Cardiovascular diseases may play a negative role in the prognosis of amyotrophic lateral sclerosis

Mandrioli, Jessica; Ferri, Laura; Fasano, Antonio; Zucchi, Elisabetta; Fini, Nicola; Moglia, Cristina; Lunetta, Christian; Marinou, Kalliopi; Ticozzi, Nicola; Ferrante, Gianluca Drago; Scialò, Carlo; Sorarù, Gian Domenico; Trojsi, Francesca; Conte, Amelia; Falzone, Yuri Matteo; Tortelli, Rosanna; Russo, Massimo; Sansone, Valeria; Mora, Gabriele; Silani, Vincenzo; Volanti, Paolo; Caponnetto, Claudia; Querin, Giorgia; Monsurrò, Maria Rosaria; Sabatelli, Mario; Chiò, Adriano; Riva, Nilo; Logroscino, Giancarlo; Messina, Sonia; Calvo, Andrea

doi:10.1111/ene.13620

Cited by 36 publications

(23 citation statements)

References 20 publications

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“…Concomitant psychiatric diseases in ALS patients, whether prior or after this fatal diagnosis, may add strain on caregivers and pose important ethical challenges for support and end-of-life decisions along the course of this disease. Until now, only few register-based studies have taken into account the prognostic significance of simultaneous psychiatric illness in ALS, showing a mild negative influence of anxiety symptoms and other psychiatric disturbances in univariate analysis, whose effect was later unconfirmed in multivariate analysis (Körner et al, 2013; Mandrioli et al, 2018). Other studies examining the impact of neuropsychiatric symptoms in ALS, expressed mainly as behavioral alterations, failed to demonstrate any impact on survival (Mioshi et al, 2014; Burke et al, 2017).…”

Section: Prognostic Role Of Psychiatric Disturbances In Alsmentioning

confidence: 99%

Psychiatric Symptoms in Amyotrophic Lateral Sclerosis: Beyond a Motor Neuron Disorder

2019

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The historical view that Amyotrophic Lateral Sclerosis (ALS) as a pure motor disorder has been increasingly challenged by the discovery of cognitive and behavioral changes in the spectrum of Frontotemporal Dementia (FTD). Less recognized and still significant comorbidities that ALS patients may present are prior or concomitant psychiatric illness, such as psychosis and schizophrenia, or mood disorders. These non-motor symptoms disturbances have a close time relationship with disease onset, may constitute part of a larger framework of network disruption in motor neuron disorders, and may impact ALS patients and families, with regards to ethical choices and end-of-life decisions. This review aims at identifying the most common psychiatric alterations related to ALS and its prognosis, looking at a common genetic background and shared structural brain pathology.

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Section: Prognostic Role Of Psychiatric Disturbances In Alsmentioning

confidence: 99%

Psychiatric Symptoms in Amyotrophic Lateral Sclerosis: Beyond a Motor Neuron Disorder

2019

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“…The link between hypertension and ALS is currently less clear. Multiple associations have been made between hypertension and ALS onset and survival [116,129], but contradicting results have also been obtained by other studies [76,94,128]. This could possibly be explained by variations in methodology, and further studies are therefore required to confirm this association.…”

Section: Abnormal Vascular Changes In Alsmentioning

confidence: 87%

Defining novel functions for cerebrospinal fluid in ALS pathophysiology

Kwong

Mehta

Chandran

2020

acta neuropathol commun

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Despite the considerable progress made towards understanding ALS pathophysiology, several key features of ALS remain unexplained, from its aetiology to its epidemiological aspects. The glymphatic system, which has recently been recognised as a major clearance pathway for the brain, has received considerable attention in several neurological conditions, particularly Alzheimer's disease. Its significance in ALS has, however, been little addressed. This perspective article therefore aims to assess the possibility of CSF contribution in ALS by considering various lines of evidence, including the abnormal composition of ALS-CSF, its toxicity and the evidence for impaired CSF dynamics in ALS patients. We also describe a potential role for CSF circulation in determining disease spread as well as the importance of CSF dynamics in ALS neurotherapeutics. We propose that a CSF model could potentially offer additional avenues to explore currently unexplained features of ALS, ultimately leading to new treatment options for people with ALS.

