Regional Pattern of Symptom Spread in Amyotrophic Lateral Sclerosis (ALS) (P06.130)

OBJECTIVE: The objective of this study is to identify patterns of symptoms spread in a cohort of ALS patients. BACKGROUND: Clinical and pathological studies of ALS progression suggest a regional disease spread. DESIGN/METHODS: Subjects were identified through ALS billing codes and data collection was completed through detailed charts review. Symptoms were classified into the following regions: Cervical (right and left), lumbar (right and left), bulbar, and respiratory. Subjects with multiple regions of disease onset were excluded. RESULTS: 150 subjects were identified. 39% had their first symptom in the cervical, 36% lumbar, 21% bulbar, and 4% respiratory regions. Subjects who had the initial symptom in the cervical region were more likely to have the second symptom in the lumbar (47%). An initial symptom in the lumbar region was more likely to spread to the cervical (70%) and an initial symptom in the bulbar region was more likely to spread to the cervical (55%) Subjects who had their first symptom in the left arm (24) were more likely to have the second symptom in the right arm (42%) or bulbar (21%) rather than in the right (4%) or left (0%) legs. Subjects who had their first symptom in the right arm (23) were more likely to have the second symptom in the left arm (30%) or bulbar (35%). Subjects who had their first symptom in the left leg (17) were more likely to have the second symptom in the right leg (41%) rather than other in regions. Subjects who had their first symptom in the right leg (20) were more likely to have the second symptom in the left leg (45%) rather than in other regions. CONCLUSIONS: Symptom spread in ALS follows a regional pattern and tends not to skip a spinal segment. Our results suggest a strong horizontal spread pattern across the spinal cord or brain. Supported by: AAN Clinical Research Training Fellowship. Disclosure: Dr. McKenery has nothing to disclose. Dr. Yu has nothing to disclose. Dr. Li has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Chang has nothing to disclose. Dr. Jankowski has nothing to disclose. Dr. Bozik has nothing to disclose. Dr. Orbey has nothing to disclose. Dr. Zipf has nothing to disclose. Dr. Cudkowicz has received personal compensation for activities with GlaxoSmithKline, Inc. and Teva Neuroscience. Dr. Cudkowicz has received research support from Biogen Idec and Neuraltis. Dr. Atassi has received personal compensation from Gerson Lehrman Group and Monitor.