stayed at a hospital (p=0.007). CONCLUSIONS Tracheostomy and invasive ventilation are frequently used in Japan. Various factors impact patients' decisions to have these procedures. This study identified factors related to the decision-making process and post-tracheostomy survival.
Collapse
|
24
|
Spectrum of cognitive impairment in Korean ALS patients without known genetic mutations. PLoS One 2014; 9:e87163. [PMID: 24498297 PMCID: PMC3911969 DOI: 10.1371/journal.pone.0087163] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022] Open
Abstract
Background Cognitive impairment is associated with a negative prognosis in amyotrophic lateral sclerosis (ALS), as well as with clinical specificity. We investigate neuropsychological function in ALS patients without known genetic mutations in a Korean tertiary clinic. Methods Three hundred and eighteen patients were enrolled in a prospective longitudinal cohort from September 2008 to February 2012. At the time of diagnosis of sporadic ALS, we carried out genetic and comprehensive neuropsychological tests on all patients, and collected demographic and clinical characteristics. Six cognitive domains, namely executive function, attention, language, calculation, visuospatial function and memory were evaluated. ANOVA and t-tests were used to assess differences in clinical characteristics and neuropsychological parameters between sporadic ALS patients. The Kaplan-Meier method and Cox proportional hazard model were used for survival analysis. Results One hundred and sixty-six patients were categorized into five subtypes: normal cognition (ALS pure), cognitive impairment (ALSci), behavioral impairment (ALSbi), frontotemporal dementia (ALS-FTD), and other types of dementia. Seventy patients (70/166, 42.2%) were cognitively or behaviorally impaired. Among the impaired patients, eight (8/166, 4.8%) had FTD-type dementia and one (1/166, 0.6%) was Alzheimer's disease-type. The ALS patients with cognitive impairment (ALSci) and with FTD (ALS-FTD) were more severely impaired in executive function, attention, language and memory than the cognitively intact ALS patients (ALS pure). In a survival analysis, ALSci (β = 1.925, p = 0.025) and ALS-FTD groups (β = 4.150, p = 0.019) tended to have shorter survival than the ALS pure group. Conclusions About half of ALS patients without known genetic variation have cognitive or behavioral impairment. ALS patients with cognitive abnormalities, especially FTD, have a poorer prognosis than those without cognitive impairment. In neuropsychological profiling, executive tasks were effective in identifying cognitive impairment in the ALS patients. It would be useful for clinicians to classify ALS according to neuropsychological profiles, and screen for subtle cognitive impairment.
Collapse
|