Amyotrophic lateral sclerosis & frontotemporal degeneration最新文献

The heterogeneity among the amyotrophic lateral sclerosis (ALS)/MND patient population is well recognized but not well understood. Such heterogeneity may represent a significant confound in our current and prior clinical trials as certain subgroups of patients might have a selective response (or resistance) to a novel therapeutic. The basis on which to segregate the patient population is, however, unclear. The ALS/MND Committee of the World Federation of Neurology (WFN) convened a symposium to discuss various strategies that might be considered for separating (stratifying) the population to further study. The results of that conference are presented here as a white paper, reflecting current understanding of several of the various criteria that could be implemented to divide the patient population as presented and discussed at that meeting. Consideration of grouping patients based on phenotype, cognitive involvement, imaging, or electrophysiology is presented here.

Objective: SOD1 mutations are the second most prevalent variants in amyotrophic lateral sclerosis (ALS). Epidemiological data about SOD1 mutations are scarce in Brazil. Here, we report the clinical and genetic findings of four Brazilian families with p.Val120Leu SOD1 variant. Methods: This study is part of an epidemiological study of the prevalence of ALS conducted in the State of Ceará, Brazil. We reviewed the medical records of families with p.Val120Leu (c.358G > C, exon 5) SOD1 variant seen at the Walter Cantídio University Hospital, Federal University of Ceará, Brazil. Results: We identified 15 patients from 4 families with p.Val120Leu SOD1 variant among 251 ALS patients. Of these, six were personally examined and had ALS confirmed and five had confirmatory genetic testing (four homozygous and one heterozygous). C9orf72 testing was normal in the heterozygous patient. In two families, three older heterozygous patients (genetically tested) had no signs or symptoms of ALS. The mean age of symptom onset was 46.7 ± 13.4 years. Features of ALS in the four families were very similar, with prolonged disease duration and upper and lower motor neuron involvement, fulfilling the Revised El Escorial, Awaji, and Gold Coast diagnostic criteria. All examined living patients had limb onset and a few bulbar symptoms. Conclusion: p.Val120Leu SOD1 variant leads to slowly progressive ALS with incomplete penetrance. Our findings are similar to a previous report of ALS due to p.Asp90Ala SOD1 variant.

Background: This study aims to develop a Machine Learning (ML) model to predict the initial diagnosis of Amyotrophic Lateral Sclerosis (ALS).

Methods: To predict ALS, a stacked model combining four ML algorithms-logistic Regression, Decision Tree, Random Forest, and Extreme Gradient Boosting-was implemented. The analysis utilized healthcare administrative data from Catalonia, encompassing 2,924,590 elderly individuals from 2014 to 2021, which were linked to socioeconomic factors and medication records.

Results: The stacked model successfully predicted first-time ALS diagnoses, achieving an AUC of 0.86, with an accuracy of 0.86, specificity of 0.88, and sensitivity of 0.84. The most influential predictors included immunization encounters, South American origin, general medical and special examinations, hypertensive heart disease, and counseling. Other relevant features were sciatica, heart failure, liver metastases, healthcare use patterns, and chronic conditions such as hypertension, kidney disease, and hypercholesterolemia. These features reflect early clinical symptoms and healthcare usage patterns relevant to ALS detection.

Conclusions: Machine Learning models, particularly stacked approaches, show promising results in predicting ALS diagnoses using administrative health data. Continued research is necessary to improve detection strategies and support their integration into healthcare systems.

Objectives: To analyze the cases of a family with a novel in-frame duplication variant (NM_000454.5:c.357_357 + 2dup, p.Val120dup) of SOD1 and a structural model of the mutated SOD1 protein.

Methods: The clinical profiles of three patients in the family were analyzed, including the neuropathological findings of the proband's mother. Genetic analyses were conducted for three patients. cDNA and in silico structural analyses were performed to evaluate the effects of duplication variants on the structure of SOD1.

