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Matteoni E, Canosa A, Chiò A, Moglia C, Gallone S. A novel DHTKD1 variant is associated with an atypical form of Charcot-Marie-Tooth disease type 2Q? Acta Neurol Belg 2024; 124:693-694. [PMID: 37907797 DOI: 10.1007/s13760-023-02419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023]
Affiliation(s)
- E Matteoni
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
| | - A Canosa
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della salute e della Scienza di Torino, SC, Neurologia 1U, Turin, Italy
- Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy
| | - A Chiò
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della salute e della Scienza di Torino, SC, Neurologia 1U, Turin, Italy
- Neuroscience Institute of Turin (NIT), Turin, Italy
| | - C Moglia
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della salute e della Scienza di Torino, SC, Neurologia 1U, Turin, Italy
| | - S Gallone
- Clinic Neurogenetic Neuroscience Department, University of Turin, Turin, Italy
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2
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Vasta R, Callegaro S, Sgambetterra S, Cabras S, Di Pede F, De Mattei F, Matteoni E, Grassano M, Bombaci A, De Marco G, Fuda G, Marchese G, Palumbo F, Canosa A, Mazzini L, De Marchi F, Moglia C, Manera U, Chiò A, Calvo A. Presymptomatic geographical distribution of ALS patients suggests the involvement of environmental factors in the disease pathogenesis. J Neurol 2023; 270:5475-5482. [PMID: 37491680 PMCID: PMC10576667 DOI: 10.1007/s00415-023-11888-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Given that the pathogenetic process of ALS begins many years prior to its clinical onset, examining patients' residential histories may offer insights on the disease risk factors. Here, we analyzed the spatial distribution of a large ALS cohort in the 50 years preceding the disease onset. METHODS Data from the PARALS register were used. A spatial cluster analysis was performed at the time of disease onset and at 1-year intervals up to 50 years prior to that. RESULTS A total of 1124 patients were included. The analysis revealed a higher-incidence cluster in a large area (435,000 inhabitants) west of Turin. From 9 to 2 years before their onset, 105 cases were expected and 150 were observed, resulting in a relative risk of 1.49 (P = 0.04). We also found a surprising high number of patients pairs (51) and trios (3) who lived in the same dwelling while not being related. Noticeably, these occurrences were not observed in large dwellings as we would have expected. The probability of this occurring in smaller buildings only by chance was very low (P = 0.01 and P = 0.04 for pairs and trios, respectively). CONCLUSIONS We identified a higher-incidence ALS cluster in the years preceding the disease onset. The cluster area being densely populated, many exposures could have contributed to the high incidence ALS cluster, while we could not find a shared exposure among the dwellings where multiple patients had lived. However, these findings support that exogenous factors are likely involved in the ALS pathogenesis.
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Affiliation(s)
- Rosario Vasta
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - S Callegaro
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - S Sgambetterra
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - S Cabras
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- International School of Advanced Studies, University of Camerino, Camerino, Italy
| | - F Di Pede
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - F De Mattei
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - E Matteoni
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - M Grassano
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - A Bombaci
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - G De Marco
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - G Fuda
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - G Marchese
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - F Palumbo
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - A Canosa
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - L Mazzini
- ALS Center, Department of Neurology, Azienda Ospedaliero Universitaria Maggiore della Carità, and University of Piemonte Orientale, Novara, Italy
| | - F De Marchi
- ALS Center, Department of Neurology, Azienda Ospedaliero Universitaria Maggiore della Carità, and University of Piemonte Orientale, Novara, Italy
| | - C Moglia
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - U Manera
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - A Chiò
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - A Calvo
- ALS Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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3
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Vasta R, D'Ovidio F, Canosa A, Manera U, Torrieri MC, Grassano M, De Marchi F, Mazzini L, Moglia C, Calvo A, Chiò A. Plateaus in amyotrophic lateral sclerosis progression: results from a population‐based cohort. Eur J Neurol 2020; 27:1397-1404. [DOI: 10.1111/ene.14287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- R. Vasta
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - F. D'Ovidio
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - A. Canosa
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - U. Manera
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - M. C. Torrieri
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - M. Grassano
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
| | - F. De Marchi
- Department of Neurology ALS Center Azienda Ospedaliero Universitaria Maggiore della Carità NovaraItaly
| | - L. Mazzini
- Department of Neurology ALS Center Azienda Ospedaliero Universitaria Maggiore della Carità NovaraItaly
| | - C. Moglia
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
- Neurology 1 Azienda Ospedaliero Universitaria Città della Salute e della Scienza Turin Italy
| | - A. Calvo
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
- Neurology 1 Azienda Ospedaliero Universitaria Città della Salute e della Scienza Turin Italy
| | - A. Chiò
- ‘Rita Levi Montalcini’ Department of Neuroscience ALS Center University of Turin TurinItaly
- Neurology 1 Azienda Ospedaliero Universitaria Città della Salute e della Scienza Turin Italy
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4
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Canosa A, Pagani M, Brunetti M, Barberis M, Iazzolino B, Ilardi A, Cammarosano S, Manera U, Moglia C, Calvo A, Cistaro A, Chiò A. Correlation between Apolipoprotein E genotype and brain metabolism in amyotrophic lateral sclerosis. Eur J Neurol 2018; 26:306-312. [PMID: 30240096 DOI: 10.1111/ene.13812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to evaluate the metabolic correlates of Apolipoprotein E (APOE) genotype in amyotrophic lateral sclerosis (ALS) and to investigate the role of ε2 as a risk factor for cognitive impairment. METHODS A total of 159 ALS cases underwent APOE and ALS-related genes analysis, neuropsychological assessment and cerebral 18 F-2-fluoro-2-deoxy-D-glucose positron emission tomography. The APOE genotype was regressed against whole brain metabolism as assessed by 18 F-2-fluoro-2-deoxy-D-glucose positron emission tomography, with age, sex, education, type of onset and C9orf72 status as covariates. RESULTS Brain metabolism was significantly positively correlated with APOE genotype from ε2/ε2 to ε3/ε4 in the left prefrontal [Brodmann area (BA) 10], orbitofrontal (BAs 11, 45, 47) and anterior cingulate (BA 32) cortices. There was a tendency to a relative hypometabolism going towards the ε2/ε2 extreme. CONCLUSIONS We found a highly significant, relatively lower metabolism in association with the ε2 allele in extra-motor areas typically affected in frontotemporal dementia (left prefrontal, orbitofrontal and anterior cingulate cortices), strengthening the finding of a role of ε2 as a risk factor for cognitive impairment in ALS. Our data suggested a link between cholesterol homeostasis and neurodegeneration.
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Affiliation(s)
- A Canosa
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin
| | - M Pagani
- Institute of Cognitive Sciences and Technologies (CNR), Rome, Italy.,Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden
| | - M Brunetti
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin
| | - M Barberis
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin
| | - B Iazzolino
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin
| | - A Ilardi
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin
| | - S Cammarosano
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin
| | - U Manera
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin
| | - C Moglia
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin
| | - A Calvo
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin.,Neuroscience Institute of Turin (NIT), Turin
| | - A Cistaro
- PET Centre AFFIDEA IRMET, Turin, Italy
| | - A Chiò
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin.,Institute of Cognitive Sciences and Technologies (CNR), Rome, Italy.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin.,Neuroscience Institute of Turin (NIT), Turin
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5
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Abstract
Aims and background. Medulloblastoma in adults is a rare tumor. The small number of cases in the reported series has not permitted a definite assessment of the prognostic role of clinical, pathologic and cell kinetics factors. The largest series of medulloblastoma in adults treated in a single institution is herein reported. Methods. The clinical, therapeutic, pathologic and proliferation features of medulloblastoma in 44 adult patients (> 18 years) were analyzed retrospectively with regard to postoperative survival. The proliferation potential of each tumor was evaluated by the immunohistochemical demonstration of proliferating cell nuclear antigen (PCNA) and Ki-67, clone MIB-1, in paraffin sections. Results. The overall 5- and 10-year survival rates were 40% and 35.6%, respectively. Significant factors in predicting a longer postoperative survival were: age < 37 years, decade of management (1977-1990), radiotherapy (50-55 Gy on the posterior fossa and 30-35 Gy on the spinal cord) and nuclear isomorphism. When corrected for adequacy of radiotreatment, desmoplastic type and differentiation were significantly correlated with a shorter survival. The PCNA-labelling index (LI) ranged from 34.5 to 82.2%, the MIB-1-LI ranged from 9.6 to 64.7%. No association was found between PCNA- or MIB-1-LI values and microscopic features, or between LI values and prognosis. Conclusions. Contrary to a general assumption, desmoplastic medulloblastoma and differentiated medulloblastoma are negative prognostic factors in adequately radiotreated adult patients. This may possibly be referred to lower radiosensitivity of these tumor variants. The LI with PCNA or Ki-67 is of no help in identifying aggressive tumors.
