Amyotrophic lateral sclerosis (ALS) is the most serious form of degenerative motor neuron disease in adults, whose relentless course leads to death within 2-5 years, generally due to respiratory ...failure. Apart from the age and site of onset, no other factors have consistently demonstrated to be related to the ALS outcome. The aim of the study was to investigate the influence of fasting serum lipid levels (cholesterol and triglycerides) and the body mass index (BMI) at the time of diagnosis on survival in ALS patients. The study included 82 patients with ALS residing in the Belgrade area who were diagnosed with ALS over a time period of 4 years (2006-2009). Survival was assessed by the Kaplan-Meier method. In this retrospective study, 39 (47·56%) patients had normal values of lipids and 43 (52·43%) patients had hyperlipidemia. The mean survival time from the onset of symptoms for patients with normal lipidemia was 4·21±0·5 years, while the mean survival time from the onset of symptoms for patients with hyperlipidemia was 5·0±0·67 years (P = 0·36). We also did not register a significant difference in survival in relation to gender, the site or age of onset, even though we noticed a longer survival in patients with hyperlipidemia in all of the examined groups, especially in the group of younger patients, with the onset of the disease before the age of 45 years. If we take into account the fact that BMI is pathophysiologically associated with cholesterol and triglyceride serum levels, the results in our study complement each other showing that patients with a higher BMI, registered in 28·8% of the cases, do not live longer. Our findings show that hyperlipidemia, which we found in 52·43% of our ALS patients, at the time of diagnosis, is not related to significantly longer survival.
The purpose of this study was to translate the Neck Disability Index into the Serbian language (NDI-S) and to investigate the validity of this version for use in Serbian population.
Fifty patients ...with cervical radiculopathy were enrolled in the study and completed a multidimensional questionnaire, including NDI-S. Inclusion criteria were ages between 18 and 65 years, Serbian speaking, no cognitive or hearing impairment, sharp and radiating neck and upper extremity pain that has lasted less than 12 months, radiculopathy signs evaluated by electromyoneurography and disc herniation, or spondylotic changes of cervical spine visualized on magnetic resonance imaging. Exclusion criteria were malignancy, previous cervical spine discectomy, trauma of the cervical spine and myelopathy, polyneuropathy, fibromyalgia, and psychiatric disorders. Validity was determined by the correlation of the Neck Disability Index, with pain measured by visual analogue scale, characteristics related to pain, and mental status. Also, factor structure of NDI-S was explored through factor analysis. Reliability was assessed through internal consistency (Cronbach’s α and item-total correlations).
Correlation analysis between pain and NDI-S showed significant values (P < .01). The NDI-S correlated well with patients mental status (r = 0.421, P < .01). Cronbach’s α of NDI-S was 0.85, denoting excellent internal consistency of the questionnaire. Item-total correlations were significant and ranged from 0.328 to 0.789. Factor analysis demonstrated a 2-factor structure with an explained variance of 55%.
The NDI-S is a valid questionnaire to measure neck and arm pain related to disability in Serbian patients with cervical radiculopathy.
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder. Median survival from symptom onset is 3 years, but some patients live longer. Identification of prognostic ...factors will facilitate optimal use of medical and social resources. OBJECTIVE: In order to define the prognostic factor for survival, at the first visit, we investigated our ALS database of patients residents in Belgrade, the last 17 years. MATERIAL AND METHODS: In the period 1992.-2009. 325 patients with the diagnosis of definite or probable ALS were discovered in the Belgrade district. The survival were assessed with the Kaplan-Meier method. The prognostic value of each factor was estimated using Cox proportional hazard analyses. RESULTS: As of December 2009. 267 ALS patients (82.2%) ALS have died. The median survival time was 3 years, (95%CI: 2.86-3.14). Mean survival time from symptoms onset was 4.35 ± 0.20 years. The mean age at onset was 57.74 ± 11.46 years and the mean age at diagnosis was 59.21 ± 11.26 years. Eighty four patients (25.8%) had a bulbar onset and 241 (74.1%) had spinal onset of the disease. Mean survival time from onset for patients with spinal onset was 4.5 ± 0.2 years and 3.7 ± 0.4 years for patients with bulbar onset (p=0.016). Mean survival time for men was 4.40 ± 0.3 years and 4.2 ± 0.3 years for women (p>0.05). In the Cox multivariable model, the factors independently related to a longer survival were younger age, longer diagnostic delay, higher ALSFRS score at first examination and early riluzole treatment. CONCLUSIONS: The identification of younger age, longer diagnostic delay as predictors of prolonged survival in ALS clinic population supports the findings of several, earlier studies. Several additional variables assessed at the first examination predict longer survival: higher ALSFRS score and early riluzole treatment. Gender had no effect on survival. Advanced age and bulbar signs at onset indicated poorer prognosis in our population.
