Benefits of early diagnosis of amyotrophic lateral sclerosis
Upload time：2016-12-12 Browse：
Author: Professor Li Xiaoguang
This article reprinted from the WeChat public number: nerve Xiaoguang, Neuroxgli. Copyright belongs to the original author, please indicate the source.
First, the reality and characteristics of early diagnosis difficulties
The onset and early progression of amyotrophic lateral sclerosis (ALS) are usually occult, and their symptoms may not be identified and diagnosed until 12 months. In the process of diagnosis and evaluation, the patient will find a series of medical specialists, and even neurologists may not be able to identify amyotrophic lateral sclerosis in the early stages of the disease. Once amyotrophic lateral sclerosis is considered, a number of laboratory tests should be performed before the diagnosis is made, because amyotrophic lateral sclerosis is often treated as a "pending diagnosis."".
There are two characteristics that explain why doctors are reluctant to quickly and directly diagnose amyotrophic lateral sclerosis. First, want to find a good response to drug treatment of the disease. There are some clues that do not support the diagnosis of amyotrophic lateral sclerosis, amyotrophic lateral sclerosis (ALS) is cruel, lethal, and difficult to change. Second, there is no specific diagnostic marker or marker for amyotrophic lateral sclerosis. However, the characteristics of amyotrophic lateral sclerosis (ALS) can be evaluated and judged according to the symptoms and signs of the patients. Clear and rapid diagnosis is very important, the beginning of treatment in the course of the disease can provide the maximum benefit.
In the past, many doctors did not consider the reasons for early diagnosis, because early diagnosis of amyotrophic lateral sclerosis patients with little benefit. However, advances in research over the past few decades have made clear the advantages of early and effective diagnosis. First, efficient diagnostic evaluation reduces the uncertainty of patient diagnosis, so that patients do not have to wait for a long time to exclude detection. Second, early diagnosis can save money. Third, early diagnosis can make patients and caregivers to see amyotrophic lateral sclerosis clinic benefit. Fourth, and most importantly, continue to produce evidence that early intervention is important, whether it is the use of riluzole (the only proven drug for the treatment of amyotrophic lateral sclerosis), or the early use of noninvasive ventilator or percutaneous gastrostomy or multidisciplinary medical intervention, clinical trial the drug enters or when conditions are good.
The diagnosis of amyotrophic lateral sclerosis is focused on speeding up the diagnosis process. The unique pathological features of amyotrophic lateral sclerosis (ALS) can help to understand the diagnosis process. The World Federation of Neurology (WFN) published the El Escorial diagnostic criteria for amyotrophic lateral sclerosis (ALS) in 1994. After 4 years of clinical use, WFN proposed a revised version of the diagnostic criteria for amyotrophic lateral sclerosis in the spring of 1998. In order to speed up the diagnosis, attention should be paid to the early diagnosis of amyotrophic lateral sclerosis. In 2006, the results of electrophysiological examination (EMG and nerve conduction velocity) were equivalent to clinical physical examination, which increased the possibility of early diagnosis. In order to make an accurate and direct diagnosis, a diagnostic rule or flow chart was established to evaluate the patients with suspected amyotrophic lateral sclerosis (ALS).
Two, the advantages of early diagnosis
The treatment should begin early in the course of amyotrophic lateral sclerosis, since there are more motor neuron survival in fashion, which can benefit from therapeutic interventions, which will be more beneficial than later treatment. This fundamental principle is supported by the results of the time history study on the loss of motor neurons in amyotrophic lateral sclerosis. The results show that in the early stage of the disease, motor neuron loss is faster, and then the loss rate slows. These findings may be explained by the presence of relatively weak motoneurons and relatively strong motor neurons. Treatment is mainly aimed at vulnerable motor neurons.
Increasing clinical data support earlier treatment to achieve greater efficacy. A rodent model similar to amyotrophic lateral sclerosis is a useful tool to study the effects and mechanisms of action. Further studies of the model show that the use of force in the early stages of the disease is much more effective in prolonging survival.
The clinical data of amyotrophic lateral sclerosis also support the beneficial effects of early treatment. In the phase III clinical trial, the effect of the force was too good in patients who were younger in the trial than in patients with a more severe disease. The longer course of disease before the trial suggests that the condition may be more severe, which can be observed by more severe muscle loss and a significant decrease in forced vital capacity. The course of the disease begins with the onset of symptoms.
In the double-blind, placebo-controlled trial showed prolonged survival. Another way to evaluate the effectiveness of a drug is to measure the time it takes for a patient to switch from a healthy state to a serious condition. A conclusion can be drawn from these results, accelerate the diagnosis of amyotrophic lateral sclerosis can make patients accept earlier treatment or other drugs such as too much into the test, to have more opportunities to prove the efficacy of the drug and benefit from.
Three, the necessity and urgency of early diagnosis
As soon as possible as soon as possible to clarify the diagnosis of amyotrophic lateral sclerosis, patients and their families to participate in treatment decisions, from both medical and ethical urgency.
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