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Affiliation(s)
- M T Giordana
- Clinica Neurologica II, Università di Torino, Italy
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6
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Vigliani MC, Chiò A, Pezzulo T, Soffietti R, Giordana MT, Schiffer D. Proliferating Cell Nuclear Antigen (PCNA) in Low-Grade Astrocytomas: Its Prognostic Significance. Tumori 2018; 80:295-300. [PMID: 7974802 DOI: 10.1177/030089169408000411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background A clear line cannot be drawn between well-differentiated and anaplastic astrocytomas, and a subset of low-grade tumors, histologically indistinguishable from the others, behaves similarly to anaplastic astrocytomas. The proliferative index could aid in the identification of this subgroup, for which a different therapeutic approach would be indicated. Methods We immunohistochemically evaluated the proliferating ceil nuclear antigen (PCNA) expression in 77 well-differentiated astrocytomas, since PCNA has been considered a good proliferation marker. The prognostic significance of PCNA labeling index (LI) was assessed in univariate and multivariate analysis, taking into consideration some clinical and histologic factors known to affect prognosis. Results PCNA immunostaining identified a subgroup of tumors, characterized by a LI > 5%, with a median survival close to that observed in anaplastic astrocytomas. The survival table of such a group was significantly different from that of the group with a lower LI (p = 0.0009). Multivariate analysis confirmed that PCNA-LI is an independent prognostic factor (p = 0.001). Conclusion These data suggest that PCNA immunostaining can be a useful tool to define the prognosis of low-grade astrocytomas on routine biopsy material.
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Affiliation(s)
- M C Vigliani
- II Department of Neurology, University of Turin, Italy
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7
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Abstract
The clinico-pathologic data of 37 primary lymphomas of the brain were retrospectively reviewed. The tumors were classified according to the Kiel classification and the Working Formulation System. They represented 1.02% of all primary intracranial tumors of our series. The radiologic prediction appeared to be difficult: the suspicion was maximal when the absence of pathologic vessels at angiography occurred in a meningioma-like lesion at CT. Median survival was 4.53 months in the 16 cases who underwent surgery only versus 25.7 months in the 8 cases operated and irradiated with 40-60 Gy (p < 0.01). The prognosis of lymphomas of the CNS, even if radioresponsive tumors, remains poor. Most patients relapse after treatment, most often locally in the brain, with a variable frequency of spinal or systemic localization.
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Affiliation(s)
- D Schiffer
- II Neurological Clinic, University of Turin, Italy
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8
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Mandrioli J, Ferri L, Fasano A, Zucchi E, Fini N, Moglia C, Lunetta C, Marinou K, Ticozzi N, Drago Ferrante G, Scialo C, Sorarù G, Trojsi F, Conte A, Falzone YM, Tortelli R, Russo M, Sansone VA, Mora G, Silani V, Volanti P, Caponnetto C, Querin G, Monsurrò MR, Sabatelli M, Chiò A, Riva N, Logroscino G, Messina S, Calvo A. Cardiovascular diseases may play a negative role in the prognosis of amyotrophic lateral sclerosis. Eur J Neurol 2018. [PMID: 29512869 DOI: 10.1111/ene.13620] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Only a few studies have considered the role of comorbidities in the prognosis of amyotrophic lateral sclerosis (ALS) and have provided conflicting results. METHODS Our multicentre, retrospective study included patients diagnosed from 1 January 2009 to 31 December 2013 in 13 referral centres for ALS located in 10 Italian regions. Neurologists at these centres collected a detailed phenotypic profile and follow-up data until death in an electronic database. Comorbidities at diagnosis were recorded by main categories and single medical diagnosis, with the aim of investigating their role in ALS prognosis. RESULTS A total of 2354 incident cases were collected, with a median survival time from onset to death/tracheostomy of 43 months. According to univariate analysis, together with well-known clinical prognostic factors (age at onset, diagnostic delay, site of onset, phenotype, Revised El Escorial Criteria and body mass index at diagnosis), the presence of dementia, hypertension, heart disease, chronic obstructive pulmonary disease, haematological and psychiatric diseases was associated with worse survival. In multivariate analysis, age at onset, diagnostic delay, phenotypes, body mass index at diagnosis, Revised El Escorial Criteria, dementia, hypertension, heart diseases (atrial fibrillation and heart failure) and haematological diseases (disorders of thrombosis and haemostasis) were independent prognostic factors of survival in ALS. CONCLUSIONS Our large, multicentre study demonstrated that, together with the known clinical factors that are known to be prognostic for ALS survival, hypertension and heart diseases (i.e. atrial fibrillation and heart failure) as well as haematological diseases are independently associated with a shorter survival. Our findings suggest some mechanisms that are possibly involved in disease progression, giving new interesting clues that may be of value for clinical practice and ALS comorbidity management.
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Affiliation(s)
- J Mandrioli
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - L Ferri
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - A Fasano
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - E Zucchi
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - N Fini
- Department of Neuroscience, S. Agostino-Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena
| | - C Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Torino
| | - C Lunetta
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Milano.,NEuroMuscular Omnicentre (NEMO) Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina
| | - K Marinou
- Department of Neurorehabilitation-ALS Center, Scientific Institute of Milan, Salvatore Maugeri Foundation IRCCS, Milan
| | - N Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan.,Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, University of Milan, Milan
| | - G Drago Ferrante
- Neurorehabilitation Unit/ALS Center, Salvatore Maugeri Foundation, IRCCS, Mistretta, Messina
| | - C Scialo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, IRCCS AOU San Martino-IST, Genova
| | - G Sorarù
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padua
| | - F Trojsi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples
| | - A Conte
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation-Pol. A. Gemelli Foundation, Rome
| | - Y M Falzone
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan
| | - R Tortelli
- Department of Clinical Research in Neurology, University of Bari at Pia Fondazione 'Card. G. Panico', Tricase, Lecce
| | - M Russo
- Department of Clinical and Experimental Medicine, University of Messina and Nemo Sud Clinical Center for Neuromuscular Diseases, Aurora Foundation, Messina
| | - V A Sansone
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation, Milano.,Department of Biomedical Sciences for Health, University of Milan, Milan
| | - G Mora
- Department of Neurorehabilitation-ALS Center, Scientific Institute of Milan, Salvatore Maugeri Foundation IRCCS, Milan
| | - V Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan.,Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, University of Milan, Milan
| | - P Volanti
- Neurorehabilitation Unit/ALS Center, Salvatore Maugeri Foundation, IRCCS, Mistretta, Messina
| | - C Caponnetto
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, IRCCS AOU San Martino-IST, Genova
| | - G Querin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padua
| | - M R Monsurrò
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Naples
| | - M Sabatelli
- NEuroMuscular Omnicentre (NEMO), Serena Onlus Foundation-Pol. A. Gemelli Foundation, Rome.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - A Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Torino
| | - N Riva
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan
| | - G Logroscino
- Department of Clinical Research in Neurology, University of Bari at Pia Fondazione 'Card. G. Panico', Tricase, Lecce
| | - S Messina
- NEuroMuscular Omnicentre (NEMO) Sud Clinical Center for Neuromuscular Diseases, Aurora Onlus Foundation, Messina.,Department of Clinical and Experimental Medicine, University of Messina and Nemo Sud Clinical Center for Neuromuscular Diseases, Aurora Foundation, Messina
| | - A Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Torino
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Marrali G, Casale F, Salamone P, Fuda G, Ilardi A, Manera U, Calvo A, Zibetti M, Lopiano L, Chiò A. NADPH oxidases 2 activation in patients with Parkinson's disease. Parkinsonism Relat Disord 2018; 49:110-111. [DOI: 10.1016/j.parkreldis.2018.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
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10
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Vasta R, Calvo A, Moglia C, Cammarosano S, Manera U, Canosa A, D'Ovidio F, Mazzini L, Chiò A. Spatial epidemiology of amyotrophic lateral sclerosis in Piedmont and Aosta Valley, Italy: a population-based cluster analysis. Eur J Neurol 2018; 25:756-761. [PMID: 29377594 DOI: 10.1111/ene.13586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/19/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The analysis of the spatial distribution of cases could give important cues on putative environmental causes of a disease. Our aim was to perform a spatial analysis of an amyotrophic lateral sclerosis (ALS) cohort from the Piedmont and Aosta Valley ALS register (PARALS) over a 20-year period. METHODS The address at the moment of diagnosis was considered for each ALS case. Municipalities' and census divisions' resident populations during the 1995-2014 period were obtained. A cluster analysis was performed adopting both Moran's index and the Kulldorff spatial scan statistic. RESULTS A total of 2702 ALS patients were identified. An address was retrieved for 2671 (99%) patients. Moran's index was -0.01 (P value 0.83), thus revealing no clusters. SaTScan identified no statistically significant clusters. When census divisions were considered, Moran's index was 0.13 (P value 0.45); SaTScan revealed one statistically significant small cluster in the province of Alessandria. Here, 0.0099 cases were expected and three cases were observed (relative risk 304.60; 95% confidence interval 109.83-845.88, P value 0.03). DISCUSSION Our study showed a substantial homogeneous distribution of ALS cases in Piedmont and Aosta Valley. The population-based setting and the adoption of proper statistical analyses strengthen the validity of our results. Such a finding further suggests the involvement of multiple environmental and genetic factors in ALS pathogenesis.
