What are the prognostic factors for ALS?

The course of ALS varies greatly and is highly individualized. The progression of symptoms is determined by the specific form of ALS present in the affected individual (typical ALS, spastic ALS, progressive muscular atrophy, primary lateral sclerosis, flail arm syndrome, flail leg syndrome, axial ALS, progressive bulbar palsy). Even within each variant of ALS, the progression can vary in its dynamics. A basic distinction can be made between rapid, moderate, or slow disease progression. This takes into account the rate at which motor symptoms progress. Of particular importance is the spread of paralysis (and associated motor deficits) from one affected region of the body to the next (spread dynamics).

The progression of motor deficits is assessed using the ALS Functional Rating Scale (ALSFRS-R). Additional progression criteria include changes in body weight (Body Mass Index), respiratory capacity ( Slow Vital Capacity, SVC), peak cough flow(PCF), and the biomarker neurofilament light chain (NfL). Predicting the course of ALS requires the consideration, interpretation, and evaluation of individual factors and their combinations. The assessment of an individual’s course of the disease is performed by neurologists who specialize in the diagnosis and treatment of ALS.