Research Reports - Head injury does not alter disease progression or neuropathologic outcomes in ALS

Neurology. 2015 Apr 28;84(17):1788-95

Fournier CN(1), Gearing M(2), Upadhyayula SR(2), Klein M(2), Glass JD(2)

OBJECTIVES: To study the effects of head injury on disease progression and on
neuropathologic outcomes in amyotrophic lateral sclerosis (ALS).
METHODS: Patients with ALS were surveyed to obtain head injury history, and
medical records were reviewed. Linear regression was performed to determine if
head injury was a predictor for mean monthly decline of Amyotrophic Lateral
Sclerosis Functional Rating Scale-revised (ALSFRS-R), while controlling for
confounders. Head injury history was obtained from family members of ALS autopsy
cases. The frequency of tau proteinopathy, brain TDP-43 inclusions, and
pathologic findings of Alzheimer disease (AD) were examined in ALS cases with
head injury compared to cases without. Logistic regression was performed with
each neuropathologic diagnosis as an outcome measure and head injury as a
predictor variable.
RESULTS: No difference was seen in rate of decline of the ALSFRS-R between
patients with head injury (n = 24) and without (n = 76), with mean monthly
decline of -0.9 for both groups (p = 0.18). Of 47 ALS autopsy cases (n = 9 with
head injury, n = 38 without), no significant differences were seen in the
frequency of tau proteinopathy (11% with head injury; 24% without), TDP-43 in the
brain (44% with head injury; 45% without), or AD pathology (33% with head injury;
26% without). Independent logistic regression models showed head injury was not a
predictor of tau pathology (p = 0.42) or TDP-43 in the brain (p = 0.99).
CONCLUSIONS: Head injury was not associated with faster disease progression in
ALS and did not result in a specific neuropathologic phenotype. The tau pathology
described with chronic traumatic encephalopathy was found in ALS autopsy cases
both with and without head injury.

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