Cerebrospinal fluid detection of enterovirus genome in ALS: A study of 242 patients and 354 controls

Abstract

Detection of enterovirus (EV) in the spinal cord of patients with amyotrophic lateral sclerosis (ALS) has been reported on post mortem central nervous system tissues. In cases of persistent infection, it is very likely that the EV genome might be detected in the cerebrospinal fluid (CSF). A study was conducted in seven French amyotrophic lateral sclerosis (ALS) centres between 1997 and 2002. A total of 242 ALS patients and 354 age- and sex-matched controls (non-ALS patients) were enrolled. A sensitive RT-PCR method was performed on the CSF to assess the presence of EV RNA; 14.5% of ALS patients were positive compared to 7.6% of controls (χ² value, 5.31; p = 0.02). Although EV infection has a seasonal pattern, we observed no seasonality in positive detection of the EV genome among ALS patients. There was no significant relationship among ALS patients between the initial clinical form or survival and the result of the RT-PCR. These findings suggest a relationship between the presence of EV sequences in CSF and ALS. Our study is consistent with the hypothesis that persistent EV infection can be one of the multiple factors involved in the development of ALS.

Key words::

• Case control studies
• viral infections
• amyotrophic lateral sclerosis
• cerebrospinal fluid

Acknowledgements

This work was supported by a grant from The French Ministry of Health Programme Hospitalier de Recherche Clinique 1997 and by a grant from the Association pour la Recherche sur la Sclerose Laterale Amyotrophique et autres maladies du motoneurone (ARS). We thank Remy Tcheng, Mylene Carlos and Pierric Giraud for their medical and technical help and NeuroBiotec-Banques of Hospices Civils de Lyon for providing control samples. Nadia Vandenberghe had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Declaration of interest: The authors report no conflicts of interest.