Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that is characterized by a high heterogeneity in patients’ disease course. Patients with bulbar onset of symptoms (b-ALS) have a poorer prognosis than patients with limb onset (l-ALS). However, neuroimaging correlates of the assumed biological difference between b-ALS and l-ALS may have been obfuscated by patients’ diversity in the disease course. We conducted Voxel-Based-Morphometry (VBM) and Tract-Based-Spatial-Statistics (TBSS) in a group of 76 ALS patients without clinically relevant cognitive deficits. The subgroups of 26 b-ALS and 52 l-ALS patients did not differ in terms of disease Phase or disease aggressiveness according to the D50 progression model. VBM analyses showed widespread ALS-related changes in grey and white matter, that were more pronounced for b-ALS. TBSS analyses revealed that b-ALS was predominantly characterized by frontal fractional anisotropy decreases. This demonstrates a higher degree of neurodegenerative burden for the group of b-ALS patients in comparison to l-ALS. Correspondingly, higher bulbar symptom burden was associated with right-temporal and inferior-frontal grey matter density decreases as well as fractional anisotropy decreases in inter-hemispheric and long association tracts. Contrasts between patients in Phase I and Phase II further revealed that b-ALS was characterized by an early cortical pathology and showed a spread only outside primary motor regions to frontal and temporal areas. In contrast, l-ALS showed ongoing structural integrity loss within primary motor-regions until Phase II. We therefore provide a strong rationale to treat both onset types of disease separately in ALS studies.
| Original language | English |
|---|---|
| Article number | 102674 |
| Journal | NeuroImage: Clinical |
| Volume | 30 |
| DOIs | |
| Publication status | Published - 01.2021 |
Funding
The present study was supported by the German Bundesministerium für Bildung und Forschung (BMBF) grant SOPHIA [01ED1202B] and ONWebDUALS [01ED15511A] to J.G. under the aegis of the EU Joint Program Neurodegenerative Disease Research (JPND) and a BMBF grant PYRAMID [01GM1304] to J.G. in the framework of the ERANET E-RARE program. T.P. was also supported by a Bundesministerium für Bildung und Forschung grant [01GY1804]. Support was also received from the Motor Neurone Disease Association (MNDA) and Deutsche Gesellschaft fuer Muskelkranke (DGM). R.S. and A.R. are supported by the Deutsche Forschungsgemeinschaft (DFG) with a clinician scientist program [WI 830/12-1]. N.G. is supported by a doctoral scholarship (Landesgraduiertenstipendien) from the Graduate Academy of Friedrich Schiller University, Jena, Germany and the state of Thuringia. We are grateful to the community of ALS patients and their caregivers, without whom this work would not be possible. We extend our thanks to Mandy Arnold, Cindy H?pfner and Ann-Kathrin Klose for continuous assessment and patient care. The present study was supported by the German Bundesministerium f?r Bildung und Forschung (BMBF) grant SOPHIA [01ED1202B] and ONWebDUALS [01ED15511A] to J.G. under the aegis of the EU Joint Program Neurodegenerative Disease Research (JPND) and a BMBF grant PYRAMID [01GM1304] to J.G. in the framework of the ERANET E-RARE program. T.P. was also supported by a Bundesministerium f?r Bildung und Forschung grant [01GY1804]. Support was also received from the Motor Neurone Disease Association (MNDA) and Deutsche Gesellschaft fuer Muskelkranke (DGM). R.S. and A.R. are supported by the Deutsche Forschungsgemeinschaft (DFG) with a clinician scientist program [WI 830/12-1]. N.G. is supported by a doctoral scholarship (Landesgraduiertenstipendien) from the Graduate Academy of Friedrich Schiller University, Jena, Germany and the state of Thuringia.
Research Areas and Centers
- Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)
- Centers: Center for Neuromuscular Diseases
