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The diagnostic pathway in amyotrophic lateral sclerosis

INTRODUCTION: We present the findings of a survey of the diagnostic pathways and treatment of 50 patients with amyotrophic lateral sclerosis (ALS). RESULTS: The mean time between first symptoms and first consultation with a physician was 5.7 months; mean time between first symptoms and first consultation with a neurologist was 9.7 months; mean time from symptom onset to confirmation of diagnosis was 11.6 months. Patients with bulbar onset appeared to be diagnosed earlier than those with limb onset, but the difference was not statistically significant. The first physician seen was an orthopedist in 30%, a general practitioner (GP) in 28%, and a neurologist in 28% of cases. The mean diagnostic intervals were 9.4 months when the neurologist was the first physician seen, and 9.8 months when the neurologist saw a patient referred from a GP. Otherwise, when a neurologist saw patients referred from an orthopedist, the mean diagnostic interval was 14.9 months. Differences between the values of mean diagnostic interval were not statistically significant. EMG and MRI were performed in all patients, cerebrospinal fluid examination and muscle biopsy in most. Treatment was by vitamins in 38% of cases, thyrotropin-releasing hormone in 24%, physical therapy in 22%, and anticholinesterase agent in 12%. CONCLUSION: The number of patients in our study is limited, and a further prospective nation-wide survey is necessary.