The Use of Antidepressant Medication before and after the Diagnosis of Amyotrophic Lateral Sclerosis: A Population-Based Cohort Study.

BACKGROUND: The prevalent use of antidepressants (ATDs) in patients with Amyotrophic Lateral Sclerosis (ALS) varies across cross-sectional and clinic-based published studies. This population-based cohort study assesses the real-world prevalence of the use of ATDs, its trajectory and the association of incident use with clinical characteristics. METHODS: All patients with incident ALS in the Friuli Venezia Giulia region, Italy, from 2002 to 2009, were identified through multiple sources including health databases. Diagnosis was validated through clinical documentation review. ATDs prescriptions from 2000 to 2011 were obtained from regional database. The trajectory was estimated through generalized estimating equations for repeated measures logistic regression and the Hazard ratio (HR) of initiating ATDs through multivariate proportional hazard Cox regression. RESULTS: In this cohort of 261 ALS cases, age-, sex-adjusted prevalence of the use of ATDs was 37.3%, higher than in general population. The trajectory increased by 16% in 1-year period across diagnosis. Age ≤67 years at diagnosis (HR 1.28, 95% CI 0.84-1.95) and bulbar onset (1.43, 95% CI 0.90-2.26) were positively associated with initiating ATDs after diagnosis. CONCLUSIONS: More than one-third of patients used ATDs. Depression may occur more frequently than previously reported. Depression may precede motor alterations and be related to both ALS diagnosis and progression.

The Dide-Botcazo syndrome: forgotten and misunderstood.

Bilateral infarcts of the posterior cerebral arteries are associated with a range of visual and memory deficits. In 1902, Dide and Botcazo presented a clinico-pathological case study linking visual field defects, topographical disorientation, retro-anterograde amnesia and alexia with bilateral medial occipito-temporal lesions. Based on the findings they suggested the occipital lobe and inferior longitudinal fasciculus played an important role in memory. The combination of deficits was subsequently referred to on occasion as Dide-Botcazo syndrome but the term was largely forgotten until revived in the 1980s. More recently, some authors have included visual anosognosia--Anton's syndrome--in the syndrome, a feature that was not in the original case report. Here we present a historical review of Dide-Botcazo syndrome, illustrated with a recent case with almost identical clinical features to that described by Dide and Botcazo. Although Dide and Botcazo's theory of occipital amnesia has been superseded by developments in our understanding of the neurobiology of memory, it seems fitting to remember in some way their description of a clinical association of visual and memory deficits. We suggest Dide-Botcazo syndrome be used to describe a variant of vascular dementia, where visual field deficits are associated with memory impairment and, depending on the location of the vascular lesions, visual perceptual dysfunction, topographic, imagery or dreaming deficits.

The incidence of amyotrophic lateral sclerosis in Friuli Venezia Giulia, Italy, from 2002 to 2009: a retrospective population-based study.

BACKGROUND: We conducted a retrospective population-based study to estimate the incidence of amyotrophic lateral sclerosis (ALS) in Friuli Venezia Giulia, Italy, from 2001 to 2009. METHODS: Multiple sources were used for case ascertainment: Health databases, archives of the neurology departments and of the regional chapter of the Italian ALS Association. The diagnosis was validated through clinical documentation review. Crude and standardized incidence rates (IRs) per 100,000 person-years were calculated. RESULTS: We identified 262 incident ALS cases, 50.4% men, 4.2% familial. Half of the patients had spinal onset (56.8% in men) and 25.2% bulbar (29% in women). Bulbar onset had a similar frequency in women (31.7%) and men (31.5%) aged 67 or above at diagnosis. The crude IR was 2.72 (95% confidence interval, 95% CI, 2.39-3.05) and the male:female ratio 1.08. The IR peaked in the 65-74 age group, with a second increase in men 85 years and older. The IR standardized to the 2001 Italian population was 2.38 (95% CI 2.13-2.63) and to the 2000 European population 2.58 (95% CI 2.34-2.81). CONCLUSIONS: This retrospective study found IRs of ALS in the range of Italian and European prospective population-based registries, suggesting an almost complete case ascertainment.