No abstract

ALS is progressive with increasing patient needs for durable medical equipment (DME) and interventions (gastric feeding tube - PEG, and non-invasive ventilation - NIV). We performed a chart review of deceased patients to determine the time-course of needs and their estimated costs. A timeline of needs was based on when clinic personnel felt an item was necessary. The point in time when an item or intervention was needed was expressed as a percentage of a patient's total disease duration. A wide range of DME and interventions was needed irrespective of site of ALS symptom onset (bulbar, upper, lower extremity), beginning at 10% of disease duration of lower extremity onset and increasing thereafter for all sites. The cumulative probability of costs of items and interventions began at 25%-50% of disease duration and increased to between $18,000 and $32,000 (USD), highest for lower extremity onset due to the cost of wheelchairs. We conclude that a high percentage of ALS patients will need a full spectrum of major DME items and interventions during the second half of disease duration. This results in a linear rise in costs over the second half of the disease duration.

Amyotrophic lateral sclerosis (ALS) is a uniformly fatal disease. In the US, care is concentrated in specialized clinics. ALS health care providers likely experience stress, but levels and associated factors and methods to manage them are not known. A questionnaire was designed to assess levels of emotional stress among ALS clinic providers (neurologists and clinic managers) at time of diagnosis, during care of the patient, and at time of the patient's death. Also included were questions about diagnostic practice patterns. Sixty-eight Muscular Dystrophy Association and ALS Association certified clinics were surveyed with a 47% response rate. Stress levels ranged from very severe to none at the various clinical stages but did not differ significantly between neurologists and managers. Stress tended to be lower in more experienced providers, although not uniformly so for all situations and time-points. Stress reduction techniques were rated as more effective for managers than for neurologists. Providers reported high levels of job satisfaction but a significant number gave consideration to leaving their positions due to stress and operational issues. In conclusion, stress is experienced by ALS clinic providers and managed by a variety of methods but with limited success.

Quantitative EMG (QEMG) techniques include automated motor unit action potential (MUAP) detection and marking of clinically useful waveform metrics. Different computer algorithms are available on modern EMG machines to perform these operations rapidly. However, the efficiency and accuracy of available algorithms are rarely directly compared. We have assessed three commercially available algorithms using both synthesized and biologic interference patterns and found differences among algorithms, some of which are clinically significant. Our results point out the importance of assessing for duplicate MUAPs (same waveform detected as two separate waveforms) and accuracy of markings used to determine MUAP metrics.

The authors discuss the techniques and use of electrodiagnosis to help fully characterize peripheral neuropathies, including electrodiagnostic principles, normal findings, correlations between underlying nerve pathology that leads to abnormal electrodiagnostic findings, and how to detect and interpret electrodiagnostic findings.