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Affiliation(s)
- R Vasta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - A Calvo
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - C Moglia
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - S Cammarosano
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - U Manera
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - A Canosa
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - F D'Ovidio
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - L Mazzini
- ALS Center, Department of Neurology, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - A Chiò
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
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11
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D'Ovidio F, d'Errico A, Carnà P, Calvo A, Costa G, Chiò A. The role of pre-morbid diabetes on developing amyotrophic lateral sclerosis. Eur J Neurol 2017; 25:164-170. [PMID: 28921834 DOI: 10.1111/ene.13465] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The literature on the association between diabetes and amyotrophic lateral sclerosis (ALS) consists of a limited number of studies. This cohort study was developed in order to assess the role of diabetes on the risk of developing ALS. METHODS The study population was represented by all residents in Turin (Italy) at the beginning of 1996 who participated in the 1991 census, over 14 years of age (n = 727 977) and followed up for ALS occurrence from 1998 to 2014. Presence of diabetes at baseline or during follow-up was ascertained through two Piedmont regional sources: the Diabetes Registry and the Anatomical Therapeutic Chemical Drug Prescription Archive. The risk of ALS was estimated using the Piedmont and Valle d'Aosta ALS Registry (PARALS). The association of diabetes, treated as a time-dependent variable, with ALS onset was estimated through Cox proportional hazard regression models adjusted for age, gender, education and marital status. RESULTS During follow-up, 397 subjects developed ALS, 24 of whom were already diabetic before ALS onset. Diabetes was associated with a significantly decreased risk of ALS [hazard ratio, 0.30 (95% confidence interval, 0.19-0.45)] without differences in risk by gender, age class or ALS phenotype. CONCLUSION The results support the protective role of diabetes toward ALS.
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Affiliation(s)
- F D'Ovidio
- 'Rita Levi Montalcini' Department of Neurosciences, University of Turin, Turin
| | - A d'Errico
- Epidemiology Department ASL TO3 - Piedmont Region, Grugliasco, Turin, Italy
| | - P Carnà
- Epidemiology Department ASL TO3 - Piedmont Region, Grugliasco, Turin, Italy
| | - A Calvo
- 'Rita Levi Montalcini' Department of Neurosciences, University of Turin, Turin
| | - G Costa
- Epidemiology Department ASL TO3 - Piedmont Region, Grugliasco, Turin, Italy
| | - A Chiò
- 'Rita Levi Montalcini' Department of Neurosciences, University of Turin, Turin
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D’Ovidio F, d’Errico A, Calvo A, Costa G, Chiò A. Occupations and amyotrophic lateral sclerosis: are jobs exposed to the general public at higher risk? Eur J Public Health 2017; 27:643-647. [DOI: 10.1093/eurpub/ckx006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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13
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De Marco G, Lomartire A, Calvo A, Risso A, De Luca E, Mostert M, Mandrioli J, Caponnetto C, Borghero G, Manera U, Canosa A, Moglia C, Restagno G, Fini N, Tarella C, Giordana MT, Rinaudo MT, Chiò A. Monocytes of patients with amyotrophic lateral sclerosis linked to gene mutations display altered TDP-43 subcellular distribution. Neuropathol Appl Neurobiol 2016; 43:133-153. [PMID: 27178390 DOI: 10.1111/nan.12328] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/20/2016] [Accepted: 05/14/2016] [Indexed: 12/12/2022]
Abstract
AIMS Cytoplasmic accumulation of the nuclear protein transactive response DNA-binding protein 43 (TDP-43) is an early determinant of motor neuron degeneration in most amyotrophic lateral sclerosis (ALS) cases. We previously disclosed this accumulation in circulating lymphomonocytes (CLM) of ALS patients with mutant TARDBP, the TDP-43-coding gene, as well as of a healthy individual carrying the parental TARDBP mutation. Here, we investigate TDP-43 subcellular localization in CLM and in the constituent cells, lymphocytes and monocytes, of patients with various ALS-linked mutant genes. METHODS TDP-43 subcellular localization was analysed with western immunoblotting and immunocytofluorescence in CLM of healthy controls (n = 10), patients with mutant TARDBP (n = 4, 1 homozygous), valosin-containing protein (VCP; n = 2), fused in sarcoma/translocated in liposarcoma (FUS; n = 2), Cu/Zn superoxide dismutase 1 (SOD1; n = 6), chromosome 9 open reading frame 72 (C9ORF72; n = 4), without mutations (n = 5) and neurologically unaffected subjects with mutant TARDBP (n = 2). RESULTS TDP-43 cytoplasmic accumulation was found (P < 0.05 vs. controls) in CLM of patients with mutant TARDBP or VCP, but not FUS, in line with TDP-43 subcellular localization described for motor neurons of corresponding groups. Accumulation also characterized CLM of the healthy individuals with mutant TARDBP and of some patients with mutant SOD1 or C9ORF72. In 5 patients, belonging to categories described to carry TDP-43 mislocalization in motor neurons (3 C9ORF72, 1 TARDBP and 1 without mutations), TDP-43 cytoplasmic accumulation was not detected in CLM or in lymphocytes but was in monocytes. CONCLUSIONS In ALS forms characterized by TDP-43 mislocalization in motor neurons, monocytes display this alteration, even when not manifest in CLM. Monocytes may be used to support diagnosis, as well as to identify subjects at risk, of ALS and to develop/monitor targeted treatments.
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Affiliation(s)
- G De Marco
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - A Lomartire
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - A Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,ALS Center, University of Turin and AOU Città della Salute e della Scienza, Turin, Italy
| | - A Risso
- Molecular Biotechnology Center, University of Turin, Turin, Italy
| | - E De Luca
- Molecular Biotechnology Center, University of Turin, Turin, Italy
| | - M Mostert
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - J Mandrioli
- Department of Neuroscience, Sant'Agostino Estense Hospital, University of Modena, Modena, Italy
| | - C Caponnetto
- Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - G Borghero
- Department of Neurology, AOU and University of Cagliari, Cagliari, Italy
| | - U Manera
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,ALS Center, University of Turin and AOU Città della Salute e della Scienza, Turin, Italy
| | - A Canosa
- ALS Center, University of Turin and AOU Città della Salute e della Scienza, Turin, Italy.,Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health, IRCCS AOU San Martino IST, University of Genoa, Genoa, Italy
| | - C Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,ALS Center, University of Turin and AOU Città della Salute e della Scienza, Turin, Italy
| | - G Restagno
- Molecular Genetics Unit, Department of Clinical Pathology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - N Fini
- Department of Neuroscience, Sant'Agostino Estense Hospital, University of Modena, Modena, Italy
| | - C Tarella
- Clinical Hemato-Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - M T Giordana
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - M T Rinaudo
- Department of Oncology, University of Turin, Turin, Italy
| | - A Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,ALS Center, University of Turin and AOU Città della Salute e della Scienza, Turin, Italy
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14
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Marrali G, Salamone P, Casale F, Fuda G, Cugnasco P, Caorsi C, Amoroso A, Calvo A, Lopiano L, Cocito D, Chiò A. NADPH oxidase 2 (NOX2) enzyme activation in patients with chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2016; 23:958-63. [DOI: 10.1111/ene.12971] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G. Marrali
- ‘Rita Levi Montalcini’ Department of Neuroscience; University of Torino; Torino Italy
| | - P. Salamone
- ‘Rita Levi Montalcini’ Department of Neuroscience; University of Torino; Torino Italy
| | - F. Casale
- ‘Rita Levi Montalcini’ Department of Neuroscience; University of Torino; Torino Italy
| | - G. Fuda
- ‘Rita Levi Montalcini’ Department of Neuroscience; University of Torino; Torino Italy
| | - P. Cugnasco
- ‘Rita Levi Montalcini’ Department of Neuroscience; University of Torino; Torino Italy
| | - C. Caorsi
- Immunogenetics and Transplant Biology Laboratory; Department of Medical Sciences; University of Torino; Torino Italy
| | - A. Amoroso
- Immunogenetics and Transplant Biology Laboratory; Department of Medical Sciences; University of Torino; Torino Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza; Torino Italy
| | - A. Calvo
- ‘Rita Levi Montalcini’ Department of Neuroscience; University of Torino; Torino Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza; Torino Italy
| | - L. Lopiano
- ‘Rita Levi Montalcini’ Department of Neuroscience; University of Torino; Torino Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza; Torino Italy
| | - D. Cocito
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza; Torino Italy
| | - A. Chiò
- ‘Rita Levi Montalcini’ Department of Neuroscience; University of Torino; Torino Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza; Torino Italy
- Institute of Cognitive Sciences and Technologies; Consiglio nazionale delle Ricerche; Rome Italy
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15
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Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A, Cavalla P, Zibetti M, Rivoiro C, Oliver DJ. Specialist palliative care improves the quality of life in advanced neurodegenerative disorders: NE-PAL, a pilot randomised controlled study. BMJ Support Palliat Care 2015; 7:164-172. [DOI: 10.1136/bmjspcare-2014-000788] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/30/2015] [Accepted: 06/23/2015] [Indexed: 12/25/2022]
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16
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Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A, Rivoiro C, Oliver DJ. The palliative care needs of people severely affected by neurodegenerative disorders: A qualitative study. Progress in Palliative Care 2015. [DOI: 10.1179/1743291x15y.0000000007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Affiliation(s)
- A Chiò
- Rita Levi Montalcini' Department of Neuroscience, University of Turin and Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy. .,Neuroscience Institute of Torino, Torino, Italy.
