Background

The Challenge: Diagnosing and Treating ALS

Receiving a diagnosis of ALS is a long and complicated process. There is currently no definitive test for ALS. Patients are tested for dozens of other possible conditions before a diagnosis is made. On average, patients wait a full year after the first symptoms appear to receive a proper diagnosis.

Receiving an earlier diagnosis of ALS helps patients in a number of ways.

• Patients would be able to attend specialized ALS clinics earlier. Here, patients receive multidisciplinary care that improves and prolongs life. These clinics typically involve meeting with neurologists, physiatrists, respirologists, respiratory therapists, physiotherapists, occupational and speech therapists, social workers, and research staff.
• Patients are able to enroll in clinical trials earlier.

Bridging the Gap: Using Advanced MRI to detect and monitor ALS

Patients living with ALS experience changes in motor functioning due to changes in the nervous system. Unlike conditions such as strokes, multiple sclerosis, or tumors, ALS cannot be detected using standard imaging methods, including MRIs ordered in the clinic.

However, advanced MRI techniques have shown changes in various measures indicative of brain health. These imaging-based measurements have immense potential in providing biomarkers for ALS.

Biomarkers (or “biological markers”) are essentially tests that indicate the presence of a disease. Depending on the nature of the disease, these markers can be found in blood, cerebrospinal fluid, urine, genes, or in the physical structure of organs.

Using advanced MRI methods, our research and the work of other scientists has shown differences in brain structure, function and chemistry in patients with ALS. We believe that we can identify imaging-based biomarkers that will not only lead to earlier diagnoses, but also help researchers and clinicians track the progress of the disease, evaluate new drugs, and improve our understanding of ALS biology.

The Future: The Impact of Biomarkers for ALS

We anticipate our research having a number of benefits on the lives of individuals living with ALS, including the following:

• Speeding up diagnosis. Patients currently wait a very long time before a diagnosis of ALS is made.
• Improving the accuracy of the diagnosis. ALS is a very complicated disease, with apparent subtypes based on features including symptoms, progression rate, and prognosis. We anticipate being able to further classify ALS types based on biomarkers and specific symptoms.
• Improving patient care. Once patients are diagnosed, they are referred to multidisciplinary clinics where they receive specialized care designed to prolong and improve quality of life.
• Assisting clinical trials. A biomarker that can monitor accurately monitor disease progression and response to treatments would improve the efficiency of clinical trials. Drug trials would be quicker and less expensive, and more drugs could be tested. MRI is an accessible, non-invasive, and safe medical technology, aspects making it an attractive technology to use in clinical trials. Earlier and accurate subtyping by biomarkers will also improve the potential for clinical trials to be successful by enrolling appropriate patients sooner when the disease is less advanced. As such, the development of biomarkers is recognized as a priority as they will play a central role in the discovery of effective treatments in ALS.
• Improve our understanding of ALS biology.  ALS has incredible variability, such as at what age it starts, what parts of the body are affected, and how fast it progresses. Advanced MRI methods can demonstrate the structural and functional changes in the brain that could give insight into why there is this broad diversity amongst individuals.