title: Outcome of patients with amyotrophic lateral sclerosis attending in a multidisciplinary care unit.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis (ALS) is a disease with very poor prognosis, and a mortality of 50% at 18 months after diagnosis. Multidisciplinary units attempt to improve the quality of life and survival of patients with ALS. The aim of this study is to evaluate every 3 months, over a 24-month period, the outcome of patients treated at the ALS unit since the time of diagnosis.
  
  
  METHODS
  We performed a prospective observational study of patients treated in the ALS unit following a clinical pathway since the time of diagnosis with quarterly reviews from 2006 to 2010. The age of onset, functional impairment (ALSFRS-r), impairment of respiratory function, dysphagia and signs of depression and/or cognitive impairment were evaluated in relation to the initial location symptoms (bulbar [B], upper limbs [UL], lower limbs [LL]).
  
  
  RESULTS
  A total of 42 patients (30 males and 12 females) were evaluated (mean age at onset of 57.97 years old, SD 14.56). There was an even distribution by location of onset of symptoms (B 14 patients, UL 14, LL 14.) Functional impairment (B -26,89 points, UL -22,48 points, LL -22,66 points), the need for use of BIPAP (B 64.28%; UL 35.71%; LL 50%), the presence of dysphagia (B 85.71; UL 42.85; LL 71.42%), signs of depression (B 78.57%; UL 35.71%; LL 64.28%) and cognitive impairment (B 42.85%; UL 21.42; LL 35.71%) was higher at 24 months of progression in patients with bulbar onset. There was no difference in mortality data (23.80% overall).
  
  
  CONCLUSIONS
  The treatment in multidisciplinary units does not change the neurological progression of the disease, but increases the survival of ALS patients regardless of their initial onset, emphasising the use of multidisciplinary care.
authors.affiliation: Unidad de ELA, Servicio de Neurología, Hospital Universitario La Paz, IDIPAZ, Universidad Autónoma de Madrid, Madrid, España. rodriguezderivera@yahoo.es
authors.forename: F J
authors.initials: FJ
authors.lastname: Rodríguez de Rivera
authors.forename: C
authors.initials: C
authors.lastname: Oreja Guevara
authors.forename: I
authors.initials: I
authors.lastname: Sanz Gallego
authors.forename: B
authors.initials: B
authors.lastname: San José Valiente
authors.forename: A
authors.initials: A
authors.lastname: Santiago Recuerda
authors.forename: M A
authors.initials: MA
authors.lastname: Gómez Mendieta
authors.forename: J
authors.initials: J
authors.lastname: Arpa
authors.forename: E
authors.initials: E
authors.lastname: Díez Tejedor
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006757:Hospital Units; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain; D016896:Treatment Outcome