title: Spread Direction and Prognostic Factors in Limb-Onset Sporadic Amyotrophic Lateral Sclerosis.
abstract: To investigate the spread direction and prognostic factors in limb-onset sporadic amyotrophic lateral sclerosis (sALS).
  
  
  
  Medical records of 128 patients with sALS were reviewed. Variables studied were age at symptom onset, gender, region and lateralization of onset, onset to diagnosis interval (ODI), progression direction, bulbar-involved, time from onset to bulbar-involved, ALSFRS-r, upper motor neuron (UMN) signs and progression rate.
  
  
  
  First, the horizontal and vertical directions are major spreading directions in limb-onset sALS. Second, in crossed and interposed groups, while ODI is shorter, the progression rate is faster and UMN signs are more pronounced (p < 0.05). Third, ALSFRS-r, UMN signs and progression rate have significant differences between with-bulbar-involved and without-bulbar-involved (p < 0.05). The progression rate is related to the time from onset symptoms to bulbar-involved (correlation coefficient -0.535, p = 0.00). Fourth, in multivariate regression analysis, progression rate could respectively increase by about 1.14 and 3.89 times with shorter ODI and bulbar-involved in limb-onset sALS patients.
  
  
  
  The horizontal and vertical directions are the major spread directions in limb-onset sALS. Except for ALSFRS-r and ODI, bulbar-involved is an adverse factor for ALS progression, and progression rate is related to the time from onset symptoms to bulbar-involved.
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Hu
authors.forename: Jiaoting
authors.initials: J
authors.lastname: Jin
authors.forename: Rui
authors.initials: R
authors.lastname: Jia
authors.forename: Li
authors.initials: L
authors.lastname: Xiang
authors.forename: Huaguang
authors.initials: H
authors.lastname: Qi
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.forename: Jingxia
authors.initials: J
authors.lastname: Dang
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis