ALS multidisciplinary clinic and survival. Results from a population-based study in Southern Italy.
BACKGROUND
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting motorneurons, for which there is no effective cure. Because of the multifactorial nature of impairment and disablity in ALS, multidisciplinary clinics (MDC) have been recently introduced in the management of ALS patients; their effects on survival remain, however, largely debated.


OBJECTIVE
To compare survival of ALS patients who received their care at MDC with that of patients followed by general neurology clinics.


METHODS
Source of the study was a prospective population-based registry of ALS established in Puglia, Southern Italy, in 1997. We examined survival of 126 out of 130 incident ALS cases that were diagnosed during the period 1998-99.


RESULTS
84 patients (67%) were enrolled and followed by MDC and the remaining 42 (33%) by general neurological clinics. No difference in median survival time from the diagnosis was observed between patients followed by ALS multidisciplinary (17.6 months) and general clinics (18 months). No beneficial effect was present among bulbar onset ALS (11.7 versus 23 months). In multivariate analysis management by ALS MDC was associated with only a 10% increase in survival probability at 12 months (HR: 0.91; 95%CI: 0.44-1.89; p = 0.9).


CONCLUSIONS
In this population-based series, we found that in Southern Italy management of ALS by multidisciplinary clinics does not improve survival, regardless of site of symptoms onset.
Zoccolella
Stefano
S
Department of Neurological Sciences, University of Bari, Operative Unit of Neurology, L Bonomo Hospital, Andria (BA), Italy.
Beghi
Ettore
E
Palagano
Guerrino
G
Fraddosio
Angela
A
Guerra
Vito
V
Lepore
Vito
V
Simone
Isabella Laura
IL
Lamberti
Paolo
P
Serlenga
Luigi
L
Logroscino
Giancarlo
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology* / Q000401:mortality*; D018672:Community Health Planning; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies