Amyotrophic lateral sclerosis & frontotemporal degeneration最新文献

There is very limited evidence around the use of reproductive genetic testing in individuals with amyotrophic lateral sclerosis (ALS)-linked gene variants. This study aimed to identify the use of reproductive genetic testing in these individuals to understand patterns of (under)utilization and to identify barriers to equitable access. Freedom of information requests were sent in January 2025 to the 22 regional clinical genetics centers across the UK around reproductive services for individuals with, or at risk for, ALS and Huntington's disease. Limited data were available with only six trusts answering in full. The data that our study yielded raises significant concerns and inconsistencies regarding clinical recording and reporting of reproductive genetic counseling and testing. The absence of standardized retrievable data limits the ability to assess utilization and may point toward a systemic issue in data capture of reproductive genetic services for individuals at risk of ALS, and by extension, those affected by other genetic conditions.

Juvenile amyotrophic lateral sclerosis (JALS) is neurodegenerative disease of the upper and lower motor neurons of rare incidence. Although fused in sarcoma (FUS) mutations in JALS patients have been associated with movement disorders, here we described the case of a young girl with very early onset of tremor, years before commencement of weakness; once symptoms of JALS were stablished, a typical rapid disease progression from spinal to bulbar symptoms were noticed. Genetic testing revealed a novel mutation in FUS gene causative of a protein dysfunction. This case emphasizes the fact that some mutations within the FUS in JALS patients may produce a symptom onset with tremor.

Objective: To characterize the phenotypic spectrum of patients with frontotemporal dementia (FTD) carrying the P392L SQSTM1 mutation. Methods: We describe the clinical phenotype of three well-characterized probands carrying the P392L mutation, and review ten previously published FTD cases with the mutation. Results: All three cases were male with a presenile age of onset (52 or 64 years). Case 1 developed an amnestic-anomic syndrome followed by a behavioral variant of FTD (bvFTD). Case 2, with an autosomal dominant family history of dementia, developed a bvFTD associated with parkinsonism. Both cases had Paget's disease of the bone (PDB). Case 3 presented with a semantic aphasia and, years later, developed a hemilateral upper motor neuron disease (MND) (Mills syndrome). Among the ten previously reported cases (four from the same family), bvFTD was the cognitive phenotype in five, but semantic, nonfluent and logopenic aphasic variants, as well as a pure hippocampal amnestic syndrome were also documented. PDB was observed in six cases, two exhibited parkinsonism, and one MND. Neuroimaging findings showed a tendency toward asymmetric temporal/frontal atrophy, sometimes with periventricular white matter signal abnormalities. Only one third of the cases reported a family history of dementia. Conclusions: The P392L mutation exhibits a pleiotropic effect, giving rise to a broad phenotypic spectrum that includes PDB, FTD, amnestic syndrome, parkinsonism, and MND. Penetrance for the different phenotypes is variable and may be influenced by additional factors. The outlined features may encourage healthcare professionals to screen for this gene, even in cases without a clear family history.

Alpha-lipoic acid (ALA) is a naturally occurring fatty acid. It serves as an essential cofactor for enzymatic reactions in mitochondrial energy production, is a potent antioxidant and has anti-inflammatory effects, which are plausible mechanisms in slowing ALS progression. In ALS preclinical studies, ALA slowed motor function decline and improved survival. There were self-reported cases of improved muscle strength in ALS patients when ALA was taken with numerous additional supplements, making it difficult to discern its efficacy. One small, 6-month open-label study showed improved quality of life, fatigue, and mood after participants took it with B vitamins and amino acids for the first 3 months. So far, no clinical trials have been published in people living with amyotrophic lateral sclerosis (PALS). Given the insufficient clinical data, we cannot endorse ALA and will support more research on its efficacy in slowing ALS progression.

Objective: In a large cohort of people with amyotrophic lateral sclerosis/motor neuron disease (pwALS), we examined the age-sex prevalence of fatigue, its relationship to other symptoms and functioning, and trajectories over time. Methods: Data from the Trajectories of Outcome in Neurological Conditions study were analyzed by Rasch analysis, structural equation and group-based trajectory models. Results: Fatigue was reported by 97.8% on Neurological Fatigue Index-MND (NFI-MND) and 96.4% on Numeric Rating Scale Fatigue among 1058 pwALS: mean age 65 (range 20-90); mean duration 23 months (range 0-301); 60.7% male; onset 26.5% Bulbar, 71.5% Limb and 2.0% Respiratory. Mean (metric) level on NFI-MND was 12.8 (SD 5.3; range 0-24). Cut-points on the NFI-MND of 10 and 15 divided fatigue into mild (27.3%); moderate (36.1%) and severe (36.2%). Structural equation modeling showed that function, cognition, spasticity, dyspnea and pain have descending order of effect. Over average 11.6 months follow-up, 60.5% had stable fatigue, 23.8% increased fatigue level, while 15.8% showed declining fatigue. Trajectory analysis showed three groups, low, average and high fatigue. Those with low trajectories had less spasticity, worry, cognitive problems, as well as better functioning, longer duration and were less likely to be male. High fatigue trajectory was associated with worse spasticity, cognition and anxiety. Conclusions: Fatigue is extremely common among pwALS, thus more work is required on fatigue management. In addition to treating fatigue itself, the current study shows that targeting cognition, spasticity, dyspnea and pain might be fruitful.

