Reinnervation and Neuromuscular Transmission in ALS

Recruiting

• Conditions: Amyotrophic Lateral Sclerosis
• Interventions: Other: Observational study

• Registration Number: NCT06219759
• Lead Sponsor: University of Aarhus

Brief Summary

The aim of this study is to describe the changes in the neuromuscular connection in patients with amyotrophic lateral sclerosis (ALS). The study consist of three substudies that have the following main hypothesis:

1. that ALS patients do not demonstrate equal capacity for muscle reinnervation and that reinnervation preserves muscle function and thereby slows down progression.

2. that blood concentrations of c-terminal agrin fragment (bCAF) reflect neuromuscular transmission deficiency and that blood concentration of neural cell adhesion molecule reflects degree of muscle denervation in patients.

3. that ALS patients with decrement when examined with repetitive nerve stimulation have more physical fatigue, slower progression, higher degree of reinnervation and higher bCAF compared to ALS patients without decrement.

There will be 3 inclusion groups.

1. patients referred for neurophysiological examination on suspicion of motor neuron disease.

2. healthy controls

3. disease control: patients with another motor neuron disease with slow progression.

All participants will be invited for at least 1 visit (baseline). If participants in group 1 eventually receive the diagnosis of ALS they will be invited for 2 additional visits 4 og 8 months after baseline visit, respectively.

Examinations will consist of:

* nerve conduction study

* repetitive nerve stimulation (except for healthy controls) to examine impairment of the neuromuscular connection.

* motor unit number estimation with MScanFit to estimate number and size of motor units.

* ultrasound examination of muscles to measure size and condition of muscles.

* questionnaires on fatigue and functional status.

* blood sample for measurement of specialized analysis (c-terminal agrin fragment and neural cell adhesion molecule) and routine analysis (liver and kidney function as well as neurofilament light chain)

* muscle strength assessment manually and by dynamometer to follow progression of muscle weakness

* bioelectrical impedance measurement to follow the overall body composition.

Detailed Description

Not available

Study Timeline

• Status Verified: 2024-01
• Study First Submitted: 2024-01-02
• Study First Submitted QC: 2024-01-12
• Study First Posted: 2024-01-23
• Study Start: 2024-05-17
• Last Update Submitted: 2024-08-06
• Last Update Posted: 2024-08-07
• Primary Completion: 2026-12
• Study Completion: 2026-12

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 120

Inclusion Criteria

• Referred to clinical neurophysiological examination on suspicion of motor neuron disease or diagnosed with ALS according to Gold Coast criteria within the last 3 months.
• Age ≥18 years old
• Able and willing to provide informed consent

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Exclusion Criteria

• Former central or peripheral nervous system disease
• Diabetes
• Electrophysiological signs of polyneuropathy at baseline visit
• Pacemaker
• Pregnancy

For disease controls the exclusion criteria are the same, but the inclusion criteria:

• Diagnosed with disease with slow, progressive loss of motor neurons
• Age ≥18 years old
• Able and willing to provide informed consent

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Healthy controls	Observational study	Healthy controls.
Disease controls	Observational study	Patients with another motor neuron disease than ALS with slow progression.
ALS patients	Observational study	Patients enrolled prior to determination of diagnosis on referral to neurophysiological examination. When the diagnosis is later established they get categorized as ALS patients. ALS patients with recent diagnosis might also be included directly.
ALS mimic disease patients	Observational study	Patients enrolled prior to determination of diagnosis on referral to neurophysiological examination. When diagnosis is later established and the diagnosis is NOT ALS they get categorized as ALS mimic disease patients.

Primary Outcome Measures

Name	Time	Method
Blood biomarkers	Baseline	Difference in blood concentration of c-terminal agrin fragment and neural cell adhesion molecule at baseline between ALS patients, healthy controls and ALS mimic disease patients.
Reinnervation	From baseline and 8 months	Difference between fast and slow progressing patients in change in mean amplitude size of motor units as estimated by MScanFit motor unit number estimation.
Fatigue and decrement	Baseline	Difference in proportion of participants with decrement between ALS patients and ALS mimic disease patients as well as degree of fatigue among ALS patients with and without neuromuscular transmission deficiency.

Trial Locations

Locations (1)

Department of Neurology, Aarhus University Hospital; 🇩🇰 Aarhus, Region Midtjylland, Denmark