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Analysis of amyotrophic lateral sclerosis as a multistep process: a population-based modelling study

journal contribution
posted on 2023-06-08, 20:56 authored by Ammar Al-Chalabi, Andrea Calvo, Adriano Chio, Shuna Colville, Cathy M Ellis, Orla Hardiman, Mark Heverin, Robin S Howard, Mark H B Huisman, Noa Keren, Nigel LeighNigel Leigh, Letizia Mazzini, Gabriele Mora, Richard W Orrell, James Rooney, Kirsten M Scott, William J Scotton, Meinie Seelen, Christopher E Shaw, Katie S Sidle, Robert Swingler, Miho Tsuda, Jan H Veldink, Anne E Visser, Leonard H van den Berg, Neil Pearce
BACKGROUND Amyotrophic lateral sclerosis shares characteristics with some cancers, such as onset being more common in later life, progression usually being rapid, the disease affecting a particular cell type, and showing complex inheritance. We used a model originally applied to cancer epidemiology to investigate the hypothesis that amyotrophic lateral sclerosis is a multistep process. METHODS We generated incidence data by age and sex from amyotrophic lateral sclerosis population registers in Ireland (registration dates 1995-2012), the Netherlands (2006-12), Italy (1995-2004), Scotland (1989-98), and England (2002-09), and calculated age and sex-adjusted incidences for each register. We regressed the log of age-specific incidence against the log of age with least squares regression. We did the analyses within each register, and also did a combined analysis, adjusting for register. FINDINGS We identified 6274 cases of amyotrophic lateral sclerosis from a catchment population of about 34 million people. We noted a linear relationship between log incidence and log age in all five registers: England r(2)=0·95, Ireland r(2)=0·99, Italy r(2)=0·95, the Netherlands r(2)=0·99, and Scotland r(2)=0·97; overall r(2)=0·99. All five registers gave similar estimates of the linear slope ranging from 4·5 to 5·1, with overlapping confidence intervals. The combination of all five registers gave an overall slope of 4·8 (95% CI 4·5-5·0), with similar estimates for men (4·6, 4·3-4·9) and women (5·0, 4·5-5·5). INTERPRETATION A linear relationship between the log incidence and log age of onset of amyotrophic lateral sclerosis is consistent with a multistage model of disease. The slope estimate suggests that amyotrophic lateral sclerosis is a six-step process. Identification of these steps could lead to preventive and therapeutic avenues. FUNDING UK Medical Research Council; UK Economic and Social Research Council; Ireland Health Research Board; The Netherlands Organisation for Health Research and Development (ZonMw); the Ministry of Health and Ministry of Education, University, and Research in Italy; the Motor Neurone Disease Association of England, Wales, and Northern Ireland; and the European Commission (Seventh Framework Programme).

History

Publication status

  • Published

Journal

Lancet Neurology

ISSN

1474-4422

Publisher

Elsevier

Issue

11

Volume

13

Page range

1108-1113

Department affiliated with

  • BSMS Neuroscience Publications

Full text available

  • No

Peer reviewed?

  • Yes

Legacy Posted Date

2015-11-26

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