| | - M Swash
- Blizard Institute of Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, London, UK.,Department of Physiology and Institute of Neuroscience, University of Lisbon, Lisbon, Portugal
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Chiò A, Logroscino G, Traynor BJ, Collins J, Simeone JC, Goldstein LA, White LA. Global epidemiology of amyotrophic lateral sclerosis: a systematic review of the published literature. Neuroepidemiology 2013; 41:118-30. [PMID: 23860588 DOI: 10.1159/000351153] [Citation(s) in RCA: 524] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/03/2013] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is relatively rare, yet the economic and social burden is substantial. Having accurate incidence and prevalence estimates would facilitate efficient allocation of healthcare resources. OBJECTIVE To provide a comprehensive and critical review of the epidemiological literature on ALS. METHODS MEDLINE and EMBASE (1995-2011) databases of population-based studies on ALS incidence and prevalence reporting quantitative data were analyzed. Data extracted included study location and time, design and data sources, case ascertainment methods and incidence and/or prevalence rates. Medians and interquartile ranges (IQRs) were calculated, and ALS case estimates were derived using 2010 population estimates. RESULTS In all, 37 articles met the inclusion criteria. In Europe, the median incidence rate (/100,000 population) was 2.08 (IQR 1.47-2.43), corresponding to an estimated 15,355 (10,852-17,938) cases. Median prevalence (/100,000 population) was 5.40 (IQR 4.06-7.89), or 39,863 (29,971-58,244) prevalent cases. CONCLUSIONS Disparity in rates among ALS incidence and prevalence studies may be due to differences in study design or true variations in population demographics such as age and geography, including environmental factors and genetic predisposition. Additional large-scale studies that use standardized case ascertainment methods are needed to more accurately assess the true global burden of ALS.
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Affiliation(s)
- A Chiò
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy.
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19
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Pupillo E, Messina P, Logroscino G, Zoccolella S, Chiò A, Calvo A, Corbo M, Lunetta C, Micheli A, Millul A, Vitelli E, Beghi E. Trauma and amyotrophic lateral sclerosis: a case-control study from a population-based registry. Eur J Neurol 2012; 19:1509-17. [PMID: 22537412 DOI: 10.1111/j.1468-1331.2012.03723.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/13/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Published reports on the association between amyotrophic lateral sclerosis (ALS) and trauma are controversial suggesting the need for a new case-control study done in a large population. METHODS A case-control study was undertaken in Italy to assess this association. Cases were patients with newly diagnosed ALS from four population-based registries. For each case, two hospital controls were selected, matched for age, sex, and province of residence, one with a neurological (non-degenerative) disease and one with a non-neurological disease (other than orthopedic or surgical). Traumatic events (defined as accidental events causing injuries requiring medical care) were recorded with details on type, site, timing, severity, and complications. The risks were assessed as odds ratios (ORs) with 95% confidence intervals (CI), crude and adjusted for age, sex, education, interviewee (patient or surrogate), physical activity, smoking, alcohol, and coffee. RESULTS The study population comprised 377 patients in each of the three groups. One or more traumatic events were reported by 225 cases (59.7%), 191 neurological controls (50.7%), and 179 non-neurological controls (47.5%) (P < 0.01) (OR 1.63; 95% CI 1.25-2.14) (P < 0.01). The ORs were 3.07 (95% CI 1.86-5.05) for patients reporting 3+ traumatic events and 2.44 (95% CI 1.36-4.40) for severe traumatic events. The ORs remained significant when the analysis was limited to events that occurred 5+ and 10+ years before ALS onset, to incident ALS, and direct informant. CONCLUSION Antecedent trauma, repeated trauma, and severe trauma may be risk factors for ALS.
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Affiliation(s)
- E Pupillo
- Laboratorio di Malattie Neurologiche, Istituto Mario Negri, Milan, Italy
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Restagno G, Gomez A, Lombardo F, Cocco E, Calvo A, Ghiglione P, Mutani R, Chiò A. The IVS1 +319 t>a of SOD1 gene is not an ALS causing mutation. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/14660820410021276a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Carrara G, Carapelli C, Venturi F, Ferraris MM, Lequio L, Chiò A, Calvo A, Sirgiovanni S, Cistaro A, Valentini MC. A distinct MR imaging phenotype in amyotrophic lateral sclerosis: correlation between T1 magnetization transfer contrast hyperintensity along the corticospinal tract and diffusion tensor imaging analysis. AJNR Am J Neuroradiol 2012; 33:733-9. [PMID: 22194369 DOI: 10.3174/ajnr.a2855] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In the search for a diagnostic marker in ALS, we focused our attention on the hyperintense signal intensity in T1 MTC MR images along the CST, detected in some patients and not found in other patients with ALS and in control subjects. The aim of this study was to investigate the relationship between the hyperintense signal intensity in T1 MTC images and white matter damage. To this purpose, we studied potential heterogeneities in DTI values within our patients by using TBSS without a priori anatomic information. MATERIALS AND METHODS In 43 patients with ALS and 43 healthy control subjects, the presence or absence of T1 MTC hyperintense signal intensity was evaluated. With a DTI analysis with a TBSS approach, differences in FA distribution between the 2 groups (patients with T1 MTC hyperintense signal intensity and patients without it) compared with each other and with control subjects were investigated. RESULTS We found regional differences in white matter FA between patients with T1 MTC hyperintense signal intensity (37.2%) and patients without it. Patients with T1 MTC abnormal signal intensity showed lower FA strictly limited to the motor network and the posterior aspect of the body of the CC without extramotor FA reductions, whereas patients without this sign showed FA reductions in several confluent regions within and outside the CST and in the whole CC. CONCLUSIONS T1 MTC hyperintense signal intensity in the CST and posterior CC, when present, is specific for ALS and represents, among patients with ALS, a possible distinct phenotype of presentation of the disease with prominent UMN involvement.
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Affiliation(s)
- G Carrara
- Neuroradiology Department of CTO Hospital, Torino, Italy.
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Chiò A, Canosa A, Gallo S, Moglia C, Ilardi A, Cammarosano S, Papurello D, Calvo A. Pain in amyotrophic lateral sclerosis: a population-based controlled study. Eur J Neurol 2011; 19:551-5. [DOI: 10.1111/j.1468-1331.2011.03540.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Chiò A, Canosa A, Gallo S, Cammarosano S, Moglia C, Fuda G, Calvo A, Mora G. ALS clinical trials: do enrolled patients accurately represent the ALS population? Neurology 2011; 77:1432-7. [PMID: 21956723 DOI: 10.1212/wnl.0b013e318232ab9b] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the effect of eligibility criteria in amyotrophic lateral sclerosis (ALS) clinical trials on the representativeness of the enrolled population. METHODS Patients enrolled in 8 placebo-controlled clinical trials in our ALS center from 2003 to 2008 were compared 1) to the patients included a prospective epidemiologic register (Piemonte and Valle d'Aosta register for ALS, PARALS) in the same period and 2) the subset of PARALS patients who met the usual criteria for inclusion in clinical trials (PARALS-ct) (definite, probable, probable laboratory-supported ALS; age between 18 and 75 years; disease duration <36 months; vital capacity at diagnosis ≥70%; score ≥3 at the items swallowing and respiratory insufficiency at the Amyotrophic Lateral Sclerosis Functional Rating Scale-revised scale; riluzole therapy). RESULTS A total of 164 patients were enrolled in 8 different clinical trials. The PARALS cohort included 813 patients, of whom 539 (66.3%) met the entry criteria for clinical trials. Patients enrolled in clinical trials were different from both epidemiologic cohorts, since they were younger, had a longer diagnostic delay, and were more likely to have a spinal onset, and to be men. Tracheostomy-free survival was significantly longer in the group of patients enrolled in clinical trials (median survival time, trial patients, 3.9 years [95% confidence interval (CI) 3.4-4.4]; PARALS, 2.6 [2.4-2.8]; PARALS-ct, 2.9 [2.7-3.1]). CONCLUSIONS Patients enrolled in clinical trials do not satisfactorily represent the ALS population; consequently, the findings of ALS trials lack of external validity (generalizability). Efforts should be made to improve patients' recruitment in trials, particularly enrolling incident rather than prevalent cases.