Results: The clinical features of the patients included predominant involvement of the lower motor neurons, asymmetric onset of motor symptoms in the lower limbs, and a relatively rapid progression of muscular weakness and respiratory insufficiency. Neuropathological findings revealed severe loss of spinal cord motor neurons, and immunohistochemistry using an anti-misfolded SOD1 antibody revealed aggregates in the spinal cord. Genetic analyses revealed a c.357_357 + 2dup at the exon 4-intron 4 boundary of SOD1 in three patients. cDNA analysis of the proband suggested the presence of a valine (p.Val120dup) duplication in the heterozygous state, and the SOD1 transcript level showed no significant differences from those of healthy controls. In silico structural analyses predicted that p.Val120dup could affect the structure of the β-barrels and copper ion binding site of SOD1, suggesting an abnormal conformation of SOD1 that is predicted to interfere with the binding of copper ions.

Conclusion: We identified a novel in-frame duplication variant in the C-terminus of β7 of SOD1. This genotype-structure-phenotype study of SOD1 provides valuable insights into disease-causing mechanisms.

Objective: Given the limited education available to practitioners who provide mental health care for persons with amyotrophic lateral sclerosis (ALS) and their family members, a partnership between Mental Health America, Global Neuro YCare, and the ALS Association developed a web-based education programme providing discussions addressing ALS background, lived experience, and impact of caregiving, to increase confidence in care and access to resources when serving persons living with ALS and their caregivers. Methods: A pre/post survey was utilized to assess the webinar's impact on provider confidence in their knowledge and experience of ALS, access to ALS information and resources, and the ability to refer persons with ALS to care. The percentage change from pretest to post-test, frequency of knowledge, and qualitative analyses were conducted. Results: The findings indicated a 24% increase in practitioners' confidence in working with people with ALS and their family members, a 19% increase in providing mental health care to a family member, and a 20% increase in assessing resource information about ALS. Qualitative data highlighted several categories of responses, including increases in knowledge from the workshop, the need for individuals to be treated as more than just ALS, and a continuing need for training, and additional emotional support for practitioners. Conclusion: The online training increased confidence in providing mental health care to people living with ALS and their family members, adding to this understudied area. Still, additional research is needed to increase confidence in referring people to care, accessing information, and growing knowledge about ALS.

Introduction: Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease characterized by the progressive loss of muscle control, leading to paralysis and death. While ALS has been extensively studied globally, little research has focused on ALS in the Middle East, specifically Saudi Arabia. This study aims to investigate the demographic data, clinical characteristics, disease progression, and prognosis of ALS patients in Saudi Arabia to better understand region-specific disease patterns and potential therapeutic strategies.

Methodology: Retrospective multicenter cohort across five tertiary Saudi centers (2003-2022). The authors identified cases from neurology/neuromuscular clinics and neurophysiology laboratories; diagnoses followed revised El Escorial criteria with EMG confirmation where indicated. ALS variants and cases lacking sufficient longitudinal evidence were excluded. Clinical genetic testing was performed at the clinician's discretion; variants were classified per ACMG and only pathogenic/likely pathogenic results were counted; C9orf72 repeat-expansion testing was not systematically available. Prespecified variables included demographics, family history, initial phenotype, MRI/EMG, genetics, treatments (riluzole, edaravone, SPT, tofersen for SOD1), times to noninvasive ventilation (NIV), gastrostomy and invasive ventilation.

Results: We included 270 patients (57% male). Mean age at first symptom was 51 years. Limb-onset occurred in 169/247 (68%) and bulbar-onset in 78/247 (32%). Among those with documented family history (97/270), 14% reported an affected relative. 37/270 underwent genetic testing; 56.7% were positive-most commonly OPTN (47.6.6% of positives) and SOD1 (38.1%). MRI brain/spine was normal in ∼53%. By 3 years from symptom onset, ∼80% of those who eventually required advanced support (NIV, invasive ventilation, and/or gastrostomy) had received it. Most patients were treated with riluzole.

Conclusion: This study provides valuable insights into ALS in Saudi Arabia, contributing to a better understanding of the disease in this region. The younger age of onset and the high familial prevalence are notable findings that warrant further investigation. Future studies focusing on genetic and environmental influences in Saudi Arabia may help improve diagnosis and therapeutic approaches.

