Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2002 Sep;78(923):513–519. doi: 10.1136/pmj.78.923.513

Motor neurone disease

K Talbot 1
PMCID: PMC1742493  PMID: 12357010

Abstract

Motor neurone disease (MND), or amyotrophic lateral sclerosis (ALS), is a neurodegenerative disorder of unknown aetiology. Progressive motor weakness and bulbar dysfunction lead to premature death, usually from respiratory failure. Confirming the diagnosis may initially be difficult until the full clinical features are manifest. For all forms of the disease there is a significant differential diagnosis to consider, including treatable conditions, and therefore specialist neurological opinion should always be sought. Clear genetic inheritance has been demonstrated in a minority of patients with familial ALS but elucidation of the biological basis of genetic subtypes is also providing important information which may lead to treatments for sporadic forms of the disease. In the absence of curative or disease modifying therapy, management is supportive and requires a multidisciplinary approach. If, as seems likely, complex inherited and environmental factors contribute to the pathogenesis of MND, future treatment may involve a combination of molecular based treatments or restoration of cellular integrity using stem cell grafts.

Full Text

The Full Text of this article is available as a PDF (151.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bensimon G., Lacomblez L., Meininger V. A controlled trial of riluzole in amyotrophic lateral sclerosis. ALS/Riluzole Study Group. N Engl J Med. 1994 Mar 3;330(9):585–591. doi: 10.1056/NEJM199403033300901. [DOI] [PubMed] [Google Scholar]
  2. Berger M. M., Kopp N., Vital C., Redl B., Aymard M., Lina B. Detection and cellular localization of enterovirus RNA sequences in spinal cord of patients with ALS. Neurology. 2000 Jan 11;54(1):20–25. doi: 10.1212/wnl.54.1.20. [DOI] [PubMed] [Google Scholar]
  3. Borasio G. D., Shaw P. J., Hardiman O., Ludolph A. C., Sales Luis M. L., Silani V., European ALS Study Group Standards of palliative care for patients with amyotrophic lateral sclerosis: results of a European survey. Amyotroph Lateral Scler Other Motor Neuron Disord. 2001 Sep;2(3):159–164. doi: 10.1080/146608201753275517. [DOI] [PubMed] [Google Scholar]
  4. Bowen J., Gregory R., Squier M., Donaghy M. The post-irradiation lower motor neuron syndrome neuronopathy or radiculopathy? Brain. 1996 Oct;119(Pt 5):1429–1439. doi: 10.1093/brain/119.5.1429. [DOI] [PubMed] [Google Scholar]
  5. Chancellor A. M., Warlow C. P. Adult onset motor neuron disease: worldwide mortality, incidence and distribution since 1950. J Neurol Neurosurg Psychiatry. 1992 Dec;55(12):1106–1115. doi: 10.1136/jnnp.55.12.1106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chaudhry V., Corse A. M., Cornblath D. R., Kuncl R. W., Drachman D. B., Freimer M. L., Miller R. G., Griffin J. W. Multifocal motor neuropathy: response to human immune globulin. Ann Neurol. 1993 Mar;33(3):237–242. doi: 10.1002/ana.410330303. [DOI] [PubMed] [Google Scholar]
  7. Cleveland D. W., Rothstein J. D. From Charcot to Lou Gehrig: deciphering selective motor neuron death in ALS. Nat Rev Neurosci. 2001 Nov;2(11):806–819. doi: 10.1038/35097565. [DOI] [PubMed] [Google Scholar]
  8. Dabby R., Lange D. J., Trojaborg W., Hays A. P., Lovelace R. E., Brannagan T. H., Rowland L. P. Inclusion body myositis mimicking motor neuron disease. Arch Neurol. 2001 Aug;58(8):1253–1256. doi: 10.1001/archneur.58.8.1253. [DOI] [PubMed] [Google Scholar]
  9. Forsyth P. A., Dalmau J., Graus F., Cwik V., Rosenblum M. K., Posner J. B. Motor neuron syndromes in cancer patients. Ann Neurol. 1997 Jun;41(6):722–730. doi: 10.1002/ana.410410608. [DOI] [PubMed] [Google Scholar]
  10. Giess R., Naumann M., Werner E., Riemann R., Beck M., Puls I., Reiners C., Toyka K. V. Injections of botulinum toxin A into the salivary glands improve sialorrhoea in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry. 2000 Jul;69(1):121–123. doi: 10.1136/jnnp.69.1.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gordon P. H., Rowland L. P., Younger D. S., Sherman W. H., Hays A. P., Louis E. D., Lange D. J., Trojaborg W., Lovelace R. E., Murphy P. L. Lymphoproliferative disorders and motor neuron disease: an update. Neurology. 1997 Jun;48(6):1671–1678. doi: 10.1212/wnl.48.6.1671. [DOI] [PubMed] [Google Scholar]
