Signs and symptoms at diagnosis of amyotrophic lateral sclerosis: A population-based study in southern Italy

S. Zoccolella, E. Beghi, G. Palagano, A. Fraddosio, V. Samarelli, P. Lamberti, V. Lepore, L. Serlenga, G. Logroscino

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Amyotrophic lateral sclerosis (ALS) diagnostic criteria are used to select patients for clinical trials based on different levels of diagnostic certainty, according to the spread of upper (UMN) and lower motoneuron (LMN) signs in different anatomic regions. However, the clinical presentation of ALS patients is extremely variable and this can delay the time to diagnosis and decrease the likelihood for trial entry. The aims of the study were to describe the signs and symptoms of diagnosis in a population-based incident cohort of ALS cases, using the El Escorial (EEC) and the Revised Airlie Diagnostic Criteria (AHC). The source of the study was a prospective population-based registry established in Puglia, southern Italy, in 1997. The diagnosis and the classification of the cases were based on EEC and AHC. All incident ALS cases during the period 1998-1999 were enrolled and followed up. During the surveillance period, we identified 130 ALS incident cases, and bulbar-ALS represented 20% of our cohort. The highest risk for bulbar onset was among subjects aged > 75 years [RR: 20.1, 95% confidence interval (CI) 3.4-118.0] compared with subjects aged <55 years and among females compared with males (Relative risk (RR): 2.75, 95% CI: 1-7.3). The vast majority of patients (72%) referred progressive muscle weakness in the limbs as the presenting symptom. Eighty percent of cases presented contemporary bulbar or spinal involvement; UMN signs in the bulbar region were present in 24% of cases and any motoneuronal sign in thoracic region in only 15% of the cases. In this population-based series, progressive muscle weakness was the most common presenting sign; bulbar onset was associated with advanced age and female sex. UMN signs in the bulbar region and any motoneuronal sign in the thoracic region were observed in 20% of our case series. This may represent the main limitation to show the spread of signs during diagnostic assessment for inclusion in epidemiological studies and clinical trials.

Original languageEnglish
Pages (from-to)789-792
Number of pages4
JournalEuropean Journal of Neurology
Volume13
Issue number7
DOIs
Publication statusPublished - Jul 2006

Fingerprint

Amyotrophic Lateral Sclerosis
Italy
Signs and Symptoms
Population
Muscle Weakness
Thorax
Clinical Trials
Confidence Intervals
Motor Neurons
Registries
Epidemiologic Studies
Extremities

Keywords

  • Amyotrophic lateral sclerosis
  • Clinical trials
  • El Escorial criteria
  • Incidence

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Signs and symptoms at diagnosis of amyotrophic lateral sclerosis : A population-based study in southern Italy. / Zoccolella, S.; Beghi, E.; Palagano, G.; Fraddosio, A.; Samarelli, V.; Lamberti, P.; Lepore, V.; Serlenga, L.; Logroscino, G.

In: European Journal of Neurology, Vol. 13, No. 7, 07.2006, p. 789-792.

Research output: Contribution to journalArticle

Zoccolella, S, Beghi, E, Palagano, G, Fraddosio, A, Samarelli, V, Lamberti, P, Lepore, V, Serlenga, L & Logroscino, G 2006, 'Signs and symptoms at diagnosis of amyotrophic lateral sclerosis: A population-based study in southern Italy', European Journal of Neurology, vol. 13, no. 7, pp. 789-792. https://doi.org/10.1111/j.1468-1331.2006.01384.x
Zoccolella, S. ; Beghi, E. ; Palagano, G. ; Fraddosio, A. ; Samarelli, V. ; Lamberti, P. ; Lepore, V. ; Serlenga, L. ; Logroscino, G. / Signs and symptoms at diagnosis of amyotrophic lateral sclerosis : A population-based study in southern Italy. In: European Journal of Neurology. 2006 ; Vol. 13, No. 7. pp. 789-792.
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abstract = "Amyotrophic lateral sclerosis (ALS) diagnostic criteria are used to select patients for clinical trials based on different levels of diagnostic certainty, according to the spread of upper (UMN) and lower motoneuron (LMN) signs in different anatomic regions. However, the clinical presentation of ALS patients is extremely variable and this can delay the time to diagnosis and decrease the likelihood for trial entry. The aims of the study were to describe the signs and symptoms of diagnosis in a population-based incident cohort of ALS cases, using the El Escorial (EEC) and the Revised Airlie Diagnostic Criteria (AHC). The source of the study was a prospective population-based registry established in Puglia, southern Italy, in 1997. The diagnosis and the classification of the cases were based on EEC and AHC. All incident ALS cases during the period 1998-1999 were enrolled and followed up. During the surveillance period, we identified 130 ALS incident cases, and bulbar-ALS represented 20{\%} of our cohort. The highest risk for bulbar onset was among subjects aged > 75 years [RR: 20.1, 95{\%} confidence interval (CI) 3.4-118.0] compared with subjects aged <55 years and among females compared with males (Relative risk (RR): 2.75, 95{\%} CI: 1-7.3). The vast majority of patients (72{\%}) referred progressive muscle weakness in the limbs as the presenting symptom. Eighty percent of cases presented contemporary bulbar or spinal involvement; UMN signs in the bulbar region were present in 24{\%} of cases and any motoneuronal sign in thoracic region in only 15{\%} of the cases. In this population-based series, progressive muscle weakness was the most common presenting sign; bulbar onset was associated with advanced age and female sex. UMN signs in the bulbar region and any motoneuronal sign in the thoracic region were observed in 20{\%} of our case series. This may represent the main limitation to show the spread of signs during diagnostic assessment for inclusion in epidemiological studies and clinical trials.",
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