Stress load and neurodegeneration after gastrostomy tube placement in amyotrophic lateral sclerosis patients.
ALS
Gastrostomy
Neurodegeneration
Neuroinflammation
Sedation
Stress
Journal
Metabolic brain disease
ISSN: 1573-7365
Titre abrégé: Metab Brain Dis
Pays: United States
ID NLM: 8610370
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
13
12
2020
accepted:
02
09
2021
pubmed:
25
9
2021
medline:
8
4
2022
entrez:
24
9
2021
Statut:
ppublish
Résumé
Dysphagia and progressive swallowing problems due to motoneuron death is one of amyotrophic lateral sclerosis (ALS) symptoms. Malnutrition and body weight loss result in immunological disturbances, fatigability and increase risk of secondary complications in ALS patients, percutaneous endoscopic gastrostomy tube (PEG) placement representing a well-recognized method for malnutrition correction and potentially increasing life expectancy. However, despite nutritional correction, occasional rapid neurological deterioration may develop after PEG placement. We have hypothesized that this decline can be a result of exteroceptive stress during PEG placement and promote neurodegeneration in ALS patients. Intravenous sedation may decrease stress during invasive procedures and it is safe during PEG placement in ALS patients. The aim of the study was comparing different PEG placement protocols of anesthesia (local anesthesia or local anesthesia plus intravenous sedation) in ALS from perspectives of stress load and neurological deterioration profile. During 1.5 years 94 ALS patients were admitted; gastrostomy was performed in 79 patients. After screening according to inclusion and exclusion criteria, 30 patients were included in the prospective consecutive study. All patients were divided in two groups, with local anesthesia and with combination of local anesthesia and intravenous sedation. Routine biochemical indices, neurodegeneration and stress markers were measured. The age of ALS patients was 61 ± 10 years; 20 patients were included at stage 4A and 10 at stage 4B (King's College staging). PEG was placed at average14 months after the diagnosis and 2.2 years after first symptoms. Mean ALS Functional Rating Scale-Revised was 27.8, mean forced vital capacity of lung 46.3% (19-91%). After one year of observation only 8 patients survived. Mean life duration after PEG was 5 months (5 days-20 months). Comparison of two PEG placement protocols did not reveal differences in survival time, stress load and inflammation level. Higher saliva cortisol levels, serum cortisol, glucose, C-reactive protein and interleukin-6 were detected after PEG placement, confirming considerable stress response. PEG is a stressful factor for ALS patients, PEG placement representing a natural model of exteroceptive stress. Stress response was detected as increased cortisol, C-reactive protein, interleukin-6, and glucose levels. Intravenous sedation did not increase the risk of PEG placement procedure, however, sedation protocol did not affect stress load.
Identifiants
pubmed: 34559375
doi: 10.1007/s11011-021-00837-x
pii: 10.1007/s11011-021-00837-x
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2473-2482Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Abrahams S, Newton J, Niven E, Foley J, Bak T (2014) Screening for cognition and behaviour changes in ALS. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration15(1–2):9–14 https://doi.org/10.3109/21678421.2013.805784
Aguinis H, Gottfredson R, Joo H (2013) Best-Practice Recommendations for Defining, Identifying, and Handling Outliers. Organ Res Methods 16(2):270–301. https://doi.org/10.1177/1094428112470848
doi: 10.1177/1094428112470848
Andersen PM et al (2012) EFNS Task Force on Diagnosis and Management of Amyotrophic Lateral Sclerosis: et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)–revised report of an EFNS task force. European journal of neurology 19: 360–375. https://doi.org/10.1111/j.1468-1331.2005.01351.x
Atassi N, Cudkowicz M, Schoenfeld D (2011) Advanced Statistical Methods to Study the Effects of Gastric Tube and Non-Invasive Ventilation on Functional Decline and Survival in Amyotrophic Lateral Sclerosis 12(4):272–277. https://doi.org/10.3109/17482968.2011.577786
doi: 10.3109/17482968.2011.577786
Aust H, Rüsch D, Schuster M, Sturm T, Brehm F, Nestoriuc Y (2016) Coping strategies in anxious surgical patients. BMC Health Serv Res 16:250. https://doi.org/10.1186/s12913-016-1492-5
doi: 10.1186/s12913-016-1492-5
pubmed: 27406264
pmcid: 4941033
Ben-Eliyahu S (2020) Tumor Excision as a Metastatic Russian Roulette: Perioperative Interventions to Improve Long-Term Survival of Cancer Patients. Trends Cancer9:S2405–8033(20)30188–6. https://doi.org/10.1016/j.trecan.2020.06.004 .