  12. Grohmann K., Schuelke M., Diers A., Hoffmann K., Lucke B., Adams C., Bertini E., Leonhardt-Horti H., Muntoni F., Ouvrier R. Mutations in the gene encoding immunoglobulin mu-binding protein 2 cause spinal muscular atrophy with respiratory distress type 1. Nat Genet. 2001 Sep;29(1):75–77. doi: 10.1038/ng703. [DOI] [PubMed] [Google Scholar]
  13. HIRAYAMA K., TSUBAKI T., TOYOKURA Y., OKINAKA S. Juvenile muscular atrophy of unilateral upper extremity. Neurology. 1963 May;13:373–380. doi: 10.1212/wnl.13.5.373. [DOI] [PubMed] [Google Scholar]
  14. Hadano S., Hand C. K., Osuga H., Yanagisawa Y., Otomo A., Devon R. S., Miyamoto N., Showguchi-Miyata J., Okada Y., Singaraja R. A gene encoding a putative GTPase regulator is mutated in familial amyotrophic lateral sclerosis 2. Nat Genet. 2001 Oct;29(2):166–173. doi: 10.1038/ng1001-166. [DOI] [PubMed] [Google Scholar]
  15. Hosler B. A., Siddique T., Sapp P. C., Sailor W., Huang M. C., Hossain A., Daube J. R., Nance M., Fan C., Kaplan J. Linkage of familial amyotrophic lateral sclerosis with frontotemporal dementia to chromosome 9q21-q22. JAMA. 2000 Oct 4;284(13):1664–1669. doi: 10.1001/jama.284.13.1664. [DOI] [PubMed] [Google Scholar]
  16. Howlett W. P., Brubaker G. R., Mlingi N., Rosling H. Konzo, an epidemic upper motor neuron disease studied in Tanzania. Brain. 1990 Feb;113(Pt 1):223–235. doi: 10.1093/brain/113.1.223. [DOI] [PubMed] [Google Scholar]
  17. Hu M. T., Ellis C. M., Al-Chalabi A., Leigh P. N., Shaw C. E. Flail arm syndrome: a distinctive variant of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry. 1998 Dec;65(6):950–951. doi: 10.1136/jnnp.65.6.950. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Jafari H., Couratier P., Camu W. Motor neuron disease after electric injury. J Neurol Neurosurg Psychiatry. 2001 Aug;71(2):265–267. doi: 10.1136/jnnp.71.2.265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kuzuhara S., Kokubo Y., Sasaki R., Narita Y., Yabana T., Hasegawa M., Iwatsubo T. Familial amyotrophic lateral sclerosis and parkinsonism-dementia complex of the Kii Peninsula of Japan: clinical and neuropathological study and tau analysis. Ann Neurol. 2001 Apr;49(4):501–511. [PubMed] [Google Scholar]
  20. La Spada A. R., Wilson E. M., Lubahn D. B., Harding A. E., Fischbeck K. H. Androgen receptor gene mutations in X-linked spinal and bulbar muscular atrophy. Nature. 1991 Jul 4;352(6330):77–79. doi: 10.1038/352077a0. [DOI] [PubMed] [Google Scholar]
  21. Lacomblez L., Bensimon G., Leigh P. N., Guillet P., Powe L., Durrleman S., Delumeau J. C., Meininger V. A confirmatory dose-ranging study of riluzole in ALS. ALS/Riluzole Study Group-II. Neurology. 1996 Dec;47(6 Suppl 4):S242–S250. doi: 10.1212/wnl.47.6_suppl_4.242s. [DOI] [PubMed] [Google Scholar]
  22. Le Forestier N., Maisonobe T., Piquard A., Rivaud S., Crevier-Buchman L., Salachas F., Pradat P. F., Lacomblez L., Meininger V. Does primary lateral sclerosis exist? A study of 20 patients and a review of the literature. Brain. 2001 Oct;124(Pt 10):1989–1999. doi: 10.1093/brain/124.10.1989. [DOI] [PubMed] [Google Scholar]
  23. Lefebvre S., Bürglen L., Reboullet S., Clermont O., Burlet P., Viollet L., Benichou B., Cruaud C., Millasseau P., Zeviani M. Identification and characterization of a spinal muscular atrophy-determining gene. Cell. 1995 Jan 13;80(1):155–165. doi: 10.1016/0092-8674(95)90460-3. [DOI] [PubMed] [Google Scholar]
  24. Ludolph A. C., Spencer P. S. Toxic models of upper motor neuron disease. J Neurol Sci. 1996 Aug;139 (Suppl):53–59. doi: 10.1016/0022-510x(96)00122-0. [DOI] [PubMed] [Google Scholar]
  25. Lyall R. A., Donaldson N., Fleming T., Wood C., Newsom-Davis I., Polkey M. I., Leigh P. N., Moxham J. A prospective study of quality of life in ALS patients treated with noninvasive ventilation. Neurology. 2001 Jul 10;57(1):153–156. doi: 10.1212/wnl.57.1.153. [DOI] [PubMed] [Google Scholar]
