title: Limb-onset amyotrophic lateral sclerosis patients visiting orthopedist show a longer time-to-diagnosis since symptom onset.
abstract: BACKGROUND
  There have been several reports concerning the survival time after symptom onset in patients with amyotrophic lateral sclerosis (ALS). However, little is known about how the choice of physician (i.e., general practitioner, neurologist, etc.) may affect the time it takes for a diagnosis of ALS to be made.
  
  
  METHODS
  We conducted a retrospective study, covering a 20-year period, comparing the type of physician first consulted by an ALS patient at the time of initial symptoms and the amount of time that elapsed to the final diagnosis of ALS. A total of 202 patients were diagnosed and stratified according to the onset of ALS symptoms (bulbar onset [BO] and limb onset [LO]). We noted the type of physician first seen by the patient. The diagnostic interval was calculated as the time between onset of symptoms and the final diagnosis of ALS.
  
  
  RESULTS
  A total of 202 ALS patients were examined. Clinical BO and LO was observed in 78 (36.6%) and in 124 (61.4%) of these patients, respectively. The type of physician examining these patients at the first symptoms of disease was as follows (BO and LO): neurologist (38.5% and 25.8%), general practitioner (14.1% and 35.5%), orthopedist (12.8% and 35.5%), otolaryngologist (15.4% and 0%), and neurosurgeon (14.1% and 3.2%). Mean diagnostic interval (standard deviation) for patients with either set of symptoms was 13.1 (6.5) months; the diagnostic interval of patients with BO and LO was 9.2 (4.5) and 15.2 (7.7) months, respectively. ALS diagnosis in LO patients was delayed by more than 10 months when the patient first consulted an orthopedist rather than a neurologist.
  
  
  CONCLUSIONS
  More than 50% of the ALS patients included in this study did not visit a neurologist at the first symptoms of disease onset. The diagnosis of ALS was prolonged in LO patients visiting an orthopedist. We speculate that this increase in the diagnostic interval in LO patients visiting an orthopedist was due to a lack of bulbar symptoms in the early stages of this disease.
authors: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan. osamukano@aol.com
authors: Osamu
authors: O
authors: Kano
authors: Konosuke
authors: K
authors: Iwamoto
authors: Hirono
authors: H
authors: Ito
authors: Yuji
authors: Y
authors: Kawase
authors: Derek
authors: D
authors: Cridebring
authors: Ken
authors: K
authors: Ikeda
authors: Yasuo
authors: Y
authors: Iwasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000473:pathology* / Q000503:physiopathology*; D018450:Disease Progression; D005121:Extremities / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010820:Physicians; D012017:Referral and Consultation; D012189:Retrospective Studies
references: Neurology. 1999 Sep 22;53(5):1123-5
references: 10496278
references: Neurology. 2003 Jul 22;61(2):171-7
references: 12874394
references: J Neurol Sci. 2008 May 15;268(1-2):95-101
references: 18164728
references: J Neurol Neurosurg Psychiatry. 2003 Sep;74(9):1258-61
references: 12933930
references: Amyotroph Lateral Scler Other Motor Neuron Disord. 2004 Dec;5(4):208-12
references: 15799548
references: Amyotroph Lateral Scler Other Motor Neuron Disord. 2000 Dec;1(5):293-9
references: 11464847
references: J Neurol Neurosurg Psychiatry. 2004 Dec;75(12):1753-5
references: 15548498
references: Amyotroph Lateral Scler Other Motor Neuron Disord. 2001 Sep;2(3):123-6
references: 11771767
references: Arch Neurol. 2006 Aug;63(8):1139-43
references: 16908741
references: Neurology. 2009 Oct 13;73(15):1218-26
references: 19822872
references: Lancet. 1996 May 25;347(9013):1425-31
references: 8676624
references: Neurosurgery. 2005 Nov;57(5):984-9; discussion 984-9
references: 16284567
references: Clin Neurol Neurosurg. 2002 May;104(2):87-9
references: 11932036
references: Neurology. 2002 Jul 23;59(2):280-2
references: 12136072
references: J Neurol Sci. 1994 Jul;124 Suppl:96-107
references: 7807156
references: Brain. 1995 Jun;118 ( Pt 3):707-19
references: 7600088
references: J Neurol Sci. 2010 Jul 15;294(1-2):81-5
references: 20452624