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Affiliation(s)
- A Chiò
- ALS Centre, Department of Neuroscience, University of Turin, Turin.
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Chiò A, Vignola A, Mastro E, Giudici AD, Iazzolino B, Calvo A, Moglia C, Montuschi A. Neurobehavioral symptoms in ALS are negatively related to caregivers' burden and quality of life. Eur J Neurol 2011; 17:1298-303. [PMID: 20402747 DOI: 10.1111/j.1468-1331.2010.03016.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the frequency of neurobehavioral symptoms related to FTLD in a consecutive series of amyotrophic lateral sclerosis (ALS) patients and to assess their influence on patients' and caregivers' mood, burden, and quality of life. METHODS A total of 70 couples of ALS patients and their caregivers consecutively seen in our ALS clinic were separately interviewed using a battery of tests assessing frontotemporal-related neurobehavioral symptoms, emotional status, and quality of life. Patients' behavioral abnormalities were assessed with the Frontal Systems Behavior Scale (FrSBe). Caregiver burden was assessed with the Caregiver Burden Inventory (CBI). RESULTS According to caregivers' evaluations, 34 (48.6%) patients had FrSBe pathological scores at the time of the interview. According to patients' evaluation, 9 (12.9%) patients had pathological scores at the time of the interview. In caregivers' assessment, at the time of the interview the most commonly impaired neurobehavioral domain was apathy (39 patients, 55.7%), followed by executive dysfunction (32, 45.7%) and disinhibition (18, 25.7%). Neurobehavioral symptoms were related to the presence of bulbar symptoms at the time of the interview, but not to patients' age, gender, or physical status (ALS-FRS score). Patients' neurobehavioral symptoms were significantly related to lower caregivers' quality of life, highest depression, and highest burden, both in univariate and in multivariable analyses. CONCLUSIONS Neurobehavioral symptoms were present in 50% of our ALS patients and were related to bulbar symptoms. They have a profound negative impact on caregivers' psychological status and were highly related with caregivers' burden.
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Affiliation(s)
- A Chiò
- ALS Center, Department of Neuroscience, University of Torino, San Giovanni Battista Hospital, Torino, Italy.
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Chiò A, Calvo A, Ghiglione P, Mazzini L, Mutani R, Mora G. Tracheostomy in amyotrophic lateral sclerosis: a 10-year population-based study in Italy. J Neurol Neurosurg Psychiatry 2010; 81:1141-3. [PMID: 20660920 DOI: 10.1136/jnnp.2009.175984] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We evaluated the clinical characteristics and outcome of tracheostomy in amyotrophic lateral sclerosis (ALS) using data from the Piemonte and Valle d'Aosta Register for ALS, a prospective epidemiological register collecting all ALS incident cases in two Italian regions. Among the 1260 patients incident in the period 1995-2004, 134 (10.6%) underwent tracheostomy. Young male patients were more likely to be tracheostomised. Site of onset (bulbar vs spinal) and period of diagnosis (1995-1999 vs 2000-2004) did not influence the likelihood of being tracheostomised. The mean duration of hospital stay was 52.0 days (SD 60.5). Overall, 27 patients died while still in hospital (20.1%). Sixty-five patients (48.5%) were discharged to home, whereas 42 (31.3%) were admitted to long-term care facilities. The median survival time after tracheostomy was 253 days. In the Cox multivariable model, the factors independently related to a longer survival were enteral nutrition, age, marital status and ALS centre follow-up. In conclusion, in an epidemiological setting, ALS survival after tracheostomy was <1 year. Sociocultural factors influence the probability of choice to be tracheostomised, even in a highly socialized health system as Italian one.
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Affiliation(s)
- A Chiò
- ALS Centre, Department of Neuroscience, University of Torino, Torino, Italy.
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Chiò A, Borghero G, Calvo A, Capasso M, Caponnetto C, Corbo M, Giannini F, Logroscino G, Mandrioli J, Marcello N, Mazzini L, Moglia C, Monsurrò MR, Mora G, Patti F, Perini M, Pietrini V, Pisano F, Pupillo E, Sabatelli M, Salvi F, Silani V, Simone IL, Sorarù G, Tola MR, Volanti P, Beghi E. Lithium carbonate in amyotrophic lateral sclerosis: lack of efficacy in a dose-finding trial. Neurology 2010; 75:619-25. [PMID: 20702794 DOI: 10.1212/wnl.0b013e3181ed9e7c] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A neuroprotective effect of lithium in amyotrophic lateral sclerosis (ALS) has been recently reported. We performed a multicenter trial with lithium carbonate to assess its tolerability, safety, and efficacy in patients with ALS, comparing 2 different target blood levels (0.4-0.8 mEq/L, therapeutic group [TG], vs 0.2-0.4 mEq/L, subtherapeutic group [STG]). METHODS The study was a multicenter, single-blind, randomized, dose-finding trial, conducted from May 2008 to November 2009 in 21 Italian ALS centers. The trial was registered with the public database of the Italian Agency for Drugs (http://oss-sper-clin.agenziafarmaco.it/) (EudraCT number 2008-001094-15). RESULTS As of October 2009, a total of 171 patients had been enrolled, 87 randomized to the TG and 84 to the STG. The interim data analysis, performed per protocol, showed that 117 patients (68.4%) discontinued the study because of death/tracheotomy/severe disability, adverse events (AEs)/serious AEs (SAEs), or lack of efficacy. The Data Monitoring Committee recommended stopping the trial on November 2, 2009. CONCLUSIONS Lithium was not well-tolerated in this cohort of patients with ALS, even at subtherapeutic doses. The 2 doses were equivalent in terms of survival/severe disability and functional data. The relatively high frequency of AEs/SAEs and the reduced tolerability of lithium raised serious doubts about its safety in ALS. CLASSIFICATION OF EVIDENCE The study provides Class II evidence that therapeutic (0.4-0.8 mEq/L) vs subtherapeutic (0.2-0.4 mEq/L) lithium carbonate did not differ in the primary outcome of efficacy (survival/loss of autonomy) in ALS. Both target levels led to dropouts in more than 30% of participants due to patient-perceived lack of efficacy and AEs.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, via Cherasco 15, 10126 Torino, Italy.
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Agosta F, Chiò A, Cosottini M, De Stefano N, Falini A, Mascalchi M, Rocca MA, Silani V, Tedeschi G, Filippi M. The present and the future of neuroimaging in amyotrophic lateral sclerosis. AJNR Am J Neuroradiol 2010; 31:1769-77. [PMID: 20360339 DOI: 10.3174/ajnr.a2043] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In patients with ALS, conventional MR imaging is frequently noninformative, and its use has been restricted to excluding other conditions that can mimic ALS. Conversely, the extensive application of modern MR imaging-based techniques to the study of ALS has undoubtedly improved our understanding of disease pathophysiology and is likely to have a role in the identification of potential biomarkers of disease progression. This review summarizes how new MR imaging technology is changing dramatically our understanding of the factors associated with ALS evolution and highlights the reasons why it should be used more extensively in studies of disease progression, including clinical trials.
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Affiliation(s)
- F Agosta
- Institute of Experimental Neurology, University Hospital San Raffaele, Milan, Italy
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Chiò A, Calvo A, Ilardi A, Cavallo E, Moglia C, Mutani R, Palmo A, Galletti R, Marinou K, Papetti L, Mora G. Lower serum lipid levels are related to respiratory impairment in patients with ALS. Neurology 2009; 73:1681-5. [PMID: 19917991 DOI: 10.1212/wnl.0b013e3181c1df1e] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Recently hyperlipidemia was reported to be related to a significantly better outcome in amyotrophic lateral sclerosis (ALS). To investigate this, we evaluated the status of blood lipids in a large Italian series of patients with ALS, and assessed the effect of hyperlipidemia on patients' survival. METHODS The study population included 658 patients with ALS consecutively observed in 2 Italian ALS centers between 2000 and 2006. They were compared to a series of 658 healthy subjects, matched by age and gender. RESULTS The mean levels of total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and the LDL/HDL ratio were similar in patients with ALS and controls. Total cholesterol, HDL, triglyceride, and LDL/HDL ratio levels showed a significant decrease in patients with forced vital capacity <70% compared to those with FVC >or=90%. For each level of ALS-FRS, poorer respiratory function was related to a lower LDL/HDL ratio. Univariate survival analysis did not find any significant effect of LDL/HDL ratio on survival, either when comparing patients with ratios <or=2.99 vs >2.99 or patients in the first quartile of LDL/HDL ratio (<or=1.67) vs those in the fourth quartile (>2.79). No dose-response was found for LDL/HDL ratio subdividing patients into 5 quintiles. CONCLUSION Our findings do not support the observation that patients with amyotrophic lateral sclerosis have hyperlipidemia or that hyperlipidemia in this population is related to longer survival. However, some evidence emerged that respiratory impairment, but not a worse clinical status or a lower body mass index, is related to a decrease in blood lipids and LDL/HDL ratio.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, University of Torino, ALS Center, Torino, Italy.
