Limb-onset amyotrophic lateral sclerosis patients visiting orthopedist show a longer time-to-diagnosis since symptom onset

Osamu Kano,Yuji Kawase,Yasuo Iwasaki,Ken Ikeda,Derek Cridebring,Hirono Ito,Konosuke Iwamoto

doi:10.1186/1471-2377-13-19

Abstract

BackgroundThere have been several reports concerning the survival time after symptom onset in patients with amyotrophic lateral sclerosis (ALS). However, little is known about how the choice of physician (i.e., general practitioner, neurologist, etc.) may affect the time it takes for a diagnosis of ALS to be made.MethodsWe conducted a retrospective study, covering a 20-year period, comparing the type of physician first consulted by an ALS patient at the time of initial symptoms and the amount of time that elapsed to the final diagnosis of ALS. A total of 202 patients were diagnosed and stratified according to the onset of ALS symptoms (bulbar onset [BO] and limb onset [LO]). We noted the type of physician first seen by the patient. The diagnostic interval was calculated as the time between onset of symptoms and the final diagnosis of ALS.ResultsA total of 202 ALS patients were examined. Clinical BO and LO was observed in 78 (36.6%) and in 124 (61.4%) of these patients, respectively. The type of physician examining these patients at the first symptoms of disease was as follows (BO and LO): neurologist (38.5% and 25.8%), general practitioner (14.1% and 35.5%), orthopedist (12.8% and 35.5%), otolaryngologist (15.4% and 0%), and neurosurgeon (14.1% and 3.2%). Mean diagnostic interval (standard deviation) for patients with either set of symptoms was 13.1 (6.5) months; the diagnostic interval of patients with BO and LO was 9.2 (4.5) and 15.2 (7.7) months, respectively. ALS diagnosis in LO patients was delayed by more than 10 months when the patient first consulted an orthopedist rather than a neurologist.ConclusionMore than 50% of the ALS patients included in this study did not visit a neurologist at the first symptoms of disease onset. The diagnosis of ALS was prolonged in LO patients visiting an orthopedist. We speculate that this increase in the diagnostic interval in LO patients visiting an orthopedist was due to a lack of bulbar symptoms in the early stages of this disease.

Highlights

There have been several reports concerning the survival time after symptom onset in patients with amyotrophic lateral sclerosis (ALS)
These studies have investigated the survival of ALS patients; little is known about the relationship between the time the patient first seeks medical attention for the initial symptoms of the disease and its influence on the time to actual diagnosis of ALS [10,11]
The patient ratio (BO:Limb onset (LO)) was 38.5%:25.8% for patients who visited a neurologist at the first symptoms of disease, 14.1%:35.5% for those who visited a general practitioner (GP), 12.8%:35.5% for those who visited an orthopedist (ORTH), 15.4%:0% for those who visited an otolaryngologist (ENT), 14.1%:3.2% for those who visited a neurosurgeon (NS), and 5.1%:0% for those who visited all other practitioners

Summary

Introduction

There have been several reports concerning the survival time after symptom onset in patients with amyotrophic lateral sclerosis (ALS). No significant change in survival was shown in patients treated more recently, despite the introduction of supportive measures (NIV, PEG, and riluzole) [9]. These studies have investigated the survival of ALS patients; little is known about the relationship between the time the patient first seeks medical attention for the initial symptoms of the disease and its influence on the time to actual diagnosis of ALS [10,11]. We conducted a retrospective hospital-based study on the basis of the time it took to attain a final diagnosis of ALS depending on the specialty of the first physician each patient saw and the type of onset symptoms (bulbar onset [BO] and limb [LO] onset)

Methods

Results

Discussion

Conclusion