Abstract Details

Title Pitfalls in the Diagnosis of Amyotrophic Lateral Sclerosis in a Hispanic Cohort

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-026

Objective To demonstrate the diagnostic pitfalls in a Hispanic cohort with Amyotrophic lateral sclerosis (ALS).

Background ALS is the most common form of motor neuron disease the diagnosis of which is primarily clinical. The significant variation in disease phenotype often leads to diagnostic delay. Given the gravity of the disease, it is critical to confirm the diagnosis in a time sensitive fashion.

Design/Methods As part of our study, we identified Hispanic patients with a confirmed diagnosis of ALS in a Southern California hospital. Patient demographics, duration of symptoms prior to confirming the diagnosis, number of primary care and emergency department visits prior to diagnosis were reviewed. Data were tabulated and are presented as percentage, mean ± standard deviation.

Results Twenty one Hispanic patients (61.9% males, age 52±8.69) with confirmed diagnosis of ALS were identified. The duration of symptoms prior to confirming the diagnosis of ALS was found to be 22.9±26.8 months. A total of 66.6% of the patients had limb onset ALS as compared to bulbar onset. An alarming 71.4% of the patients received alternate diagnosis prior to final diagnosis of ALS. Symptoms were commonly mistaken to be associated with a previous traumatic event in 40% of the individuals while 13.3% were misdiagnosed as arthritis and multifocal motor neuropathy. The diagnosis of ALS was missed by primary physicians 61.5%, followed by emergency department 13.4%. Interestingly neurologists missed the diagnosis by 7.6%.

Conclusions Our study highlights the delay in diagnosis of ALS in Hispanic population. The prompt referral of such patients to specialist neurological services for assessment is thus important. The key to the correct diagnosis of ALS is the recognition of progressive weakness and the evolution of physical signs of mixed motor system degeneration. A thorough knowledge of ALS diagnostic pitfalls should help reduce the misdiagnosis rate significantly.

Authors/Disclosures
Bhavesh Trikamji, MD (University of California Los Angeles) PRESENTER	Dr. Trikamji has nothing to disclose.
Margaret Adler, MD (Harbor UCLA Department of Neurology)	Dr. Adler has nothing to disclose.

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