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Restagno G, Gomez A, Lombardo F, Cocco E, Calvo A, Ghiglione P, Mutani R, Chiò A. Randomised controlled trial in non-invasive ventilation: what trial? ACTA ACUST UNITED AC 2009; 6:45-9. [PMID: 16036425 DOI: 10.1080/14660820410021276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is caused by mutations in the gene for Cu/Zn superoxide dismutase (SOD1) in 10% of familial and sporadic cases. During the SOD1 analysis of 9 FALS and 121 SALS, in only one sporadic case we found the exonic mutation N19S; in 15 SALS patients we found a 319t>a variation in IVS1 sequence, at 108 bp upstream from exon 2. This variation has an unusually high frequency of 11% and is always in linkage disequilibrium with a described polymorphism in IVS3, +34a>c. The 319t>a variation is classified in two different public databases, HGMD and The ALS Online Database, as a splicing mutation and not as a polymorphism. The unusually high frequency of this mutation in our patients prompted us to determinate its frequency in 130 age- and gender- matched healthy controls and in 54 patients with Alzheimer's disease. We found again linkage disequilibrium with the polymorphism in intron 3, and the frequency of 11% and 7.8%, respectively. These results strongly support the idea that the IVS1 +319 t>a alone is not an ALS causing mutation, and that special care must be taken in the interpretation of data from mutations databases for correct genetic counselling.
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Affiliation(s)
- G Restagno
- S.C.Molecolare, Dipartmento di Patalogia Clinica, A.O.O.I.R.M.-S. Anna, Torino, Italy
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Vercellino M, Romagnolo A, Mattioda A, Masera S, Piacentino C, Merola A, Chiò A, Mutani R, Cavalla P. Multiple sclerosis relapses: a multivariable analysis of residual disability determinants. Acta Neurol Scand 2009; 119:126-30. [PMID: 18684216 DOI: 10.1111/j.1600-0404.2008.01076.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recovery from multiple sclerosis (MS) relapses is variable. The factors influencing persistence of residual disability (RD) after a relapse are still to be thoroughly elucidated. AIMS OF STUDY To assess RD after MS relapses and to define the factors associated with persistence of RD. METHODS Data were retrospectively collected for all relapses in a population of relapsing-remitting MS patients during 3 years. Relapse severity and RD after 1 year were calculated on Expanded Disability Status Scale basis. A multivariable analysis for factors influencing RD and relapse severity was performed (variables: age, gender, disease duration, oligoclonal bands, relapse severity, monosymptomatic/polysymptomatic relapse, immunomodulating treatment, incomplete recovery at 1 month). RESULTS A total of 174 relapses were assessed. RD after 1 year was observed in 54.5% of the relapses. Higher risk of RD was associated with occurrence of a severe relapse (P = 0.024). Incomplete recovery at 1 month was highly predictive of RD at 1 year (P < 0.0001). Risk of a severe relapse was associated with age <or= 30 years (P = 0.025) and inversely associated with the use of immunomodulating treatment (P = 0.006). CONCLUSIONS Incomplete recovery at 1 month is a predictor of long-term persistence of RD. Higher relapse severity is associated with higher risk of RD. Risk of severe relapses is lower in patients treated with immunomodulating drugs.
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Affiliation(s)
- M Vercellino
- Department of Neuroscience, University of Turin, Italy
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Vignola A, Guzzo A, Calvo A, Moglia C, Pessia A, Cavallo E, Cammarosano S, Giacone S, Ghiglione P, Chiò A. Anxiety undermines quality of life in ALS patients and caregivers. Eur J Neurol 2008; 15:1231-6. [PMID: 18803649 DOI: 10.1111/j.1468-1331.2008.02303.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although depression has been widely studied in amyotrophic lateral sclerosis (ALS), there is little information on anxiety. OBJECTIVE To detect anxiety in patients with ALS and their caregivers, comparing the diagnostic and the follow-up phases of the disease and assessing its impact on quality of life (QoL). METHODS Anxiety has been evaluated with the State and Trait Anxiety Inventory in a series of 75 consecutive ALS patients and their primary caregivers. Anxiety has been related to depression, QoL, and satisfaction with life. RESULTS In patients, state anxiety was significantly higher during the diagnostic phase, whilst in caregivers it was similar in the two phases. Patients' state anxiety was related to depression, shorter disease duration and lower satisfaction with life. Caregivers' state anxiety was related to their trait anxiety. Whilst in patients QoL and satisfaction with life were similar in the two phases, in caregivers there was a significant decrease of satisfaction with life in the follow-up phase. CONCLUSIONS Treating neurologists should recognize that the diagnostic phase and the earlier period after the diagnosis is characterized by a high level of anxiety both in ALS patients and in their caregivers, and should propose pharmacological and psychological interventions to relieve this highly distressing disturbance.
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Affiliation(s)
- A Vignola
- Department of Neuroscience, ALS Center, University of Torino, Torino, Italy
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Chiò A, Cocito D, Bottacchi E, Buffa C, Leone M, Plano F, Mutani R, Calvo A. Idiopathic chronic inflammatory demyelinating polyneuropathy: an epidemiological study in Italy. J Neurol Neurosurg Psychiatry 2007; 78:1349-53. [PMID: 17494979 PMCID: PMC2095630 DOI: 10.1136/jnnp.2007.114868] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Revised: 03/15/2007] [Accepted: 04/09/2007] [Indexed: 11/03/2022]
Abstract
AIM The clinical and epidemiological characteristics of chronic inflammatory demyelinating polyneuropathy (CIDP) in an Italian population were assessed. SUBJECTS AND METHODS All subjects with a diagnosis of demyelinating neuropathy after 1990 in Piemonte and Valle d'Aosta (4,334,225 inhabitants) were considered. The diagnosis of CIDP was based on the research criteria of the American Academy of Neurology. 165 of 294 patients met the diagnostic criteria. RESULTS The crude prevalence rate was 3.58/100,000 population (95% CI 3.02 to 4.20). At the prevalence day, 76 (49.0%) cases had definite, 67 (43.2%) probable and 12 (7.7%) possible CIDP; disability was mild in 105 (67.7%) cases, moderate in 32 (20.6%) and severe in 18 (11.6%). The course was remitting-relapsing in 40 cases (25.8%), chronic progressive in 96 (61.9%) and monophasic in 19 (12.3%). Considering the 95 patients whose disorder presented in the period 1995-2001, the mean annual crude incidence rate was 0.36/100,000 population (95% CI 0.29 to 0.44), with a male to female ratio of 2.3:1. 14 cases were affected by diabetes mellitus. In multivariate analysis, factors related to severe disability at the prevalence day were: age >60 years; failure of immunomodulating therapies at the time of diagnosis; worse disability at nadir; and chronic course. CONCLUSION Incidence and prevalence rates of CIDP in Italy were higher than those observed in most previous studies. At the prevalence day, more than 80% of cases had a mild or moderate disability, indicating either a good response to immunomodulating therapy or a tendency of CIDP to have a mild course in most cases.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, University of Torino, Italy.
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Chiò A, Montuschi A, Cammarosano S, De Mercanti S, Cavallo E, Ilardi A, Ghiglione P, Mutani R, Calvo A. ALS patients and caregivers communication preferences and information seeking behaviour. Eur J Neurol 2007; 15:55-60. [PMID: 18005051 DOI: 10.1111/j.1468-1331.2007.02000.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To evaluate information preferences and information seeking behaviour in ALS patients and caregivers. Sixty ALS patients and caregivers couples were interviewed using a structured questionnaire about the content of diagnosis communication and their information seeking behaviour. The patients (35 men and 25 women) had a mean age of 63.4 years (SD 9.5). The caregivers (21 men and 39 women) had a mean age of 53.3 years (SD 14.9). The overall satisfaction with bad news communication and the impression that the physician had understood their feelings were higher amongst patients. Both parties indicated that the most important aspects to be informed were current researches, disease-modifying therapies and ALS outcome. Approximately 55% of patients and 83.3% of caregivers searched for information from sources outside the healthcare system. The most frequently checked source was internet, although its reliability was rated low. The caring neurologist should better attune the content of communication to patients' and caregivers' preferences, trying to understand what they want to know and encouraging them to make precise questions. Health professionals should be aware that ALS patients and caregivers often use internet to obtain information and should help them to better sort-out and interpret the news they found.
