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MND is a progressive neurodegenerative disease characterised by death of upper and lower motor neurons, leading to progressive weakness of the bulbar, limb, thoracic and abdominal muscles. MND has a fairly stereotypical course, with death from respiratory failure occurring 2-4 years after symptom onset in most cases (1). Making the diagnosis of MND can be straightforward when key clinical criteria are met; however, at first presentation, rarely do patients meet these criteria, neurological changes may be subtle and disease progression slow. Thus, diagnosis poses a significant challenge, particularly in general practice, where patients are most likely to first present. Not surprisingly, there is usually a delay of 10-18 months between symptom onset and MND diagnosis (2). Importantly, early assessment by a neurologist is associated with a shorter time to MND diagnosis (3), which has significant implications for access to healthcare, including Riluzole and multidisciplinary clinics, which improve survival (4). Although delay in diagnosis is well documented, there have been no studies that have sought to identify factors associated with time to diagnosis, thereby enabling targeted implementation of a public health intervention. To characterise the clinical factors that influence time to diagnosis of MND. 112 patients with MND attending the Southern Adelaide MND Clinic enrolled between January 2016 - 2018 were retrospectively recruited in to a cohort study. Information pertaining to the patient's demographics and their journey to diagnosis collected by a specialist physician and stored in the Australian MND Registry during clinic review were analysed to identify factors associated with time to diagnosis. Mean time to diagnosis was 13 ± 1 months (range 1 - 38 months) from symptom onset. 41% of patients were classified as having fast disease progression; compared to those with slow disease progression, these patients were diagnosed earlier (8 ± 1 months vs 16 ± 2 months) ( < 0.0001, = 34.6, df =220), were less likely to undergo multiple specialist opinions prior to referral to a neurologist (53% vs 73%) ( < 0.05, = 9.5, df =1), and were more disabled at time of diagnosis (mean ALSFRS-R 33 ± 5 vs ALSFRS-R 41 ± 5) ( < 0.0001, = 12.4, df =220). Fast disease progression identifies a dichotomy of MND patients diagnosed earlier, although more disabled at diagnosis, likely mediated by a more efficient referral process. A greater awareness of MND is required to shorten time to diagnosis.
This article was published in the following journal.
Name: Amyotrophic lateral sclerosis & frontotemporal degeneration
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A SMN complex protein that is closely-related to SURVIVAL OF MOTOR NEURON 1 PROTEIN. In humans, the protein is encoded by an often duplicated gene found near the inversion centromere of a large inverted region of CHROMOSOME 5.
A SMN complex protein that is essential for the function of the SMN protein complex. In humans the protein is encoded by a single gene found near the inversion telomere of a large inverted region of CHROMOSOME 5. Mutations in the gene coding for survival of motor neuron 1 protein may result in SPINAL MUSCULAR ATROPHIES OF CHILDHOOD.
A sustained and usually painful contraction of muscle fibers. This may occur as an isolated phenomenon or as a manifestation of an underlying disease process (e.g., UREMIA; HYPOTHYROIDISM; MOTOR NEURON DISEASE; etc.). (From Adams et al., Principles of Neurology, 6th ed, p1398)
Involuntary contraction of the muscle fibers innervated by a motor unit. Fasciculations can often by visualized and take the form of a muscle twitch or dimpling under the skin, but usually do not generate sufficient force to move a limb. They may represent a benign condition or occur as a manifestation of MOTOR NEURON DISEASE or PERIPHERAL NERVOUS SYSTEM DISEASES. (Adams et al., Principles of Neurology, 6th ed, p1294)
A syndrome characterized by DYSARTHRIA, dysphagia, dysphonia, impairment of voluntary movements of tongue and facial muscles, and emotional lability. This condition is caused by diseases that affect the motor fibers that travel from the cerebral cortex to the lower BRAIN STEM (i.e., corticobulbar tracts); including MULTIPLE SCLEROSIS; MOTOR NEURON DISEASE; and CEREBROVASCULAR DISORDERS. (From Adams et al., Principles of Neurology, 6th ed, p489)
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