RT Journal Article
SR Electronic
T1 How common are ALS plateaus and reversals?
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 808
OP 812
DO 10.1212/WNL.0000000000002251
VO 86
IS 9
A1 Richard S. Bedlack
A1 Timothy Vaughan
A1 Paul Wicks
A1 Jamie Heywood
A1 Ervin Sinani
A1 Roger Selsov
A1 Eric A. Macklin
A1 David Schoenfeld
A1 Merit Cudkowicz
A1 Alex Sherman
YR 2016
UL http://n.neurology.org/content/86/9/808.abstract
AB Objective: To determine the frequency of amyotrophic lateral sclerosis (ALS) plateaus and reversals in the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database.Methods: We analyzed Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) and ALSFRS–revised (ALSFRS-R) data from PRO-ACT participants. The frequencies of participants experiencing plateaus (periods where scores did not change) were calculated over 6-, 12-, and 18-month epochs. The percentage of participants ever experiencing reversals (periods where scores improved) of different lengths were also calculated and plotted.Results: Over 6 months, 25% of 3,132 participants did not decline. Over 12 months, 16% of 2,105 participants did not decline. Over 18 months, 7% of 1,218 participants did not decline. Small ALS reversals were also common, especially over shorter follow-up intervals; 14% of 1,343 participants had a 180-day interval where their ALSFRS-R slope was greater than zero. Fewer than 1% of participants ever experienced improvements of 4 or more ALSFRS-R points lasting at least 12 months.Conclusion: ALS plateaus and small reversals are common, especially over brief intervals. In light of these data, stable disease, especially for a short period of time, should not be interpreted as an ALS treatment effect. Large sustained ALS reversals, on the other hand, are rare, potentially important, and warrant further study.ALS=amyotrophic lateral sclerosis; ALSFRS=Amyotrophic Lateral Sclerosis Functional Rating Score; ALSFRS-R=Amyotrophic Lateral Sclerosis Functional Rating Score–revised; PRO-ACT=Pooled Resource Open-Access ALS Clinical Trials