Objectives: Prognostic health communication is a critical challenge for amyotrophic lateral sclerosis (ALS) health-care professions, however patient-based evidence for best practice remains limited. We investigated how the experiences of ALS patients and caregivers can inform prognostic communication and whether patient-based evidence supports clinical use of predictive tools. Methods: Data were drawn from ALS Talk, an asynchronous, online focus group study. Patients and family caregivers were recruited from across Canada. Seven groups interacted in a threaded web-forum structure. Sixty-four participants shared experiences and perspectives on prognostic communication. Data were qualitatively analyzed using conventional content analysis and the constant-comparative approach. Results: Primary themes were prognostic communication as an ongoing, evolving conversation; prognostic heterogeneity; progression as an embodiment of prognosis; and functional prognosis. The theme, information needs/wants, contributed to the primary themes. Participants highlighted the importance of stepwise discussions of general and personalized prognosis; prognostic heterogeneity as a source of hope and a potential communication barrier; and how progression facilitates material understanding of prognosis, adaptation, and future planning. Further, participants wanted more information about functional prognosis and the impact of interventions/therapies on function and survival. Conclusions: We discuss participants' central questions: "how long" and "how well," and provide recommendations for patient-centred ALS prognostic communication. Participants' embodied understanding of prognosis and desire for information that anticipates functional change, informs disease management, and facilitates timely planning suggests that clinical application of ALS staging systems may meet patient and caregiver need. Testing in real-world clinical settings is needed to ensure the development of patient-centred predictive tools.

Objective: Advanced neurodegenerative diseases (NDDs) lead to severe mobility limitations, creating significant challenges for patients and caregivers at home. We aimed to investigate the quality of life (QOL) and care burden of people living with amyotrophic lateral sclerosis (ALS, pALS) and other NDDs and their family caregivers in Korea. Methods: This prospective survey study included people living with NDDs with mobility restrictions and their caregiver enrolled in a home-based medical care (HBMC) program at one tertiary hospital in South Korea from 2022 to 2024. Data collected included demographics, clinical characteristics, care burden (the Zarit Caregiver Burden Interview Short Form, ZBI-12), QOL (EQ-5D-5L), and depression (Patient Health Questionnaire-9). The results were compared between ALS and other NDDs (non-ALS). Results: Of 44 patients requiring HBMC, 70.5% (31) were pALS. pALS were younger than non-ALS (median age, 65 vs. 79 years); more often, the caregiver was a spouse (64.5% vs. 46.1%, p = 0.30). One-fourth (25.8%) of pALS were on polypharmacy (>10 medications a day). One-third (29%) of pALS and 22.6% of their caregivers experienced moderate or severe depression. Half of pALS caregivers experienced high caregiving burden (ZBI-12 score ≥17). The mean EQ-5D-5L index score was 0.48 for pALS and 0.84 for their caregivers, which was lower than the results for the Korean general population. Conclusions: Patients with severe NDD and caregivers experienced low QOL and high caregiving burden, with pALS caregivers particularly vulnerable to depression and heavy burden. Designing optimal HBMC programs to support pALS and home caregivers is warranted.

Objective: Assess the accuracy of ALS patient recall of genetic testing results and evaluate comprehension of key implications of results. Methods: Participants were recruited from the Center for Disease Control's National ALS Registry. A survey collected participant demographics, their recollection of their genetic test result, and their understanding of the implications of their result. Comprehension was scored based on responses to key questions. Whenever possible, patient-reported test results were confirmed by review of their test report. Results: Most participants (n = 246) were white (n = 238, 96.7%) with high health literacy. Among participants whose self-reported result could be validated, most 93/98 (94.9%) accurately recalled whether they received a positive, negative, or uncertain result. Among participants who reported positive results, 32/50 (64.0%) demonstrated understanding that their genetic testing results explained their ALS, while 38/50 (76.0%) accurately characterized the risk that first degree relatives carried the same variant. Among participants who reported negative results, 100/142 (70.4%) incorrectly indicated that their result ruled out a genetic cause. When asked about the risk for family members to develop ALS, 98/142 (69.0%) correctly characterized this residual risk. However, only 12/142 (8.5%), answered both questions correctly. Overall, participants who saw a genetic counselor were more likely to demonstrate high comprehension (p = 0.022). Conclusions: The majority of participants demonstrated accurate recall of their ALS genetic testing result. However, deficits in understanding of key implications were identified, particularly among those with negative results. Participants who saw a genetic counselor had significantly better comprehension of their test results than those who did not.