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Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration Volume 24, 2023 - Issue 7-8
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Review

Non-motor symptoms in amyotrophic lateral sclerosis: lessons from Parkinson’s disease

Ali Shojaie1 Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKView further author information
,
Silvia Rota1 Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;2 Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK;3 Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKView further author information
,
Ahmad Al Khleifat1 Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKORCID Iconhttps://orcid.org/0000-0002-7406-9831View further author information
ORCID Icon,
K Ray Chaudhuri1 Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;2 Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK;4 National Institute for Health Research Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK;5 Department of Neurology, King’s College Hospital, London, UKView further author information
&
Ammar Al-Chalabi1 Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;4 National Institute for Health Research Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK;5 Department of Neurology, King’s College Hospital, London, UKCorrespondence[email protected]
ORCID Iconhttps://orcid.org/0000-0002-4924-7712View further author information
ORCID Icon
Pages 562-571 | Received 17 Feb 2023, Accepted 28 May 2023, Published online: 22 Jun 2023

Figures & data

Figure 1 Percentage of studies on non-motor symptoms in ALS, compared to studies focused on other aspects of ALS, based on publication counts. (a) The pie chart shows different areas of research in ALS. The search generated 2,210 papers dedicated to the study of non-motor symptoms in ALS, out of a total of 388,000 publications in ALS. (b) Research on different non-motor symptoms in ALS. The search generated 33551 papers for ALS, 3260 papers dedicated to cognition, psychiatric symptoms, and pain in ALS, out of a total of 5331 publications on non-motor symptoms of ALS. Search keywords: ‘ALS’, ‘non-motor symptoms’, ‘pain’, ‘cognition’, ‘sleep problems’, ‘psychiatric symptoms’, ‘gastrointestinal symptoms’, and ‘autonomic symptoms’. Search performed on 19/04/2023 (2010–2023, PubMed). ALS: amyotrophic lateral sclerosis.

Figure 1 Percentage of studies on non-motor symptoms in ALS, compared to studies focused on other aspects of ALS, based on publication counts. (a) The pie chart shows different areas of research in ALS. The search generated 2,210 papers dedicated to the study of non-motor symptoms in ALS, out of a total of 388,000 publications in ALS. (b) Research on different non-motor symptoms in ALS. The search generated 33551 papers for ALS, 3260 papers dedicated to cognition, psychiatric symptoms, and pain in ALS, out of a total of 5331 publications on non-motor symptoms of ALS. Search keywords: ‘ALS’, ‘non-motor symptoms’, ‘pain’, ‘cognition’, ‘sleep problems’, ‘psychiatric symptoms’, ‘gastrointestinal symptoms’, and ‘autonomic symptoms’. Search performed on 19/04/2023 (2010–2023, PubMed). ALS: amyotrophic lateral sclerosis.

Figure 2 Percentage of studies on non-motor symptoms in PD, compared to studies focused on other aspects of PD, based on publication counts. Search keywords: ‘PD’, ‘non-motor symptoms’. Search performed on 16/05/2022 (2010–2022, Google scholar). PD: Parkinson’s disease.

Figure 2 Percentage of studies on non-motor symptoms in PD, compared to studies focused on other aspects of PD, based on publication counts. Search keywords: ‘PD’, ‘non-motor symptoms’. Search performed on 16/05/2022 (2010–2022, Google scholar). PD: Parkinson’s disease.

Figure 3 Defining non-motor symptoms in ALS. Non-motor symptoms in ALS can be caused by motor impairment (red line) or neurodegeneration outside the corticobulbar and corticospinal pathways and their lower motor neuron outflows (blue lines). Symptoms secondary to motor degeneration might have a trivial explanation, and our main interest should be focused on the non-motor symptoms arising from an underlying neurodegenerative process affecting areas different from the motor pathway. We therefore define non-motor symptoms as the ones that originate from these non-trivial processes. Among these, frontotemporal degeneration is the best studied, but it is now time to extend our knowledge to other non-motor symptoms.

Figure 3 Defining non-motor symptoms in ALS. Non-motor symptoms in ALS can be caused by motor impairment (red line) or neurodegeneration outside the corticobulbar and corticospinal pathways and their lower motor neuron outflows (blue lines). Symptoms secondary to motor degeneration might have a trivial explanation, and our main interest should be focused on the non-motor symptoms arising from an underlying neurodegenerative process affecting areas different from the motor pathway. We therefore define non-motor symptoms as the ones that originate from these non-trivial processes. Among these, frontotemporal degeneration is the best studied, but it is now time to extend our knowledge to other non-motor symptoms.

Figure 4 The spectrum of non-motor symptoms in ALS and PD. ALS: amyotrophic lateral sclerosis; PD: Parkinson’s disease. SDB: sleep-disordered breathing. RLS: restless leg syndrome. PLM: periodic limb movements. REM: rapid eye movement. RBD: REM sleep behavior disorder. PSG: polysomnography. ICD: impulse control disorder.

Figure 4 The spectrum of non-motor symptoms in ALS and PD. ALS: amyotrophic lateral sclerosis; PD: Parkinson’s disease. SDB: sleep-disordered breathing. RLS: restless leg syndrome. PLM: periodic limb movements. REM: rapid eye movement. RBD: REM sleep behavior disorder. PSG: polysomnography. ICD: impulse control disorder.
 

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