A case-control study of hormonal exposures as etiologic factors for ALS in women: Euro-MOTOR

James P K Rooney, Anne E Visser, Fabrizio D'Ovidio, Roel Vermeulen, Ettore Beghi, Adriano Chio, Jan H Veldink, Giancarlo Logroscino, Leonard H van den Berg, Orla Hardiman, Euro-MOTOR Consortium

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To investigate the role of hormonal risk factors for amyotrophic lateral sclerosis (ALS) among women from 3 European countries.

METHODS: ALS cases and matched controls were recruited over 4 years in Ireland, Italy, and the Netherlands. Hormonal exposures, including reproductive history, breastfeeding, contraceptive use, hormonal replacement therapy, and gynecologic surgical history, were recorded with a validated questionnaire. Logistic regression models adjusted for age, education, study site, smoking, alcohol, and physical activity were used to determine the association between female hormones and ALS risk.

RESULTS: We included 653 patients and 1,217 controls. Oral contraceptive use was higher among controls (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.51-0.84), and a dose-response effect was apparent. Hormone replacement therapy (HRT) was associated with a reduced risk of ALS only in the Netherlands (OR = 0.57, 95% CI 0.37-0.85). These findings were robust to sensitivity analysis, but there was some heterogeneity across study sites.

CONCLUSIONS: This large case-control study across 3 different countries has demonstrated an association between exogenous estrogens and progestogens and reduced odds of ALS in women. These results are at variance with previous findings, which may be partly explained by differential regulatory, social, and cultural attitudes toward pregnancy, birth control, and HRT across the countries included. Our results indicate that hormonal factors may be important etiologic factors in ALS; however, a full understanding requires further investigation.

Original languageEnglish
Pages (from-to)1283-1290
Number of pages8
JournalNeurology
Volume89
Issue number12
DOIs
Publication statusPublished - Sep 19 2017

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Amyotrophic Lateral Sclerosis
Case-Control Studies
Hormone Replacement Therapy
Netherlands
Logistic Models
Odds Ratio
Confidence Intervals
Reproductive History
Progestins
Oral Contraceptives
Contraceptive Agents
Breast Feeding
Contraception
Ireland
Italy
Estrogens
Smoking
History
Alcohols
Hormones

Keywords

  • Aged
  • Amyotrophic Lateral Sclerosis
  • Case-Control Studies
  • Contraceptives, Oral, Hormonal
  • Dose-Response Relationship, Drug
  • Estrogen Replacement Therapy
  • Estrogens
  • Female
  • Humans
  • Ireland
  • Italy
  • Middle Aged
  • Netherlands
  • Progestins
  • Risk Factors
  • Journal Article

Cite this

Rooney, J. P. K., Visser, A. E., D'Ovidio, F., Vermeulen, R., Beghi, E., Chio, A., ... Euro-MOTOR Consortium (2017). A case-control study of hormonal exposures as etiologic factors for ALS in women: Euro-MOTOR. Neurology, 89(12), 1283-1290. https://doi.org/10.1212/WNL.0000000000004390

A case-control study of hormonal exposures as etiologic factors for ALS in women : Euro-MOTOR. / Rooney, James P K; Visser, Anne E; D'Ovidio, Fabrizio; Vermeulen, Roel; Beghi, Ettore; Chio, Adriano; Veldink, Jan H; Logroscino, Giancarlo; van den Berg, Leonard H; Hardiman, Orla; Euro-MOTOR Consortium.

In: Neurology, Vol. 89, No. 12, 19.09.2017, p. 1283-1290.

Research output: Contribution to journalArticle

Rooney, JPK, Visser, AE, D'Ovidio, F, Vermeulen, R, Beghi, E, Chio, A, Veldink, JH, Logroscino, G, van den Berg, LH, Hardiman, O & Euro-MOTOR Consortium 2017, 'A case-control study of hormonal exposures as etiologic factors for ALS in women: Euro-MOTOR', Neurology, vol. 89, no. 12, pp. 1283-1290. https://doi.org/10.1212/WNL.0000000000004390
Rooney, James P K ; Visser, Anne E ; D'Ovidio, Fabrizio ; Vermeulen, Roel ; Beghi, Ettore ; Chio, Adriano ; Veldink, Jan H ; Logroscino, Giancarlo ; van den Berg, Leonard H ; Hardiman, Orla ; Euro-MOTOR Consortium. / A case-control study of hormonal exposures as etiologic factors for ALS in women : Euro-MOTOR. In: Neurology. 2017 ; Vol. 89, No. 12. pp. 1283-1290.
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abstract = "OBJECTIVE: To investigate the role of hormonal risk factors for amyotrophic lateral sclerosis (ALS) among women from 3 European countries.METHODS: ALS cases and matched controls were recruited over 4 years in Ireland, Italy, and the Netherlands. Hormonal exposures, including reproductive history, breastfeeding, contraceptive use, hormonal replacement therapy, and gynecologic surgical history, were recorded with a validated questionnaire. Logistic regression models adjusted for age, education, study site, smoking, alcohol, and physical activity were used to determine the association between female hormones and ALS risk.RESULTS: We included 653 patients and 1,217 controls. Oral contraceptive use was higher among controls (odds ratio [OR] 0.65, 95{\%} confidence interval [CI] 0.51-0.84), and a dose-response effect was apparent. Hormone replacement therapy (HRT) was associated with a reduced risk of ALS only in the Netherlands (OR = 0.57, 95{\%} CI 0.37-0.85). These findings were robust to sensitivity analysis, but there was some heterogeneity across study sites.CONCLUSIONS: This large case-control study across 3 different countries has demonstrated an association between exogenous estrogens and progestogens and reduced odds of ALS in women. These results are at variance with previous findings, which may be partly explained by differential regulatory, social, and cultural attitudes toward pregnancy, birth control, and HRT across the countries included. Our results indicate that hormonal factors may be important etiologic factors in ALS; however, a full understanding requires further investigation.",
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T1 - A case-control study of hormonal exposures as etiologic factors for ALS in women