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“…1 Most patients die of respiratory complications 3-5 years after its onset. 4,5 Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, represents an acute heart failure syndrome characterized by ST-segment elevation and reversible left ventricular regional wall motion abnormalities (typically involving the apex). 1,2 Difficult swallowing is another frequent complication often requiring percutaneous endoscopic gastrostomy (PEG) in order to provide proper nutritional support and minimize the risk of aspiration pneumonia.…”

Section: Introductionmentioning

confidence: 99%

“…1,3 Recent publications have reported that heart diseases, including atrial fibrillation and heart failure, are common in ALS patients and are independently associated with reduced survival. 4,5 Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, represents an acute heart failure syndrome characterized by ST-segment elevation and reversible left ventricular regional wall motion abnormalities (typically involving the apex). 6,7 The precise pathogenesis of TTS remains unknown; a neurogenic origin with excessive catecholamine production causing microvascular spasm and direct cardiotoxicity may be involved.…”

Section: Introductionmentioning

confidence: 99%

“…6 Several recent publications suggest that TTS, presenting with acute exacerbation of dyspnoea and chest discomfort, is relatively common in ALS patients, particularly in the advanced stages of ALS. 8,9 Additionally, atrial fibrillation (AF) is a common complication of both TTS and ALS, 5,7 and the use of anticoagulation in such fragile patients may be particularly challenging.…”

Section: Introductionmentioning

confidence: 99%

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Sustained safe and effective anticoagulation using Edoxaban via percutaneous endoscopic gastrostomy

et al. 2019

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Extensive data support the safety of direct oral anticoagulants compared with vitamin K antagonists in patients with non‐valvular atrial fibrillation, leading to a significantly increase in the use of these compounds in clinical practice. However, there is no compelling evidence supporting the use of direct oral anticoagulant in individuals who are intubated or have a percutaneous endoscopic gastrostomy (PEG): patients with several co‐morbidities are underrepresented in clinical trials, so the best long‐term strategy for anticoagulation is difficult to ascertain. The aim of the present report was to evaluate the safety and efficacy of edoxaban administered via PEG in a patient with heart failure and a history of atrial fibrillation affected by amyotrophic lateral sclerosis (ALS). A 71‐year‐old man with atrial fibrillation, advanced ALS, type II diabetes mellitus, and hypertension presented to the emergency department with dyspnoea and tachycardia. Because vitamin K antagonist and rivaroxaban 15 mg were dropped because of difficult international normalized ratio control (time in therapeutic range <30%) and severe haematuria, respectively, edoxaban 30 mg (crushed pill) daily was administered based on the patient's weight of 58 kg. Mean edoxaban plasma concentration–time profiles were measured, as anti‐Xa activity, 2 h before and at 2, 6, and 22 h after drug administration and then compared with the pharmacokinetic profile of edoxaban 30 mg in healthy subjects. An additional testing of steady‐state peak plasma concentration of edoxaban after 10 days and a 30 day follow‐up were evaluated. The values of the pharmacokinetic parameters, analysed with a non‐compartmental analysis by PKSolver module, showed that Cmax and AUC0→t were only slightly higher than those observed in healthy subjects, while the half‐life and observed clearance were significantly longer and lower, respectively, than in normal subjects. Steady‐state peak plasma concentration of edoxaban was very similar to the levels reported in healthy subjects, and neither relevant bleeding nor thromboembolic event was reported at a 30 day follow‐up. These results support safe and effective anticoagulation with edoxaban 30 mg but suggest caution with the use of full dose of edoxaban (60 mg daily) in this kind of patients. We report, for the first time, a safe and effective anticoagulation based on the administration of edoxaban 30 mg daily through PEG in a patient with advanced ALS, acute respiratory, and heart failure, presenting with Takotsubo syndrome and atrial fibrillation.

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Cardiovascular diseases may play a negative role in the prognosis of amyotrophic lateral sclerosis

Cited by 36 publications

References 20 publications

Psychiatric Symptoms in Amyotrophic Lateral Sclerosis: Beyond a Motor Neuron Disorder

Psychiatric Symptoms in Amyotrophic Lateral Sclerosis: Beyond a Motor Neuron Disorder

Defining novel functions for cerebrospinal fluid in ALS pathophysiology

Sustained safe and effective anticoagulation using Edoxaban via percutaneous endoscopic gastrostomy

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