Abstract Details

Title Dextromethorphan-Quinidine (Nuedexta) Improves Swallowing in Bulbar Onset ALS Patients with Pseudobulbar Affect - Pre-Post Observational Study in 86 ALS Patients

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-019

Objective

To present data on effect of DMq treatment on swallowing in 86 ALS patients treated for PBA.

Background

Dextramethorphan-20mg-Quinidine-10mg(Nuedexta)[DMq]has been approved by the Food and Drug Administration for treatment of pseudobulbar affect[PBA]in multiple conditions[Pioro et al, 2010]. A small observational single arm clinical trial identified benefit of DMq on swallowing in 15 of 29 ALS patients[Wright et al, 2016]. A recent randomized cross-over clinical trial of DMq versus placebo indicated a significant clinical effect of DMq treatment on speech and swallowing in ALS patients[Smith et al, 2017].

Design/Methods

DMq was given to 86 ALS patients to treat PBA and their pre- and post- swallowing rates for 90 mL of water were recorded approximately 4-8 weeks apart. Measurements included number of breaths taken, swallow time in seconds, number of swallows, and if any coughs or clearings of the throat. Patients completed Center for Neurologic Study-Lability Scale(CNS-LS)for pseudobulbar affect and the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R). Statistical analysis was completed with MedCalc (Ostend, Belgium).

Results

Liquid Swallowing (90mL water) Rate [ LSR ] improved statistically significantly in the patient group overall from median LSR=4.16 mL/sec (95%CI-3.30-5.22) to median LSR= 5.43 L/min (95 % CI=4.28-6.65) [ Wilcoxan paired P=0.0091 ].

Conclusions

DMq treatment is associated with increased LSR swallowing capacity in 54 / 86 ( 63 % ) ALS patients with PBA. In 35 / 86 ( 41 % ) DMq treated ALS patients with PBA improving more than 20% above pre-treatment, the LSR improved + 49 % ( 95 % CI = +40 to +58 %) compared with + 16 % ( 95 % CI = +12 to +19 %) in those 19 / 86 ( 22 % ) who showed less than 20% improvement. LSR improvement was not associated with a self-report of improvement in ALSFRS-R Swallowing Item score and a preponderance of the > 20 % LSR improvement responders were bulbar onset patients.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
Elena Bravver, MD	No disclosure on file
Urvi G. Desai, MD, FAAN (Dept of Neurology, CMC)	Dr. Desai has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Desai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Desai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Takeda. Dr. Desai has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Desai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Fulcrum. Dr. Desai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Catalyst. Dr. Desai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Desai has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Desai has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Argenx.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Benjamin R. Brooks, MD, FAAN (Clinical Trials Planning LLC)	Dr. Brooks has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Mitsubishi Tanabe Pharma America. Dr. Brooks has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medicinova. Dr. Brooks has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Brooks has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AB Science. Dr. Brooks has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ionis. Dr. Brooks has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Mitsubishi Tanabe Pharma America. The institution of Dr. Brooks has received research support from Mitsubishi TanabePharma America. Dr. Brooks has received personal compensation in the range of $0-$499 for serving as a Member Annual Surveillance Committee CDC National ALS Registry with Center for Disease Control Agency Toxic Substances Disease Registry. Dr. Brooks has a non-compensated relationship as a Member ALS Quality Measures Subcommittee with ��ɫ�� that is relevant to AAN interests or activities.

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