T2 - Euro-MOTOR

AU - Rooney, James P K

AU - Visser, Anne E

AU - D'Ovidio, Fabrizio

AU - Vermeulen, Roel

AU - Beghi, Ettore

AU - Chio, Adriano

AU - Veldink, Jan H

AU - Logroscino, Giancarlo

AU - van den Berg, Leonard H

AU - Hardiman, Orla

AU - Euro-MOTOR Consortium

N1 - © 2017 American Academy of Neurology.

PY - 2017/9/19

Y1 - 2017/9/19

N2 - OBJECTIVE: To investigate the role of hormonal risk factors for amyotrophic lateral sclerosis (ALS) among women from 3 European countries.METHODS: ALS cases and matched controls were recruited over 4 years in Ireland, Italy, and the Netherlands. Hormonal exposures, including reproductive history, breastfeeding, contraceptive use, hormonal replacement therapy, and gynecologic surgical history, were recorded with a validated questionnaire. Logistic regression models adjusted for age, education, study site, smoking, alcohol, and physical activity were used to determine the association between female hormones and ALS risk.RESULTS: We included 653 patients and 1,217 controls. Oral contraceptive use was higher among controls (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.51-0.84), and a dose-response effect was apparent. Hormone replacement therapy (HRT) was associated with a reduced risk of ALS only in the Netherlands (OR = 0.57, 95% CI 0.37-0.85). These findings were robust to sensitivity analysis, but there was some heterogeneity across study sites.CONCLUSIONS: This large case-control study across 3 different countries has demonstrated an association between exogenous estrogens and progestogens and reduced odds of ALS in women. These results are at variance with previous findings, which may be partly explained by differential regulatory, social, and cultural attitudes toward pregnancy, birth control, and HRT across the countries included. Our results indicate that hormonal factors may be important etiologic factors in ALS; however, a full understanding requires further investigation.

AB - OBJECTIVE: To investigate the role of hormonal risk factors for amyotrophic lateral sclerosis (ALS) among women from 3 European countries.METHODS: ALS cases and matched controls were recruited over 4 years in Ireland, Italy, and the Netherlands. Hormonal exposures, including reproductive history, breastfeeding, contraceptive use, hormonal replacement therapy, and gynecologic surgical history, were recorded with a validated questionnaire. Logistic regression models adjusted for age, education, study site, smoking, alcohol, and physical activity were used to determine the association between female hormones and ALS risk.RESULTS: We included 653 patients and 1,217 controls. Oral contraceptive use was higher among controls (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.51-0.84), and a dose-response effect was apparent. Hormone replacement therapy (HRT) was associated with a reduced risk of ALS only in the Netherlands (OR = 0.57, 95% CI 0.37-0.85). These findings were robust to sensitivity analysis, but there was some heterogeneity across study sites.CONCLUSIONS: This large case-control study across 3 different countries has demonstrated an association between exogenous estrogens and progestogens and reduced odds of ALS in women. These results are at variance with previous findings, which may be partly explained by differential regulatory, social, and cultural attitudes toward pregnancy, birth control, and HRT across the countries included. Our results indicate that hormonal factors may be important etiologic factors in ALS; however, a full understanding requires further investigation.

KW - Aged

KW - Amyotrophic Lateral Sclerosis

KW - Case-Control Studies

KW - Contraceptives, Oral, Hormonal

KW - Dose-Response Relationship, Drug

KW - Estrogen Replacement Therapy

KW - Estrogens

KW - Female

KW - Humans

KW - Ireland

KW - Italy

KW - Middle Aged

KW - Netherlands

KW - Progestins

KW - Risk Factors

KW - Journal Article

U2 - 10.1212/WNL.0000000000004390

DO - 10.1212/WNL.0000000000004390

M3 - Article

C2 - 28835399

VL - 89

SP - 1283

EP - 1290

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 12

ER -