0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Slower Disease Progression and Prolonged Survival in Contemporary Patients With Amyotrophic Lateral Sclerosis

Osamu I. Kano, MD; Keisuke Arasaki, MD; Ken Ikeda, MD; Yasuo Iwasaki, MD
Arch Neurol. 2007;64(3):458-459. doi:10.1001/archneur.64.3.458-b.
Text Size: A A A
Published online

Extract

We read with great interest the recent excellent article by Czaplinski et al1 concerning slower disease progression and prolonged survival with amyotrophic lateral sclerosis (ALS). The authors point out the possibility that the disease course has changed over time to be less aggressive.

We also analyzed the diagnostic interval and clinical course through hospital records for 147 patients with ALS between 1990 and 2005. Patients with ALS were divided into 2 groups. The historical group was defined as 117 patients diagnosed according to criteria from the World Federation of Neurology2 for definite or probable ALS up to 2000. The contemporary group consisted of 30 patients diagnosed by revised criteria3 for definite, probable, or “probable laboratory supported” ALS from 2001 to 2005. Despite the revised criteria, including electromyogram examination,3 our data suggested that the mean diagnostic interval in the contemporary group was longer, 13.3 months vs 12.3 months in the historical group. A similar pattern of diagnostic delay in patients of Czaplinski et al1 showed 12.9 months in the historical group and 14.2 months in the contemporary group. How do we explain the prolongation of diagnostic interval in contemporary patients? A delay in referring patients to neurologists may explain a possible cause. The rate of bulbar onset in our patients was 44% in the historical group and 29% in the contemporary group. Those results are similar to those found by Czaplinski et al1 for initial symptoms in bulbar muscles (20.1% in the historical group vs 10.7% in the contemporary group). Although bulbar ALS has a poor prognosis compared with limb-onset ALS, the authors indicate a slower progression in contemporary patients with a Cox proportional hazards multivariate model adjusted for age, sex, diagnostic delay, and site of onset.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

50 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com
brightcove.createExperiences();