Research Article| Volume 107, P133-137, January 2023

Download started.


Multidisciplinary clinic contributes to the decreasing trend in the number of emergency hospitalizations for amyotrophic lateral sclerosis in Japan


      • A wide range of medical care is required in patients with ALS as symptoms progress.
      • The medical charts of patients with amyotrophic lateral sclerosis were studied.
      • Collaborative care by multidisciplinary team is recommended for patients with ALS.
      • The multidisciplinary care team for ALS shares information on treatment and problems.
      • Multidisciplinary care effectively controlled multiple emergency hospitalizations and improved survival.



      Multidisciplinary care is recommended for amyotrophic lateral sclerosis (ALS). We opened the first multidisciplinary care “ALS clinic” in Japan in February 2017. This study aimed to clarify the impact of multidisciplinary care on the number and incidence rate of emergency hospitalizations, as well as the survival rate of patients with ALS.


      We studied the medical charts of patients with ALS who visited our hospital between March 1, 2014, and February 29, 2020, in a retrospective study. All patients were divided into two groups: a General Neurology Clinic group (GNC) and an ALS Clinic group (AC), based on the duration of the first visit to our hospital.


      The survey participants included 90 patients with ALS (32 in the GNC vs 58 in the AC). The mean follow-up duration was 276 ± 257 days in the GNC and 307 ± 267 days in the AC. The number of emergency hospitalizations was 11 in the GNC and nine in the AC. The number of patients with two or more emergency hospitalizations was decreased in the AC (3 in the GNC vs 0 in the AC), which was statistically significantly different (p = 0.04). The survival rate was significantly different between the two groups (p = 0.01).


      Our results suggest that intervention through ALS multidisciplinary care in the hospital setting effectively controls emergency hospitalizations and improves the survival rate in patients with ALS. Multidisciplinary care is recommended since various medical treatments are required as the condition progresses.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kiernan M.C.
        • Vucic S.
        • Cheah B.C.
        • Turner M.R.
        • Eisen A.
        • Hardiman O.
        • et al.
        Amyotrophic lateral sclerosis.
        Lancet. 2011; 377: 942-955
        • Mitchell J.D.
        • Borasio G.D.
        Amyotrophic lateral sclerosis.
        Lancet. 2007; 369: 2031-2041
        • Pisa F.E.
        • Logroscino G.
        • Battiston P.G.
        • Barbone F.
        Hospitalizations due to respiratory failure in patients with amyotrophic lateral sclerosis and their impact on survival: A population-based cohort study.
        BMC Pulm Med. 2016; 16: 136
        • Dubinsky R.
        • Chen J.
        • Lai S.M.
        Trends in hospital utilization and outcome for patients with ALS: Analysis of a large U.S. cohort.
        Neurology. 2006; 67: 777-780
        • Niedermeyer S.
        • Murn M.
        • Choi P.J.
        Respiratory failure in amyotrophic lateral sclerosis.
        Chest. 2019; 155: 401-408
        • Miller R.G.
        • Jackson C.E.
        • Kasarskis E.J.
        • England J.D.
        • Forshew D.
        • Johnston W.
        • et al.
        Practice parameter update: The care of the patient with amyotrophic lateral sclerosis: Drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Neurology. 2009; 73: 1218-1226
        • Andersen P.M.
        • Borasio G.D.
        • Dengler R.
        • Hardiman O.
        • Kollewe K.
        • Leigh P.N.
        • et al.
        EFNS task force on management of amyotrophic lateral sclerosis: guidelines for diagnosing and clinical care of patients and relatives.
        Eur J Neurol. 2005; 12: 921-938
      1. Societas Neurologica Japonica. Practical Guideline for Amyotrophic Lateral Sclerosis 2013. Japan: Nankodo; 2013.

        • Kano O.
        • Banno H.
        • Sugisawa T.
        • Sawada M.
        • Murata K.
        • Washizawa N.
        • et al.
        The new style of outpatient clinic with multidisciplinary care. Sogo.
        Rehabilitation. 2018; 46: 1039-1044
        • Van den Berg J.P.
        • Kalmijn S.
        • Lindeman E.
        • Veldink J.H.
        • De Visser M.
        • Van der Graaff M.M.
        • et al.
        Multidisciplinary ALS care improves quality of life in patients with ALS.
        Neurology. 2005; 65: 1264-1267
        • Corr B.
        • Frost E.
        • Traynor B.J.
        • Hardiman O.
        Service provision for patients with ALS/MND: a cost-effective multidisciplinary approach.
        J Neurol Sci. 1998; 160: 141-145
        • Sorenson E.J.
        • Mandrekar J.
        • Crum B.
        • Stevens J.C.
        Effect of referral bias on assessing survival in ALS.
        Neurology. 2007; 68: 600-602
        • Traynor B.J.
        • Alexander M.
        • Corr B.
        • Frost E.
        • Hardiman O.
        Effect of a multidisciplinary Amyotrophic lateral Sclerosis (ALS) clinic on survival: A population based study 1996–2000.
        J Neurol Neurosurg Psychiatry. 2003; 74: 1258-1261
        • Zoccolella S.
        • Beghi E.
        • Palagano G.
        • Fraddosio A.
        • Guerra V.
        • Lepore V.
        • et al.
        ALS multidisciplinary clinic and survival. Results from a population-based study in Southern Italy.
        J Neurol. 2007; 254: 1107-1112
        • Chio A.
        • Bottacchi E.
        • Buffa C.
        • Mutani R.
        • Mora G.
        Positive effects of tertiary centres for amyotrophic lateral sclerosis on outcome and use of hospital facilities.
        J Neurol Neurosurg Psychiatry. 2006; 77: 948-950
        • Cedarbaum J.M.
        • Stambler N.
        • Malta E.
        • Fuller C.
        • Hilt D.
        • Thurmond B.
        • et al.
        The ALSFRS-R: A revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III).
        J Neurol Sci. 1999; 169: 13-21
        • Gil J.
        • Funalot B.
        • Verschueren A.
        • Danel-Brunaud V.
        • Camu W.
        • Vandenberghe N.
        • et al.
        Causes of death amongst French patients with amyotrophic lateral sclerosis: a prospective study.
        Eur J Neurol. 2008; 15: 1245-1251
        • Vender R.L.
        • Mauger D.
        • Walsh S.
        • Alam S.
        • Simmons Z.
        Respiratory systems abnormalities and clinical milestones for patients with amyotrophic lateral sclerosis with emphasis upon survival.
        Amyotroph Lateral Scler. 2007; 8: 36-41
        • Chio A.
        • Mora G.
        • Leone M.
        • Mazzini L.
        • Cocita D.
        • Giordana M.T.
        • et al.
        Early symptom progression rate is related to ALS outcome.
        Neurology. 2002; 59: 99-103
        • Millul A.
        • Beghi E.
        • Logroscino G.
        • Micheli A.
        • Vitelli E.
        • Zardi A.
        Survival of patients with amyotrophic lateral sclerosis in a population-based registry.
        Neuroepidemiology. 2005; 25: 114-119
        • Jawaid A.
        • Murthy S.B.
        • Wilson A.M.
        • Qureshi S.U.
        • Amro M.J.
        • Wheaton M.
        • et al.
        A decrease in body mass index is associated with faster progression of motor symptoms and shorter survival in ALS.
        Amyotroph Lateral Scler. 2010; 11: 542-548