Researchers Say This Test Can Predict ALS Patient Outcomes—What You Need to know
A new study has found a marker of ALS outcomes through brain imaging.
This marker can be measured in the brain during its resting state and highlights the importance of the brain’s ability to adapt to changes in ALS patients.
“This information can help for care planning purposes and may also help, in a personalized medicine approach, to predict the best timing for interventions.”
If you ever did the ice-bucket challenge in 2014, you might remember that its main goal (aside from causing a stir online) was to raise awareness for ALS (Amyotrophic Lateral Sclerosis). Coming around the same time as news of a FDA-approved drug to treat ALS, researchers have found a new biomarker that can predict clinical outcomes—a measurable change in symptoms, overall health, ability to function, quality of life, or survival outcomes that result from giving care to patients with ALS.
A new study by Human Brain Project (HBP) researchers identified the marker, which could predict a patient’s longevity with the disease using magnetoencephalography, a specific type of brain imaging. This marker, or predictor, can be measured in the brain during its resting state and highlights the importance of your brain’s ability to adapt to new, changing, or unplanned events for ALS patients, which researchers call brain flexibility. The new study builds on previous work by the same group, which applied the methodology to Parkinson’s disease.
The researchers collected imaging data on 42 ALS patients and 42 healthy control patients, in which they measured the flexibility of their brains. The researchers focused on determining the brain’s ability to adapt to new, changing, or unplanned events, of those with ALS, even when the patient is unprompted and the brain is in a resting state.
ALS, sometimes referred to as Lou Gehrig’s disease, is a rare progressive neurodegenerative disease, explains Michelle Mielke, P.h.D., professor of epidemiology and prevention at Wake Forest University School of Medicine and member of Prevention’s Medical Review Board.
“ALS affects the nerve cells in the brain and spinal cord which lead to a loss of muscle function. Gradually, all muscles are affected resulting in an inability to eat and eventually to breathe,” says Mielke. She adds that approximately 18,000 people in the United States have a diagnosis of ALS at any given time. According to a statement from Human Brain Project, there is no known cure for ALS but treatments to improve symptoms, including magnetic stimulation, are being tested.
“The behavior of the brain of an ALS patient is often hard to understand. The impairments can be caused by neuronal dysfunction of a small area of the brain that influences a much larger area, meaning you need whole brain scans to make predictions of the clinical outcome,” explains Pierpaolo Sorrentino, the last author of the study, in a statement. “Patients can struggle with motor tasks during the scans. This new method, instead, can be applied to the brain at rest, making it easier for the patients and more consistent.”
Sorrentino adds that “a healthy brain is a flexible one, capable of reconfiguring itself to respond to stimuli, triggering neuronal avalanches across different areas.” He says, “think of it as a goalkeeper waiting for a penalty kick. If you are fast enough, constantly moving rather than standing in the same place is a better strategy for being ready for most possible trajectories.”
“We found that a restriction of the [flexibility measurement] corresponded to a more severe functional impairment. The more flexible the brain, the better the clinical outcome: the [measurement of brain flexibility] can be used as a reliable predictor of how the clinical outlook of a patient will likely evolve,” explains Polverino.
“It is often difficult to tell how a particular therapy is working—now we might have a strong marker to predict its outcome,” says Sorrentino. The next step, according to the statement from the research team, is to use this technique in a study that tracks the evolution of the disease in a patient-specific way and adjusts the treatment accordingly over an extended period of time. “The ultimate goal is to apply the predictive power of the functional repertoire (brain flexibility) in personalized medicine, perhaps extending the same approach to brain dynamics to other, large-scale applications,” concludes Polverino.
What does this new biomarker mean for people with ALS?
The rate of decline varies based on the ALS patient, explains Mielke. “The mean survival time is two to five years, but some people live 10 years after a diagnosis or even longer,” she says. Mielke also says it’s therefore difficult to determine survival and impairments such as the ability to walk, communicate, or even breathe.
Mielke explains that the new study suggests that magnetoencephalography (MEG) may help to identify when the brain is losing the ability to respond to changes in its environment, and therefore nearing functional impairment or even cognitive or behavioral impairment. “This information can help for care planning purposes and may also help, in a personalized medicine approach, to predict the best timing for interventions.”
But, it’s important to note that this study has limitations. “This is the first study examining MEG as a biomarker in ALS,” says Mielke. “The findings need to be replicated. In addition… [more long-term study] is needed to determine whether change in the MEG biomarker correlates with change in specific functional, cognitive, or behavioral domains.” It should also be noted that the sample of participants in this study was relatively small, so we do not yet know if these findings can be generalized to all people with ALS.
What does this mean for the future of ALS treatment?
“As mentioned, the findings of the study need to be replicated before the biomarker can be clinically utilized,” says Mielke. “Thus, the current study will not immediately impact how ALS is diagnosed and treated.”
So while there is a lot of exciting news on the ALS research front, there won’t be any immediate impacts from this study until further research is done—but, it’s a promising start.
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