UVOD: Amiotrofična lateralna skleroza (ALS) je progresivno neurodegenerativno obolenje sa prosečnim srednjim vremenom preživljavanja od 3 godine. Kod pojedinih bolesnika je, međutim, preživljavanje duže. S obzirom na brz i fatalan tok bolesti, značajno je identifikovati prognostičke faktore preživljavanja u cilju optimalne upotrebe medicinskih i društvenih resursa. CILj RADA: ustanoviti moguće faktore dužeg preživljavanja bolesnika sa ALS u trenutku postavljanja dijagnoze, tokom 17 –ogodišnjeg praćenja na teritoriji Beograda. METODE RADA: ispitivano je 325 bolesnika sa prebivalištem u Beogradu koji su dijagnostikovani u periodu od januara 1992. do decembra 2009. godine. Preživljavanje je procenjivano Kaplan-Meier-ovom metodom. Prognostičke faktore smo izdvojili primenom Cox-og proporcionalnog regresionog modela. REZULTATI: Do kraja decembra 2009.g. ukupno je 267 bolesnika sa ALS umrlo (82.2%). Mediana vremena preživljavanja je 3 godine (95%CI 2.86-3.14). Srednje vreme trajanja bolesti od početka prvih simptoma je 4.35 ± 0.20 godina. Srednje životno doba na početku bolesti je 57.74 ± 11.46 godina dok je srednje životno doba prilikom postavljanja dijagnoze 59.21 ± 11.26 godina. Bulbarni početak je registrovan kod 84 (25.8%) bolesnika, spinalni početak kod 241 (74.1%). Kod bolesnika sa spinalnim početkom je srednje vreme trajanja ALS 4.5 ± 0.2 godina, bilo značajno duže u odnosu na bolesnike sa bulbarnim početkom (3.7 ± 0.4 godina, p=0.016). Iako je duže srednje vreme trajanja bolesti kod muškaraca (4.40 ± 0.3 godina) u odnosu na žene (4.2 ± 0.3 godina), pol nema uticaja na preživljavanje u našoj kohorti (p>0.05). Cox-ovom pocedurom je utvrđeno da su: mlađe životno doba na početku bolesti, duže dijagnostičko kašnjenje, viši ALSFRS skor prilikom dijagnostikovanja i rana primena riluzola u statistički značajnoj korelaciji sa dužim preživljavanjem. ZAKLjUČAK: Mlađe životno doba na početku bolesti i duže dijagnostičko kašnjenje su prognostički faktori dužeg preživljavanja bolesnika sa ALS koji su registrovani i u studijama drugih autora. Veća vrednost ALSFRS skora u momentu postavljanja dijagnoze i rana primena riluzola su dodatni prognostički faktori dužeg preživljavanja. Starije životno doba na početku bolesti i bulbarni početak bolesti su faktori lošije prognoze u našoj kohorti bolesnika.
Our aim was to assess the incidence, survival and its prognostic factors in ALS patients from the area of the City of Belgrade, Serbia. A retrospective analysis included 325 probable or definite ALS ...cases from all five Belgrade neurology departments in the period 1992-2009. Each patient was regularly followed up during the disease until death or until 31 December 2009. Results showed that the average annual ALS incidence rate was 1.11 per 100,000 inhabitants. Male predominance was registered, except for patients with ALS onset after the age of 80 years. Mean survival from the first symptoms was 4.4 ± 0.2 years. Cumulative probability of survival was 71% for two years, 24% for five years, and 17% for seven years. Patients with diagnostic delay longer than 1.6 years had a 1.4-times better chance for survival (p <0.01). Spinal-onset patients on riluzole therapy had 1.8-times better survival (p < 0.01). Patients with early-onset ALS and higher ALSFRS-R score at initial evaluation also had somewhat better survival (p < 0.05). In conclusion, the average annual ALS incidence rate was 1.11 per 100,000 inhabitants. Longer survival was observed in patients with early onset, longer diagnostic delay, less functional impairment at the time of diagnosis, and riluzole treatment.
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