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17th International Conference on 4 th International Conference on
NEUROLOGY AND NEUROSCIENCE & MENTAL HEALTH AND PRIMARY CARE
October 16-18, 2017 | Toronto, Canada
J Neurol Neurorehabil Res 2017 | Volume 2 Issue 3
Symptoms in patients with ALS before and after onset of weakness
Alexander Shtilbans, Mona Shahbazi, Kara Fields and Dale J Lange
Hospital for Special Surgery, USA
Symptoms unrelated to weakness occur in patients with
ALS. No studies systematically categorizing such symptoms
onset and evolution with disease progression using patient
reported questionnaires compared with controls exist.
Therefore, these symptoms might be missed during patients’
visits. Also it is not known if motor symptoms are the first
manifestations, or if there might be other manifestations
preceding the most obvious weakness-related symptoms by
months or years. In this cross-sectional, retrospective study,
we investigated the prevalence of various symptoms and
their possible onset prior to weakness in 36 Amyotrophic
Lateral Sclerosis (ALS) patients and 38 healthy controls using
a newly designed questionnaire. The questions were chosen
based on previously published literature and experience of
the members of our Muscular Dystrophy Association and ALS
Association Clinics. Besides musculoskeletal, symptoms from
psychiatric, sleep, sensory, autonomic and extrapyramidal
domains were most prevalent in the ALS group compared
to controls. The most commonly reported symptoms
besides muscle weakness in the ALS group were: muscle
cramping and twitching, poor balance, stiffness, slowness
of movements and feeling sad or depressed, compared to
controls. Occasionally, these symptoms appeared before
the onset of weakness although that was not statistically
significant. The symptom burden correlated with advanced
disease. There was a weak correlation of amount of these
symptoms with ALSFRS scores. Our study shows that non-
strength related symptoms in ALS patients are more common
than in healthy controls and some may occur before onset of
weakness. Additional studies are necessary to confirm this
data and to further validate our questionnaire as a useful
screening tool. The knowledge of various organ systems
involved in the disease process would prevent failure to
diagnose potentially co-morbid symptoms and improve
individualized delivery of care.
Speaker Biography
Alexander Shtilbans is an Assistant Professor of Neurology at the Parkinson’s Disease
and Movement Disorders Institute of Weill Cornell Medical College and Hospital for
Special Surgery. His clinical and research interests are in Neurodegenerative Diseases in
general and in Parkinson disease and ALS. Having started out as a Molecular Biologist
in Neuroscience, after obtaining his PhD, he had transitioned into Clinical Neurology
to work with patients and to better understand the clinical course of the diseases. He
has received his Medical degree from Mount Sinai School of Medicine, where he also
completed his residency in Neurology and served as a Chief Resident. Subsequently, he
has completed his Clinical Fellowship in Movement Disorders at Columbia University.
He has a longstanding interest in translational research and currently leads several NIH-
funded clinical trials on Parkinson’s disease as a Principal Investigator and is involved in
studies on Amyotrophic Lateral Sclerosis. He has published in peer-reviewed journals
and received awards from the American Academy of Neurology.
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