title: Searching for a link between the L-BMAA neurotoxin and amyotrophic lateral sclerosis: a study protocol of the French BMAALS programme.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis (ALS) is the most common motor neurone disease. It occurs in two forms: (1) familial cases, for which several genes have been identified and (2) sporadic cases, for which various hypotheses have been formulated. Notably, the β-N-methylamino-L-alanine (L-BMAA) toxin has been postulated to be involved in the occurrence of sporadic ALS. The objective of the French BMAALS programme is to study the putative link between L-BMAA and ALS.
  
  
  METHODS
  The programme covers the period from 1 January 2003 to 31 December 2011. Using multiple sources of ascertainment, all the incident ALS cases diagnosed during this period in the area under study (10 counties spread over three French regions) were collected. First, the standardised incidence ratio will be calculated for each municipality under concern. Then, by applying spatial clustering techniques, overincidence and underincidence zones of ALS will be sought. A case-control study, in the subpopulation living in the identified areas, will gather information about patients' occupations, leisure activities and lifestyle habits in order to assess potential risk factors to which they are or have been exposed. Specimens of drinking water, food and biological material (brain tissue) will be examined to assess the presence of L-BMAA in the environment and tissues of ALS cases and controls.
  
  
  BACKGROUND
  The study has been reviewed and approved by the French ethical committee of the CPP SOOM IV (Comité de Protection des Personnes Sud-Ouest & Outre-Mer IV). The results will be published in peer-reviewed journals and presented at national and international conferences.
authors.affiliation: Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Delzor
authors.affiliation: Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Couratier
authors.affiliation: Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Boumédiène
authors.affiliation: Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Nicol
authors.affiliation: Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Druet-Cabanac
authors.affiliation: Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France.
authors.forename: François
authors.initials: F
authors.lastname: Paraf
authors.affiliation: Interdisciplinary Laboratory for Tomorrow's Energy Pack (LIED), CNRS UMR 8236, University Paris Diderot-Paris 7, Paris, France.
authors.forename: Annick
authors.initials: A
authors.lastname: Méjean
authors.affiliation: Interdisciplinary Laboratory for Tomorrow's Energy Pack (LIED), CNRS UMR 8236, University Paris Diderot-Paris 7, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Ploux
authors.affiliation: Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Leleu
authors.affiliation: UMR 6553 ECOBIO, Ecosystems-Biodiversity-Evolution, University Rennes I, Rennes, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Brient
authors.affiliation: UMR 6553 ECOBIO, Ecosystems-Biodiversity-Evolution, University Rennes I, Rennes, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Lengronne
authors.affiliation: Department of Analytical, Bioanalytical Sciences and Miniaturization (LSABM), UMR ESPCI-ParisTech-CNRS 8231 CBI, Paris, France University Sorbonne, University Pierre and Marie Curie (UPMC), Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Pichon
authors.affiliation: Department of Analytical, Bioanalytical Sciences and Miniaturization (LSABM), UMR ESPCI-ParisTech-CNRS 8231 CBI, Paris, France University Sorbonne, University Pierre and Marie Curie (UPMC), Paris, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Combès
authors.affiliation: Department of Analytical, Bioanalytical Sciences and Miniaturization (LSABM), UMR ESPCI-ParisTech-CNRS 8231 CBI, Paris, France University Sorbonne, University Pierre and Marie Curie (UPMC), Paris, France.
authors.forename: Saïda
authors.initials: S
authors.lastname: El Abdellaoui
authors.affiliation: Environment and Health Prediction in Populations (EPSP), CNRS-TIMC-IMAG UMR 5525 UJF-Grenoble 1, Grenoble, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bonneterre
authors.affiliation: Department of Neurology, University Hospital of Grenoble, Grenoble, France.
authors.forename: Emmeline
authors.initials: E
authors.lastname: Lagrange
authors.affiliation: Department of Neurology, University Hospital of Grenoble, Grenoble, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Besson
authors.affiliation: Environment and Health Prediction in Populations (EPSP), CNRS-TIMC-IMAG UMR 5525 UJF-Grenoble 1, Grenoble, France Biomathematics and Epidemiology, Environment and Health Prediction in Populations (EPSP), VetAgro Sup, Marcy-l'Etoile, France.
authors.forename: Dominique J
authors.initials: DJ
authors.lastname: Bicout
authors.affiliation: Department of Neurology, University Hospital of Grenoble, Grenoble, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Boutonnat
authors.affiliation: Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France.
authors.forename: William
authors.initials: W
authors.lastname: Camu
authors.affiliation: Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pageot
authors.affiliation: Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France.
authors.forename: Raul
authors.initials: R
authors.lastname: Juntas-Morales
authors.affiliation: Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Rigau
authors.affiliation: UMR 5119 ECOSYM, Ecology of Coastal Marine Systems, UM2-CNRS-IRD-Ifremer-UM1, University Montpellier II, Montpellier, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Masseret
authors.affiliation: Environment Resources Laboratory/Languedoc-Roussillon, Ifremer, Sète, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Abadie
authors.affiliation: Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Preux
authors.affiliation: Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Marin
mesh_terms: D000599:Amino Acids, Diamino / Q000032:analysis*; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology*; D001921:Brain; D001923:Brain Chemistry; D016022:Case-Control Studies; D016000:Cluster Analysis; D000087522:Cyanobacteria Toxins; D060766:Drinking Water / Q000032:analysis; D004781:Environmental Exposure / Q000032:analysis / Q000706:statistics & numerical data*; D005504:Food Analysis; D005602:France / Q000453:epidemiology; D006801:Humans; D007899:Leisure Activities; D009498:Neurotoxins / Q000032:analysis*; D016273:Occupational Exposure / Q000706:statistics & numerical data; D009790:Occupations / Q000706:statistics & numerical data; D012042:Registries
chemical_list: D000599:Amino Acids, Diamino; D000087522:Cyanobacteria Toxins; D060766:Drinking Water; D009498:Neurotoxins; C001824:beta-N-methylamino-L-alanine
keywords: EPIDEMIOLOGY; PUBLIC HEALTH