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Affiliation(s)
- A Chiò
- ALS Centre, Department of Neuroscience, University of Torino, Torino, Italy.
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Schymick JC, Yang Y, Andersen PM, Vonsattel JP, Greenway M, Momeni P, Elder J, Chiò A, Restagno G, Robberecht W, Dahlberg C, Mukherjee O, Goate A, Graff-Radford N, Caselli RJ, Hutton M, Gass J, Cannon A, Rademakers R, Singleton AB, Hardiman O, Rothstein J, Hardy J, Traynor BJ. Progranulin mutations and amyotrophic lateral sclerosis or amyotrophic lateral sclerosis-frontotemporal dementia phenotypes. J Neurol Neurosurg Psychiatry 2007; 78:754-6. [PMID: 17371905 PMCID: PMC2117704 DOI: 10.1136/jnnp.2006.109553] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Mutations in the progranulin (PGRN) gene were recently described as the cause of ubiquitin positive frontotemporal dementia (FTD). Clinical and pathological overlap between amyotrophic lateral sclerosis (ALS) and FTD prompted us to screen PGRN in patients with ALS and ALS-FTD. METHODS The PGRN gene was sequenced in 272 cases of sporadic ALS, 40 cases of familial ALS and in 49 patients with ALS-FTD. RESULTS Missense changes were identified in an ALS-FTD patient (p.S120Y) and in a single case of limb onset sporadic ALS (p.T182M), although the pathogenicity of these variants remains unclear. CONCLUSION PGRN mutations are not a common cause of ALS phenotypes.
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Affiliation(s)
- J C Schymick
- Laboratory of Neurogenetics, National Institute of Aging, NIH, Bethesda, Maryland, USA
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Gauthier A, Vignola A, Calvo A, Cavallo E, Moglia C, Sellitti L, Mutani R, Chiò A. A longitudinal study on quality of life and depression in ALS patient–caregiver couples. Neurology 2007; 68:923-6. [PMID: 17372127 DOI: 10.1212/01.wnl.0000257093.53430.a8] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate the modification of quality of life (QoL) and depression in a series of amyotrophic lateral sclerosis (ALS) patient-caregiver couples during a period of 9 months and compare them to patients' ALS Functional Rating Scale (ALS-FRS). METHODS Depression was assessed with Zung Depression Scale (ZDS) and QoL with McGill Quality of Life Questionnaire (MQoL). Caregivers' burden was assessed with Caregiver Burden Inventory (CBI), and patients' feeling to be a burden with the Self-Perceived Burden Scale (SPBS). RESULTS Thirty-one ALS patient-caregiver couples were interviewed at baseline and after 9 months. The mean ALS-FRS score was 28.7 (SD 7) at baseline and 24.1 (6.9) at the second interview (p = 0.0001). Patients' mean MQoL score slightly increased from 6.8 (1.6) to 7 (1.1) (p = 0.07); their ZDS score slightly increased (43.2 [8.7] at baseline and 45.7 [9.3] at the second interview) but they remained in the not depressed range. Caregivers' mean MQoL score slightly decreased, and their mean ZDS increased from 38.9 (8.1) to 42.2 (8.7) (p = 0.02). The mean CBI score increased from 50.3 (17.6) to 55.8 (16.4) (p = 0.03). CONCLUSIONS We found a substantial steadiness of quality of life and depression in patients with amyotrophic lateral sclerosis over a 9-month period, vs a significant increase of burden and depression of their caregivers.
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Affiliation(s)
- A Gauthier
- Dipartimento di Neuroscienze, University of Torino, Torino, Italy
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Restagno G, Lombardo F, Ghiglione P, Calvo A, Cocco E, Sbaiz L, Mutani R, Chiò A. HFE H63D polymorphism is increased in patients with amyotrophic lateral sclerosis of Italian origin. J Neurol Neurosurg Psychiatry 2007; 78:327. [PMID: 17308297 PMCID: PMC2117634 DOI: 10.1136/jnnp.2006.092338] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
The authors evaluated the caregiver time for 70 patients with ALS. The mean number of caregivers per patient was 2.0 (SD 1.3). Caregiver time increased with worsening of disability (p = 0.0001). The most time-consuming duties were housekeeping, feeding, and toileting. With worsening of patients' disability, families relied increasingly on paid caregivers. Caregiver time is a hidden cost of ALS care and is a major burden for caregivers.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, University of Turin, Torino, Italy.
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Chiò A, Bottacchi E, Buffa C, Mutani R, Mora G. Positive effects of tertiary centres for amyotrophic lateral sclerosis on outcome and use of hospital facilities. J Neurol Neurosurg Psychiatry 2006; 77:948-50. [PMID: 16614011 PMCID: PMC2077622 DOI: 10.1136/jnnp.2005.083402] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 02/17/2006] [Accepted: 03/31/2006] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the effects of tertiary centres for amyotrophic lateral sclerosis (ALS) on ALS outcome and the use of hospital facilities. METHODS The study was based on the data of an epidemiological, prospective, population-based register on ALS (Piemonte and Valle d'Aosta Register for amyotrophic lateral sclerosis, PARALS). The 221 patients recruited between 1995 and 1996 were prospectively followed up for outcome and use of hospital-based services. RESULTS In all, 97 patients were followed up by tertiary ALS centres and 124 by general neurological clinics. Patients followed up by tertiary ALS centres were found to be 4 years younger and underwent percutaneous endoscopic gastronomy and non-invasive positive-pressure ventilation more often. Patients followed up by tertiary ALS centres were found to have a considerably longer median survival time (1080 v 775 days), even when stratifying by age, site of onset and respiratory function at diagnosis. In Cox multivariate analysis, attending a tertiary ALS centre was observed to be an independent positive prognostic factor. Moreover, patients attending a tertiary ALS centre were admitted to hospital less often (1.2 v 3.3) and were more frequently admitted for planned interventions. Conversely, patients followed up by general neurological clinics were more frequently admitted for acute events. Also, the hospital stay was considerably shorter for patients attending tertiary ALS centres (5.8 v 12.4 days). CONCLUSIONS Improved survival was seen in patients with ALS attending tertiary ALS centres, independently from all other known prognostic factors, possibly through a better implementation of supportive treatments. Moreover, because of these centres, the hospitalisation rate was markedly reduced, thus offering a cost-effective service to patients with ALS and to the community as a whole.
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Affiliation(s)
- A Chiò
- Divisione di Neurologia 1, Dipartimento di Neuroscienze, Università di Torino, Torino, Italy.
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Cocito D, Chiò A, Tavella A, Poglio F, Paolasso I, Ciaramitaro P, Bergamasco B, Isoardo G. Treatment response and electrophysiological criteria in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2006; 13:669-70. [PMID: 16796598 DOI: 10.1111/j.1468-1331.2006.01259.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The determinants of ALS caregiver burden and the feeling of the patients as being a burden were assessed using the Caregiver Burden Inventory and the Self-Perceived Burden Scale in 60 caregiver-patient couples. Caregiver burden was correlated to their level of depression and quality of life and, differently from other chronic disorders, increased with the worsening of patients' disability. ALS patients have a good objective perception of their impact on caregivers.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, University of Turin, Italy.
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Abstract
BACKGROUND Understanding the determinants of quality of life (QoL) in amyotrophic lateral sclerosis (ALS) has become increasingly important with the recent emphasis on the comprehensive management of patients. OBJECTIVE To evaluate the determinants of QoL in ALS using two scales with different theoretical constructs: the Schedule for the Evaluation of QoL-Direct Weighting (SEIQoL-DW), which evaluates subjective aspects of QoL, and the McGill QoL Questionnaire (MQOL), which evaluates both health related and non-health related factors of QoL. METHODS Eighty consecutive patients with ALS underwent a battery of tests evaluating QoL and a series of physical, emotional, psychological, and socioeconomic predictor variables. A stepwise linear regression model was used to compare QoL scores and explicatory variables. RESULTS SEIQoL-DW score was related to social support, depression, religiosity, and socioeconomic status. Total MQOL score was related to social support, socioeconomic status, and clinical status. MQOL single item score (MQOL-SIS) was related to social support, depression, social withdrawal, and socioeconomic status. SEIQoL-DW score was not related to total MQOL score. Conversely, a significant correlation was found between SEIQoL-DW and MQOL-SIS. CONCLUSIONS With both QoL scales, the most important explicatory variable of QoL was the self perceived quality of social support. Physical status was not relevant in determining QoL. This study indicates that health related QoL measures are not adequate to assess QoL in patients with ALS, because their appreciation of QoL mainly relies on psychological, supportive, and spiritual factors. Therapeutic interventions should consider the psychological needs of patients and pay greater attention to caregivers' issues.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Torino, Italy.