Objective: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that significantly impacts quality of life. Patient-Reported Outcome Measures (PROMs) offer a patient-centered approach by capturing self-reported assessments of symptoms and well-being. Despite their recognized value, PROM integration into ALS management remains inconsistent. This study evaluates the attitudes, practices, and barriers experienced by Spanish neurologists regarding PROM use in ALS care. Methods: A cross-sectional survey was distributed to Spanish neurologists specializing in neuromuscular disorders. The questionnaire assessed familiarity with and use of PROMs, as well as perceived benefits and barriers to their implementation. Statistical analysis included descriptive statistics, group comparisons, and exploratory factor analysis (EFA) to identify underlying factors influencing PROM use. Results: Among 60 neurologists surveyed, 93.3% were familiar with PROMs, yet only 18.3% used them routinely. PROM use did not vary significantly with years of experience, type of clinical setting, exclusive dedication to neuromuscular disorders, or the percentage of time spent on patient care. The only variable approaching significance was the number of ALS patients managed daily, with higher patient volumes associated with more frequent PROM use. Over 70% of non-users cited limited consultation time as a barrier; however, factor analysis indicated that time constraints were not a substantial limitation. PROMs were valued for supporting clinical decision-making, monitoring disease progression, and improving patient engagement. Conclusions: While PROMs are widely recognized for their potential in ALS care, barriers hinder their use. Targeted training, simplified tools, and culturally adapted PROMs are needed to facilitate broader adoption and improve outcomes.

Objective: To describe the epidemiology, the clinical features, and the management of amyotrophic lateral sclerosis (ALS) in the neurology department of the Bogodogo University Hospital. Methods: This was a retrospective study including patients followed in the neurology department of the Bogodogo University Hospital between April 15, 2017 and December 31, 2024 for ALS. The socio-demographic, clinical and follow-up data of these patients were studied. Results: During our study period, 14 patients were followed for ALS, an average of 2 cases per year. The mean age of patients at symptom onset was 38.50 ± 14.23 years. The mean time to diagnosis was 19.71 ± 5.27 months. Four patients underwent no spinal cord magnetic resonance imaging (MRI). Riluzole was prescribed in 02 patients (14.29%). No patient benefited from noninvasive ventilation or gastrostomy. Six patients (42.85%) were discharged against medical advice. On December 31, 2024, there were 2 patients alive (14.29%), 5 patients who died (14.29%) and 7 patients (50%) who were lost to follow-up. Conclusion: Our cohort is characterized by a low hospital incidence, a young age of patients and difficulties in the care and follow-up of patients.

Amyotrophic lateral sclerosis (ALS) is a rare and fatal neurodegenerative disease thought to be precipitated by genetic, environment and lifestyle factors. In the UK, whole genome sequencing has become available to all people living with ALS, regardless of their family history or age of onset of disease. However, there is currently no formal guidance on how to deliver genetic counseling and testing in busy mainstream clinics. This article offers practical suggestions to clinicians who may wish or need to discuss genomic testing. As more clinical trials and targeted gene therapies develop, it is likely that conversations will evolve, reflecting the dynamic nature of this important and complex field.

Background: In amyotrophic lateral sclerosis (ALS), dextromethorphan/quinidine (DMQ) has been reported to reduce bulbar symptoms, including dysarthria and dysphagia. However, data on patients' perceptions of DMQ treatment are limited.

Methods: Data on DMQ treatment were collected from 1065 ALS patients treated at 13 ALS centers between 10-2015 and 06-2025. Patient-reported outcome measures (PROM) of 179 participants were remotely assessed via the "ALS App". PROM included the self-explanatory version of the ALS Functional Rating Scale (ALSFRS-R-SE), the Net Promoter Score (NPS); and Treatment Satisfaction Questionnaire for Medication (TSQM-9).

Results: Mean disease duration was 29.3 months (SD 38.1). ALS progression before treatment was 0.82 points/month (ALSFRS-R). Mean DMQ treatment duration was 8.4 months (SD 10.8), including 35.2% (n = 374) of shorter (<3 months), 35.3% (n = 375) of longer (3-9 months), and 29.5% (n = 313) of very long DMQ treatment (>9 months). Patients' recommendation (n = 178) was positive (NPS: +23) with higher scores after very long DMQ treatment (NPS +37) compared to longer (NPS +15) and shorter treatment (NPS +7.5), respectively. TSQM-9 scores (n = 163) demonstrated high satisfaction for effectiveness 60.0 (SD 25.9), convenience 73.8 (SD 18.2), and global satisfaction 63.4 (SD 29.8).

Interpretation: The positive perception in PROM underscores the value of DMQ as an individualized treatment option for bulbar symptoms in ALS. However, shortage of clinical data, online assessment, and selection biases are among the limitations of this study that need to be addressed in further investigations.

The c.166C > T p.(Pro56Ser) or P56S mutation in the VAPB gene was initially identified as a cause of motor neuron disease in Brazil in a large extended pedigree comprising >1,500 individuals including more than 200 cases. This VAPB mutation gives rise to three phenotypes: late-onset spinal muscular atrophy, classical ALS with bulbar involvement, pyramidal signs and rapid disease progression, and atypical ALS with slow progression. Nearly all known cases originate from a single founder, with most cases outside of Brazil being related to this pedigree. However, there is one report of an independent German family with the same mutation on a different haplotype, indicating a second founder event. Here, we report the first Dutch patient with a P56S mutation in VAPB and motor neuron disease. Documenting rare genetic causes of MND and their natural history are of increasing importance in light of emerging gene-specific therapies.