  26. Lyall R. A., Donaldson N., Polkey M. I., Leigh P. N., Moxham J. Respiratory muscle strength and ventilatory failure in amyotrophic lateral sclerosis. Brain. 2001 Oct;124(Pt 10):2000–2013. doi: 10.1093/brain/124.10.2000. [DOI] [PubMed] [Google Scholar]
  27. MacGowan D. J., Scelsa S. N., Waldron M. An ALS-like syndrome with new HIV infection and complete response to antiretroviral therapy. Neurology. 2001 Sep 25;57(6):1094–1097. doi: 10.1212/wnl.57.6.1094. [DOI] [PubMed] [Google Scholar]
  28. Meucci N., Nobile-Orazio E., Scarlato G. Intravenous immunoglobulin therapy in amyotrophic lateral sclerosis. J Neurol. 1996 Feb;243(2):117–120. doi: 10.1007/BF02444000. [DOI] [PubMed] [Google Scholar]
  29. Moulignier A., Moulonguet A., Pialoux G., Rozenbaum W. Reversible ALS-like disorder in HIV infection. Neurology. 2001 Sep 25;57(6):995–1001. doi: 10.1212/wnl.57.6.995. [DOI] [PubMed] [Google Scholar]
  30. Pestronk A., Cornblath D. R., Ilyas A. A., Baba H., Quarles R. H., Griffin J. W., Alderson K., Adams R. N. A treatable multifocal motor neuropathy with antibodies to GM1 ganglioside. Ann Neurol. 1988 Jul;24(1):73–78. doi: 10.1002/ana.410240113. [DOI] [PubMed] [Google Scholar]
  31. Pringle C. E., Hudson A. J., Munoz D. G., Kiernan J. A., Brown W. F., Ebers G. C. Primary lateral sclerosis. Clinical features, neuropathology and diagnostic criteria. Brain. 1992 Apr;115(Pt 2):495–520. doi: 10.1093/brain/115.2.495. [DOI] [PubMed] [Google Scholar]
  32. Ringel S. P., Murphy J. R., Alderson M. K., Bryan W., England J. D., Miller R. G., Petajan J. H., Smith S. A., Roelofs R. I., Ziter F. The natural history of amyotrophic lateral sclerosis. Neurology. 1993 Jul;43(7):1316–1322. doi: 10.1212/wnl.43.7.1316. [DOI] [PubMed] [Google Scholar]
  33. Robberecht W. Oxidative stress in amyotrophic lateral sclerosis. J Neurol. 2000 Mar;247 (Suppl 1):I1–I6. doi: 10.1007/s004150050551. [DOI] [PubMed] [Google Scholar]
  34. Rosen D. R., Siddique T., Patterson D., Figlewicz D. A., Sapp P., Hentati A., Donaldson D., Goto J., O'Regan J. P., Deng H. X. Mutations in Cu/Zn superoxide dismutase gene are associated with familial amyotrophic lateral sclerosis. Nature. 1993 Mar 4;362(6415):59–62. doi: 10.1038/362059a0. [DOI] [PubMed] [Google Scholar]
  35. Sendtner M. Molecular mechanisms in spinal muscular atrophy: models and perspectives. Curr Opin Neurol. 2001 Oct;14(5):629–634. doi: 10.1097/00019052-200110000-00012. [DOI] [PubMed] [Google Scholar]
  36. Sobue I., Saito N., Iida M., Ando K. Juvenile type of distal and segmental muscular atrophy of upper extremities. Ann Neurol. 1978 May;3(5):429–432. doi: 10.1002/ana.410030512. [DOI] [PubMed] [Google Scholar]
  37. Swash M., Desai J., Misra V. P. What is primary lateral sclerosis? J Neurol Sci. 1999 Nov 15;170(1):5–10. doi: 10.1016/s0022-510x(99)00184-7. [DOI] [PubMed] [Google Scholar]
  38. Talbot K., Davies K. E. Spinal muscular atrophy. Semin Neurol. 2001 Jun;21(2):189–197. doi: 10.1055/s-2001-15264. [DOI] [PubMed] [Google Scholar]
  39. Traynor B. J., Codd M. B., Corr B., Forde C., Frost E., Hardiman O. M. Clinical features of amyotrophic lateral sclerosis according to the El Escorial and Airlie House diagnostic criteria: A population-based study. Arch Neurol. 2000 Aug;57(8):1171–1176. doi: 10.1001/archneur.57.8.1171. [DOI] [PubMed] [Google Scholar]
  40. Traynor B. J., Codd M. B., Corr B., Forde C., Frost E., Hardiman O. Incidence and prevalence of ALS in Ireland, 1995-1997: a population-based study. Neurology. 1999 Feb;52(3):504–509. doi: 10.1212/wnl.52.3.504. [DOI] [PubMed] [Google Scholar]
  41. Turner M. R., Parton M. J., Leigh P. N. Clinical trials in ALS: an overview. Semin Neurol. 2001 Jun;21(2):167–175. doi: 10.1055/s-2001-15262. [DOI] [PubMed] [Google Scholar]
  42. Yang Y., Hentati A., Deng H. X., Dabbagh O., Sasaki T., Hirano M., Hung W. Y., Ouahchi K., Yan J., Azim A. C. The gene encoding alsin, a protein with three guanine-nucleotide exchange factor domains, is mutated in a form of recessive amyotrophic lateral sclerosis. Nat Genet. 2001 Oct;29(2):160–165. doi: 10.1038/ng1001-160. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES