Need For New ALS Classification System To Advance Care And Research

It has been established that Amyotrophic Lateral Sclerosis (ALS) would benefit from a new classification system. This is going by an argument by a team of researchers who featured the limitations of existing systems for diagnosing ALS and allocating patients to sub-types of the disease.

The opinion article focusing on how ALS shifting towards a new classification system strategized that it could combine systematic classification systems with the highly varied symptoms experienced in real life while simultaneously enhancing both patient care and research of ALS.
Nearly a century ago, researchers agreed that ALS encompassed conditions impacting on both upper and lower motor neurons. Currently, with advancements in the medical field, scientists are still debating if ALS is one condition or several varied conditions.
Researchers at King’s College in London argue that the current classification systems are not consistent and do not facilitate accurate descriptions of ALS symptoms. As it is, there are two systems used, that is, the El Escorial and the International Classification of Diseases (ICD).
According to the El Escorial criteria, an ALS diagnosis is dependent on symptoms of motor neuron disease that can be divided into four body regions. However, ALS is diagnosed with various degrees of certainty, and the system is occasionally contradicting clinical observations.
The ICD system has proven invaluable when comparing data between research institutions. On a different note, the ICD is revised often and as the classification of ALS and its symptoms is based on clinical findings, each ICD revision ends up differing significantly from the one preceding it. The system has its limitation since no method exists for defining the classification.
Classification systems are required to consider the predominant type of motor involvement, the age of onset and disease progression, non-movement symptoms, and genetic and molecular biomarkers. Such a development depends on a comprehension of disease mechanisms.
The researchers suggest that scientists and clinicians need to alter their perception towards ALS. More specifically, building new knowledge on multidisciplinary studies connecting symptoms to genetic and molecular findings.
To initiate a reliable classification system that is applicable in both research and clinical practice, the team suggests a standard description of ALS. This description would need to have information on the clinical stage of the disease, any exceptional disease features, the balance between upper and lower motor neuron symptoms, the presence of relevant risk factors or biomarkers and the certainty of ALS type according to the El Escorial criteria.
The diagnostic category could be modified in detail by adding information of a familial disease type, if the disease is found in a first-degree relative, or the presence of frontotemporal dementia (FTD). This system, the researchers argue, could bring forth vital information in a comprehensive and orderly manner while at the same time facilitating descriptions of disease manifestations.
Future discoveries in ALS research could be incorporated into such a system, which will offer an accurate approach towards research and treatment of the disease. This is because it will provide specialists with details about the cause, the balance of upper and lower motor neuron involvement, and clinical stage of ALS.