Researchers in the Academic Unit of Neurology at Trinity College Dublin have identified characteristic changes in the patterns of electrical brain wave activity in motor neurone disease (MND).
This ground breaking observation will help to develop treatments for the disease that affects over 350 people in Ireland.
Their findings, published in the recent issue of the journal Human Brain Mapping reveals how MND affects the neural communication in different brain networks.
Motor neurone disease (MND), also known as Amyotrophic Lateral Sclerosis (ALS), is a devastating condition which causes progressive paralysis, increasing physical disability and ultimately death within an average of two to three years.
One person is diagnosed every 3 days with the condition in Ireland.
Using electroencephalography (EEG), the team at Trinity College has been able to capture second to second changes in electrical signalling, and have identified specific groups (or networks) of nerves that behave abnormally in MND.
This is the first time researchers have used EEG in this way in MND. The work shows that this inexpensive technology can give information about abnormal brain activity that rivals functional MRI, and at a fraction of the cost.
The team has been able to identify and study in detail more than six different brain networks associated with MND.
Lead author of the study, Stefan Dukic, who is pursuing his Ph.D. jointly between Trinity College Dublin (Ireland) and University Medical Centre Utrecht (The Netherlands) said: “The human brain works by electrical signalling between billions of neurons in different networks.
This electrical signalling between neurons allows us to perform every-day tasks such as movement, sensing and thinking.
In MND, we have for the first time found specific and reproducible changes in electrical brain signalling using electroencephalography (EEG) recordings”
“The new findings have identified previously unrecognised abnormalities in the brain networking.
This advances our understanding of the specific brain networks that become dysfunctional as the disease progresses.”
The Fr Tony Coote Assistant Professor in Neural Signalling, and senior author of the study, Dr. Bahman Nasseroleslami said:
“The emerging technologies such as advanced signal analysis and electrical source imaging of the brain are changing our understanding of MND and related diseases.
We can now use EEG, which is inexpensive compared to MRI, to probe brain networks instantaneously and identify important changes that reflect the impact of the disease on the patients.”
Head of the Academic Unit of Neurology at Trinity, Professor Orla Hardiman, a world expert in MND said:
“In MND research, these findings are a major leap from the current state-of-the-art approach to studying the disease.
The work of Dukic and Nasseroleslami has shown how we can now begin to carefully quantify changes in specific parts of brain networks.
This will have major implications on how we classify the sub-types of the disease. It can also help to tell us what patient groups may respond to new therapies.”
The cutting edge work undertaken at Trinity College Dublin moves the field one step closer to the quest for better treatments.
“There is an urgent need for new treatments that can slow disease progression, and the development of new biomarkers that can help to identify patient subgroups is a very important unmet need,” added Professor Hardiman.
The Motor Neurone Disease Association is a charity focused on motor neuron disease (MND) care, research and campaigning with approximately 8000 members in England, Wales and Northern Ireland.
Its mission is to improve the care and the support for people with MND, their families and carers, to campaign and raise awareness about the needs of people living with MND and to fund and promote relevant research.1
The current study is part of a broader research project initiated by the Association investigating the sociodemographic characteristics of patients with MND in Greater London, the extent of their met and unmet needs and their utilisation of services and resources offered by the Association.
Amyotrophic lateral sclerosis (ALS), the most common form of MND, is an idiopathic, fatal neurodegenerative disease.2
Currently, it is estimated that there are approximately 5000 patients diagnosed with ALS in the UK, with an average age of onset of 55 years.
The prevalence of ALS is 4–6 cases per 100 000 population, with a lifetime ALS risk ranging from 1/600 to 1/1000.1 3 4
Although diverse in its presentation, course and progression, ALS causes progressive muscle atrophy, which results in physical disabilities, loss of independence and eventually death due to respiratory muscle failure.
Hence, the socioeconomic burden of the disease is immense both for the patients and their carers.4
Although the socioeconomic implications of ALS may be similar for all the patients (eg, income reduction, increased health expenses), their impact on the everyday reality of the patients and their families is subject to their socioeconomic status prior to the onset of the disease.
Current evidence suggests that people belonging to the lower socioeconomic strata tend to suffer worse health and to have less access to healthcare and health-promoting resources.5 6
In Britain, health inequalities persist as low income and low levels of subjective financial well-being are associated with poorer health in midlife and older age.7
From this perspective, it is likely that patients with MND with lower socioeconomic status bear an increased health but also socioeconomic disadvantage.
This implies that they have less means to maintain a human quality of life after the ALS onset but also that the socioeconomic consequences of the disease have a devastating impact on them and their close environment.
Moreover, studies on ethnic inequalities have revealed considerable gaps in self-rated health comparing ethnic minorities to the white British population.
Analysis of 2011 census data has revealed that the White Gypsy or Irish Traveller men and women suffer a significant health disadvantage compared with the white British group, while the rest of the ethnic minorities report similar or better health outcomes than the white British group.
This pattern appears stronger among men, as women in most cases either report worse health than the white British group (eg, Pakistani, Bangladeshi, Arab, Black Caribbean) or their health advantage is smaller than that of their male counterparts (eg, Black African, Indian).5 7
At older ages, ethnic minorities suffer higher levels of morbidity compared with the white British population.5 8
In London, the most ethnically diverse area of England and the region where the highest socioeconomic inequalities are observed, ethnic health inequalities are much more severe than in the rest of the country.8 9
These findings suggest that beyond the pure economic, other dimensions of social positioning like ethnicity, gender or domicile have also a crucial impact on people’s health and hence shape health inequalities among social groups.
These inequalities translate both into an increased vulnerability to poor health, and into less capabilities to deal with disease.10
People living with MND in London experience a unique situation of being part of a population structure diverse in terms of demographic characteristics, with a number of socioeconomic and health inequalities within groups.
The Motor Neurone Disease Association acknowledging both the financial implications of the disease for the patients’ lives and the existing socioeconomic inequalities in Greater London concentrates its efforts in providing direct (ie, grants) or indirect (ie, equipment) financial support to patients with MND in the area.
For this, all patients are informed by their care centre about the existence of the Association and those patients who express their interest in initiating a contact get referred to it by the care centre.
Next, the Association sends to them extensive information material about the challenges of the disease, the available services offered by the National Health Service and those offered by the Motor Neurone Disease Association including financial support.
Thus, patients can claim for it according to their needs. Their claims are usually made directly to the regional care development adviser in a personal manner and they get approved up to a maximum of 2000 pounds.
The Motor Neurone Disease Association is the only large association working for people living with MND in London.
The overarching aim of this study was to evaluate if support given by the Motor Neurone Disease Association was distributed equally or fairly among people living with MND in London.
As a consequence, we aimed to describe the provision offered by the Motor Neurone Disease Association among patients with MND living in the ethnically and socially diverse area of Greater London, according to the patients’ demographic and socioeconomic situation and needs.
The main objectives were first to estimate the prevalence of MND in London, starting from the data held by the Motor Neurone Disease Association, and, second, to explore whether the patients’ socioeconomic position, gender and age were associated with the likelihood of receiving a grant, and with the amount of the grant received from the Motor Neurone Disease Association either in the form of cash or equipment (eg, riser recliners).
More information: Stefan Dukic et al, Patterned functional network disruption in amyotrophic lateral sclerosis, Human Brain Mapping (2019).DOI: 10.1002/hbm.24740
Journal information: Human Brain Mapping
Provided by Trinity College Dublin