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Chiò A, Galletti R, Finocchiaro C, Righi D, Ruffino MA, Calvo A, Di Vito N, Ghiglione P, Terreni AA, Mutani R. Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS. J Neurol Neurosurg Psychiatry 2004; 75:645-7. [PMID: 15026518 PMCID: PMC1739007 DOI: 10.1136/jnnp.2003.020347] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion. OBJECTIVE To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure. METHODS 25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) <50% underwent PRG after October 2000. They were compared with 25 consecutive ALS patients with FVC <50% who underwent PEG before October 2000. Respiratory function was evaluated before and after the procedure. RESULTS The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (p<0.004). Respiratory function decreased more in the PEG group than in the PRG group (p<0.02). CONCLUSIONS PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.
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Affiliation(s)
- A Chiò
- Second Division of Neurology, Department of Neuroscience, University of Turin, via Cherasco 15, 10126 Turin, Italy.
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Abstract
BACKGROUND Cesare Lombroso supported a common origin of criminality, genius, and epilepsy as caused by factors impairing the embryonic development of the CNS, mainly affecting the hierarchically superior neural centers. OBJECTIVE To describe the first observations of cortical dysplasia in patients with epilepsy by Cesare Lombroso and his coworkers in 1896. RESULTS To confirm his theories, Lombroso emphasized the need for the direct observation of the patient, using anthropologic, social, neurophysiologic, economic, and pathologic data. With the collaboration of his pupil Luigi Roncoroni, Lombroso described a prevalence of large, giant pyramidal neurons and polymorphous cells through the gray matter of the frontal cortex in 13 patients with epilepsy. Most of the large pyramidal neurons were haphazardly arranged, presenting also an abnormal orientation of their apical dendrites. The number of nervous cells was noticeably reduced, with the presence of abundant gliosis. Moreover, the granular layers were dramatically reduced or absent in most patients, and numerous nervous cells were present in the subcortical white matter. This particular finding was never observed in specimens from criminal and healthy control subjects. Lombroso and Roncoroni explained their finding as evidence of an arrest of CNS development. CONCLUSIONS More than one century ago, Cesare Lombroso and collaborators described developmental lesions in the frontal cortex of patients with epilepsy, which correspond to what currently is called Taylor's dysplasia. However, they used their observations to support their scientific misconception on the relationship between criminality, epilepsy, and genius.
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Affiliation(s)
- A Chiò
- Section of Neurology, Department of Neuroscience, University of Turin, Italy.
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Abstract
OBJECTIVE The authors evaluated the incidence and long-term prognostic factors of Guillain-Barré syndrome (GBS) in a prospective, population-based study. METHODS Patients with GBS diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke criteria in the 2-year period 1995 to 1996 in two Italian regions were prospectively followed up for 2 years after onset of GBS. RESULTS A total of 120 patients were found, corresponding to a crude annual incidence rate of 1.36/100,000 population (95% CI, 1.13 to 1.63). A total of 7 (5.8%) patients, all but one with axonal or mixed EMG pattern, died acutely within 30 days from the onset of the disease. Acute mortality was due to respiratory involvement and intensive care unit complications. In multivariate analysis, a worse 2-year outcome (Hughes score >or=2) was related to a higher Hughes grade at nadir, axonal or mixed EMG, age >or=50 years, and absence of respiratory infections preceding GBS. The persistence of disability 2 years after the acute phase was related to axonal involvement and a worse status at nadir. CONCLUSIONS After adjustment to US population, the incidence rates for GBS from different countries showed no significant differences. Both acute mortality and long-term disability in GBS seem to be related to an axonal involvement and a Hughes grade >or=2 at nadir.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, University of Turin, San Giovanni Battista Hospital, Italy.
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Cocito D, Chiò A, Isoardo G, Ciaramitaro P, Ghiglione P, Poglio F, Vercellino M, Mutani R, Bergamasco B. Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 57. J Peripher Nerv Syst 2003. [DOI: 10.1046/j.1529-8027.2003.00057.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chiò A, Mora G, Leone M, Mazzini L, Cocito D, Giordana MT, Bottacchi E, Mutani R. Early symptom progression rate is related to ALS outcome: a prospective population-based study. Neurology 2002; 59:99-103. [PMID: 12105314 DOI: 10.1212/wnl.59.1.99] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To define the factors related to ALS outcome in a population-based, prospective survey. METHODS The 221 patients (120 men and 101 women) listed in the Piemonte and Valle d'Aosta ALS Register between 1995 and 1996 were enrolled in the study. The patients were prospectively monitored with a standard evaluation form after diagnosis. RESULTS Mean age at onset was 62.8 (SD = 11.2) years. According to El Escorial diagnostic criteria (EEDC), 112 patients had definite ALS, 85 probable ALS, 18 possible ALS, and six suspected ALS. The median survival time from symptom onset was 915 days (95% CI = 790 to 1065). The median survival time from diagnosis was 580 days (95% CI = 490 to 670). In univariate analysis, outcome was significantly related to age, onset site, EEDC classification, and symptom progression rate (i.e., the rate of decline of muscle strength and bulbar and respiratory function in the 6 months after diagnosis). In the Cox multivariate model, age, progression rate of respiratory, bulbar, and lower limb symptoms, EEDC classification, percutaneous endoscopic gastrostomy, and treatment with riluzole were significantly related to outcome. CONCLUSIONS The rate of progression of symptoms in early ALS is predictive of disease outcome.
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Affiliation(s)
- A Chiò
- Division of Neurology, Department of Neuroscience, University of Torino and Azienda Ospedaliera S. Giovanni Battista, Torino, Italy.
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Abstract
Recently, formal standards for the management of amyotrophic lateral sclerosis (ALS) have been proposed by the American Academy of Neurology (AAN). However, there are few information about the actual care of ALS. We have assessed the management of ALS in Italy in various clinical settings, on basis of a self-reported questionnaire. Thirty-six out of the 80 Italian ALS neurological departments with a particular interest in ALS care answered the questionnaire. The centers were subdivided according the mean number of patients currently followed-up (> or =30 vs. <30). An integrated health-care team for ALS existed in all large centers but only in 14% of small centers (p=0.0001). Diagnosis was communicated to most but not all patients. Symptomatic therapies were generally offered to patients in all centers. Nutritional interventions, including percutaneous endoscopic gastrostomy (PEG), were proposed by most centers, but the percentage of patients who underwent PEG was significantly higher in large centers (p=0.04). Respiratory management seemed to be lacking both in large and in small centers since non-invasive positive pressure ventilation (NIPPV) was proposed by only 70% of large and 50% of small centers; however, the percentage of patients who underwent NIPPV was significantly higher in large centers (p=0.03). Moreover, the discussion of respiratory issues was performed quite late in the course of the disease, usually when the patients have first respiratory symptoms. Therefore, there are considerable opportunities to improve the care of ALS patients in Italy, primarily through the education of neurologists on AAN standards of care for ALS.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, University of Turin Medical School, Turin, Italy.
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Chiò A, Herrero Hernandez E, Discalzi G, Ghiglione P, Di Vito N, Calvo A, Vercellino M, Plano F, Mutani R. Conjugal amyotrophic lateral sclerosis: suggestion for the implication of environmental factors. Amyotroph Lateral Scler Other Motor Neuron Disord 2001; 2:165-6. [PMID: 11771774 DOI: 10.1080/146608201753275526] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
The cell-cycle regulator p16 inhibits the complex cdk4-cyclin D1 and controls G1-S transition. In human tumors, p16 inactivation is often accomplished by homozygous deletion (HD) of its encoding gene, CDKN2A. Methylation of the 5' CpG island promoter has been proposed as an alternative mechanism of inactivation. Expression of p16, CDKN2A HD and 5' CDKN2A CpG island methylation was studied in 25 oligodendrogliomas by immunohistochemistry and PCR amplification. Ten oligodendrogliomas were p16-immunonegative, and CDKN2A HD was determined in 8 of these cases. In the 2 immunonegative cases without HD, no CpG island methylation was found. The absence of CpG island methylation in the p16-immunonegative cases without HD suggests either non-genetic regulation of p16 or different genetic changes. CDKN2A HD did not correlate with histological grading (p = n.s.); however, it showed a correlation with survival (p = 0.03), supporting an important role of CDKN2A in the prognosis of oligodendrogliomas.
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Affiliation(s)
- S Bortolotto
- Division of Neurology, Department of Neuroscience, University of Turin, Turin, Italy
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