Blasco H, Veyrat-Durebex C, Bocca C et al (2017) Lipidomics Reveals Cerebrospinal-Fluid Signatures of ALS. Sci Rep 7(1):17652. https://doi.org/10.1038/s41598-017-17389-9
doi: 10.1038/s41598-017-17389-9
pubmed: 29247199
pmcid: 5732162
Bond L, Ganguly P, Khamankar N et al (2019) A Comprehensive Examination of Percutaneous Endoscopic Gastrostomy and Its Association with Amyotrophic Lateral Sclerosis Patient Outcomes. Brain Sci 9(9):223. https://doi.org/10.3390/brainsci9090223
doi: 10.3390/brainsci9090223
pmcid: 6770872
Brooks B, Miller R, Swash M, Munsat T and World Federation of Neurology Research Group on Motor Neuron Diseases (2000) El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis and other motor neuron disorders 1(5): 293–299. https://doi.org/10.1080/146608200300079536
Chełstowska B, Kuźma-Kozakiewicz M (2020) Biochemical parameters in determination of nutritional status in amyotrophic lateral sclerosis. Neurol Sci 41(5):1115–1124. https://doi.org/10.1007/s10072-019-04201-x
doi: 10.1007/s10072-019-04201-x
pubmed: 31897946
Chernenkaya V, Gorbachev K, Gorbachev D, Ataulina A, Fominykh V, Brylev L, Guekht A (2018) The Edinburgh Cognitive and Behavioral ALS Screen (ECAS): a Russian version. Zh Nevrol Psikhiatr Im S S Korsakova 118(12):36–39. https://doi.org/10.17116/jnevro201811812136
Chiò A, Calvo A, Bovio G et al (2014) Piemonte and Valle d’Aosta Register for Amyotrophic Lateral Sclerosis. Amyotrophic lateral sclerosis outcome measures and the role of albumin and creatinine: a population-based study. JAMA Neurol 71(9):1134–42. https://doi.org/10.1001/jamaneurol.2014.1129 .
Choi S, Hong Y, Shin J et al (2017) Takotsubo cardiomyopathy in amyotrophic lateral sclerosis. J Neurol Sci 375:289–293. https://doi.org/10.1016/j.jns.2017.02.012
doi: 10.1016/j.jns.2017.02.012
pubmed: 28320151
Crockford C, Newton J, Lonergan K et al (2018) ALS-specific cognitive and behavior changes associated with advancing disease stage in ALS. Neurology 91(15):e1370–e1380. https://doi.org/10.1212/WNL.0000000000006317
doi: 10.1212/WNL.0000000000006317
pubmed: 30209236
pmcid: 6177274
Finsterer J, Wahbi K (2014) CNS disease triggering Takotsubo stress cardiomyopathy. Int J Cardiol 177(2):322–329. https://doi.org/10.1016/j.ijcard.2014.08.101
doi: 10.1016/j.ijcard.2014.08.101
pubmed: 25213573
Fominykh V, Vorobyeva A, Onufriev MV, Brylev L, Zakharova MN, Gulyaeva NV (2018) Interleukin-6, S-Nitrosothiols, and Neurodegeneration in Different CentralNervous System Demyelinating Disorders: Is There a Relationship? J Clin Neurol 14(3):327–332. https://doi.org/10.3988/jcn.2018.14.3.327
doi: 10.3988/jcn.2018.14.3.327
pubmed: 29856157
pmcid: 6031979
Gulyaeva N (2019) Biochemical Mechanisms and Translational Relevance of Hippocampal Vulnerability to Distant Focal Brain Injury: The Price of Stress Response. Biochemistry (mosc) 84(11):1306–1328. https://doi.org/10.1134/S0006297919110087
doi: 10.1134/S0006297919110087
Heffernan C et al (2004) Nutritional management in MND/ALS patients: an evidence based review. Amyotroph Lateral Scler Other Motor Neuron Disord 5(2):72–83. https://doi.org/10.1080/14660820410020349
doi: 10.1080/14660820410020349
pubmed: 15204009
Hill CM, Walker RV (2001) Salivary cortisol determinations and self-rating scales in the assessment of stress in patients undergoing the extraction of wisdom teeth. Br Dent J 191(9):513–515. https://doi.org/10.1038/sj.bdj.4801220
doi: 10.1038/sj.bdj.4801220
pubmed: 11726064
Hodgins F, Mulhern S, Abrahams S (2020) The clinical impact of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and neuropsychological intervention in routine ALS care. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration 21(1–2):92–99. https://doi.org/10.1080/21678421.2019.1674874
doi: 10.1080/21678421.2019.1674874
Hoeper A, Barbara D, Watson J et al (2019) Amyotrophic lateral sclerosis and anesthesia: a case series and review of the literature. J Anesth 33(2):257–265. https://doi.org/10.1007/s00540-019-02611-x
doi: 10.1007/s00540-019-02611-x
pubmed: 30656405
Kalava A, Clendenen S, McKinney J, Bojaxhi E, Greengrass R (2016) Bilateral thoracic paravertebral nerve blocks for placement of percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis: a case series. Romanian journal of anaesthesia and intensive care 23(2):149–153. https://doi.org/10.21454/rjaic.7518/232.scl
Larauche M, Mulak A, Taché Y (2012) Stress and visceral pain: from animal models to clinical therapies. Exp Neurol 233(1):49–67. https://doi.org/10.1016/j.expneurol.2011.04.020
doi: 10.1016/j.expneurol.2011.04.020
pubmed: 21575632
Lu C, Petzold A, Topping J et al (2015) Plasma neurofilament heavy chain levels and disease progression in amyotrophic lateral sclerosis: insights from a longitudinal study. J Neurol Neurosurg Psychiatry 86(5):565–573. https://doi.org/10.1136/jnnp-2014-307672
doi: 10.1136/jnnp-2014-307672
pubmed: 25009280
Manou-Stathopoulou V, Korbonits M, Ackland GL (2019) Redefining the perioperative stress response: a narrative review. Br J Anaesth 123(5):570–583. https://doi.org/10.1016/j.bja.2019.08.011
doi: 10.1016/j.bja.2019.08.011
pubmed: 31547969
Prabhakar A, Owen CP, Kaye AD (2013) Anesthetic management of the patient with amyotrophic lateral sclerosis. J Anesth 27(6):909–918. https://doi.org/10.1007/s00540-013-1644-2
doi: 10.1007/s00540-013-1644-2
pubmed: 23728364
ProGas Study Group (2015) Gastrostomy in patients with amyotrophic lateral sclerosis (ProGas): a prospective cohort study. The Lancet Neurology 14(7):702–709. https://doi.org/10.1016/S1474-4422(15)00104-0
doi: 10.1016/S1474-4422(15)00104-0
pmcid: 4578147
Steinthorsdottir K, Kehlet H, Aasvang E (2017) Surgical stress response and the potential role of preoperative glucocorticoids on post-anesthesia care unit recovery. Minerva anestesiologica 83(12):1324–1331. https://doi.org/10.23736/S0375-9393.17.11878-X
Strijbos D, Hofstede J, Keszthelyi D, Masclee A, Gilissen L (2017) Percutaneous endoscopic gastrostomy under conscious sedation in patients with amyotrophic lateral sclerosis is safe: an observational study. Eur J Gastroenterol Hepatol 29(11):1303–1308. https://doi.org/10.1097/MEG.0000000000000959
doi: 10.1097/MEG.0000000000000959
pubmed: 28877087
Toone R, Peacock O, Smith A, Thompson D, Drawer S, Cook C, Stokes KA (2013) Measurement of steroid hormones in saliva: Effects of sample storage condition. Scand J Clin Lab Invest 73(8):615–621. https://doi.org/10.3109/00365513.2013.835862
doi: 10.3109/00365513.2013.835862
pubmed: 24033227
Vergonjeanne M, Fayemendy P, Marin B et al (2020) Predictive factors for gastrostomy at time of diagnosis and impact on survival in patients with amyotrophic lateral sclerosis. Clin Nutr 39(10):3112–3118. https://doi.org/10.1016/j.clnu.2020.01.018
doi: 10.1016/j.clnu.2020.01.018
pubmed: 32063408