30/09/2024
AMYOTROPHIC LATERAL SCLEROSIS (ALS)
Amyotrophic lateral sclerosis (ALS), also known as Charcot's disease or Lou Gehrig's disease, belongs to the group of neurological diseases of the central nervous system. It is a neurodegenerative disease that affects the upper and lower motor neurons. The condition arises due to the destruction of motor neurons.
The initial symptoms can vary. In the beginning, there may be muscle weakness, twitching, or cramping, and as the disease progresses, it gradually impairs walking, speech, swallowing, and eventually breathing. The disease most commonly appears between the ages of 45 and 55, although exceptions exist.
DIAGNOSIS: The diagnosis is based on clinical presentation, electrophysiological testing, and histological examinations. A precise diagnosis, including determining the ALS subtype, is made through genetic testing.
PRECISE DIAGNOSIS: ALS can manifest as either a familial (inherited) form or a sporadic form.
The familial form occurs when two or more family members are affected by ALS. This type has a clear genetic basis and typically appears earlier in life, accounting for approximately 10% of cases.
The sporadic form also has a genetic basis, but it is usually caused by new gene mutations or genes that were previously “hidden” (low expression). It generally appears later in life and represents about 90% of cases.
RECOMMENDATION: Use all available diagnostic resources to establish as precise a diagnosis as possible, including identifying the specific ALS subtype. This involves clinical evaluations and genetic testing (genetic counselling, family history, and finally, genetic testing). Today, gene panels (groups of suspect genes) are commonly used for ALS. The most commonly implicated genes are C9orf72, SOD1, TARDBP, FUS, as well as genes involved in protein sorting and recycling (UBQLN2, UBQLN4). Typically, a panel of 20 to 50 genes is tested.
This enables the most accurate treatment plan, prognosis, and risk assessment.