To study the clinical, electrophysiological profile and the role of  the metallo-toxic etiology of ALS in the region of North Coastal Andhra Pradesh, India

To study the clinical and electrophysiological profile of the patients diagnosed with ALS in the tertiary care hospital of North Coastal Andhra Pradesh, India. Also studied the association of blood level of heavy metals in patients, diagnosed with ALS by comparing with controls. Diagnostic criteria used were Awaji criteria. Measured the concentration of nine toxic metals in the plasma from 109 patients with MND. Independent sample T-test was applied to find statistical difference between means of heavy metal levels in ALS patients and controls. P-value of <0.05 was considered statistically significant.

Total of 56 patients (51.4%) had ALS, concentration of toxic metals in the plasma from 56 ALS patients and from 42 age matched controls was measured by inductively coupled plasma mass spectrometry (ICP-MS). We found that higher blood levels of Arsenic (As), Lead (Pb) and lower levels of Cesium (Cs) are associated with ALS. Spinal onset ALS had association with high blood levels of Cadmium (Cd) and Lead (Pb) as compare to bulbar onset ALS.

The results suggest that metal exposure contributes to the pathogenesis of ALS. Further heavy metal analysis should be carried out in the large population based multicenter studies, along with assay in common exposure sources like drinking water, air, soil, occupational areas for an in-depth investigation on their possible role in the pathogenesis of ALS that can open a door to new therapeutic targets.