Neurologist #2 poked and prodded him with electrical needles this morning, muttering, "bee stang, bee stang, bee stang," then spent 15 minutes writing up a little death warrant.

"Amyotropic Lateral Scelerosis cannot be ruled out witb this patient. His nerves show extensive innervation and renervation."

Response from Neurologist #2: "I'm very sorry I have to give you this news."

Be well,
lilamy

https://secure.alsa.org/serving/litorder.cfm

MEDLINE Abstracts: Amyotrophic Lateral Sclerosis
http://www.medscape.com/viewarticle/452552

from Topics in Advanced Practice Nursing eJournal
Posted 05/07/2003

What is the latest research on amyotrophic lateral sclerosis (ALS)? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Nursing.

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Prognosis in Amyotrophic Lateral Sclerosis: A Population-Based Study
del Aguila MA, Longstreth WT Jr, McGuire V, Koepsell TD, van Belle G
Neurology. 2003;60:813-819

Background: Accurate information on prognosis of ALS is useful to patients, families, and clinicians.
Methods: In a population-based study of ALS in western Washington, the authors assembled a cohort of 180 patients with incident ALS between 1990 and 1994. Information on potential prognostic factors was collected during an in-person interview. Patients also completed the Medical Outcomes Study Short Form 36 (SF-36). Vital status through December 1999 was known for all patients.
Results: Median survival was 32 months from onset of symptoms and 19 months from diagnosis. The 5-year survival after diagnosis was 7%. Older age and female sex were strongly associated with poor survival. In multivariable Cox proportional hazards regression models, factors significantly and independently associated with a worse prognosis included older age, any bulbar features at onset, shorter time from symptom onset to diagnosis, lack of a marital partner, and residence in King County. Recursive partitioning identified age, time from symptom onset to diagnosis, and marital status as the strongest predictors of survival. Good summary scores for physical health on the SF-36, but not for mental health, were significantly associated with longer survival than poor scores.
Conclusion: These findings are consistent with other population-based studies of ALS and confirm its pernicious nature. Older age, female sex, any bulbar features at onset, short time from symptom onset to diagnosis, lack of a marital partner, and disease severity are key prognostic factors. Serial measurement of severity would likely improve predictions.