The Knowns and Unknowns about Amyotrophic Lateral Sclerosis (ALS)

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Paul Mehta
photograph courtesy of Dr. Paul Mehta.

“It’s the ‘knowns’ that hold me humble, and the ‘unknowns’ that hold me challenged,” says Paul Mehta, M.D. Paul is a medical epidemiologist and the principal investigator who gives oversight for the congressionally mandated Nationwide Amyotrophic Lateral Sclerosis (ALS) Registry on the Company for Poisonous Substances and Illness Registry (ATSDR) in Atlanta.

ALS is also referred to as “Lou Gehrig’s illness,” named after famend baseball participant Lou Gehrig who was identified with ALS in 1939 when he was simply 36. Over 75 years have handed since, and ALS continues to perplex researchers and sufferers alike.

Humbling and Difficult

“As a scientist it’s each humbling and difficult to work at CDC/ATSDR. If you find yourself a federal scientist, there are various challenges that have to be overcome, particularly when you’re working with a illness like ALS, which has many unknowns and knowns,” says Paul.

The Knowns of ALS:

  • ALS is a illness of the nerves and muscle mass that will get worse over time.
  • Roughly 80% of sufferers die inside 2 – 5 years of analysis; the prognosis or final result differs affected person to affected person.
  • Ten % of instances are genetic in origin; 90% of instances are sporadic (random) in origin.
  • The illness impacts principally whites and principally males.
  • Present remedy extends life expectancy by solely 2 – three months on common.

The Unknowns of ALS:

  • How random instances of ALS could possibly be linked to the setting.
  • The place, what, and when environmental hyperlinks happen.
  • Why the illness impacts principally whites and principally males.
  • Why the illness impacts veterans, athletes.
  • How ALS may be handled or cured.

The Nationwide ALS Registry

In 2008, Congress handed the ALS Registry Act giving ATSDR the duty for growing and managing the registry, and in 2010, ATSDR launched the primary and solely ALS Registry in america. The population-based registry collects and analyzes knowledge on individuals with ALS in america.

The purpose of the ALS Registry is to assemble info that can be utilized to

  • Estimate the variety of new instances of ALS annually
  • Estimate the quantity of people that have ALS at a particular cut-off date
  • Perceive extra about who will get ALS and what elements have an effect on the illness
  • Study the connection between ALS and different issues that may be confused with ALS

There have been nearly sixteen thousand instances of ALS within the ALS Registry as of 2013. The Registry will get knowledge from a number of sources comparable to Medicare, and the Veterans Administration, and from self-identification by people with ALS. ATSDR anticipates releasing its 2014 prevalence report later this yr.

Dr. Mehta and his staff work very carefully with ALS advocacy and help teams, researchers, healthcare professionals, and others to encourage these residing with ALS to affix the Registry and take threat issue surveys.

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Nationwide ALS Biorepository and Analysis Notification System

In January 2017, ATSDR launched one other element of the Nationwide ALS Registry—the primary nationwide biorepository for ALS in america. The time period “biorepository” often refers to a facility that collects and shops samples of organic materials. Samples within the ALS biorepository might embrace blood, urine, and saliva, and are used to assist advance ALS analysis. When a affected person joins the Registry, she or he can select to obtain info on find out how to donate samples. There is no such thing as a price or price for sufferers to take part.

The Registry collaborates with tutorial and personal trade to help with their recruitment efforts. Recruiting for medical trials and research may be tough and costly. The Registry’s analysis notification system informs sufferers who’ve chosen to obtain e-mail about trials and research they could be eligible for.

“Researchers can work with the Registry in a wide range of methods, together with acquiring knowledge and/or samples from the Registry/Biorepository and requesting assist recruiting for his or her medical trials and research. To this point, thirty establishments have used this free mechanism to help with recruitment and over 100,000 emails have been despatched to sufferers,” says Paul.

PALS (Individuals with ALS)

What Dr. Mehta finds most humbling is assembly individuals with ALS, generally known as “PALS,” as they’re known as. “Nearly all of them are selfless people. They themselves know that of their lifetime there might not be a remedy or a treatment for ALS, however they wish to assist others. To me, that may be very humbling. They vary from these of their thirties, to middle-aged, and to the very previous,” he says. ALS doesn’t discriminate and might have an effect on anybody.

Dr. Mehta feels privileged to satisfy with PALS by way of partnership conferences and academic symposiums which might be open to sufferers, and their important caregivers all through the nation. He makes use of these alternatives to talk with them, study their tales, and hearken to their suggestions in regards to the Nationwide ALS Registry to study what ATSDR can enhance upon and do higher.

About Dr. Paul Mehta

Paul is married, and the daddy of three sons: one in faculty, one in highschool, and one in center college. His spouse works as a nurse practitioner on the Veterans Affairs Medical Middle in Atlanta. They usually have two canines that add to their busy and boisterous family.
When not working or parenting, he makes use of his very restricted free time taking part in tennis, figuring out on the fitness center, catching up on studying, and watching U.S. and world information on TV, which he encourages his sons to do as effectively.

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Though Paul was born in New Delhi, India, he grew up in Toledo, Ohio, after his mother and father immigrated to the U.S. when he was 5 years previous. He got here to Atlanta after medical college in 2000. Paul skilled within the Nationwide Well being Service in England, making the choice to enter public well being as a substitute of personal follow to have an effect on particular person well being, however on a broader scale. Publish-graduate coaching within the Nationwide Well being Service allowed him to see how public well being is delivered in numerous components of the world.

Rising up, Paul at all times needed to be a doctor. His father was in enterprise, however kinfolk on his mom’s aspect of the household have been physicians – uncles, aunts, and cousins. So from an early age, he at all times had the drive to contribute to science and to care for people.

Paul joined CDC in 2002 as a contractor, then grew to become an worker in 2006, beginning out as a staff chief for CDC’s Division of Choose Brokers and Toxins. He moved to what’s now the Division of Toxicology and Human Well being Sciences at ATSDR as principal investigator for ALS when a place opened up in October of 2013.  Paul considers his work at CDC/ATSDR the excessive level of his profession.

Most Rewarding

Paul feels privileged to work with a devoted and cohesive staff of a couple of dozen gifted, hardworking epidemiologists, statisticians, well being scientists, and well being communicators, whose function is to make the ALS Registry the perfect it may be. “Most significantly, and most difficult, we’re right here to determine the unknowns for ALS such because the environmental threat elements, who will get ALS, and why. We wish to advance ALS analysis to attempt to decide the causes for ALS, main to higher therapies for the illness, and probably a treatment.”

ATSDR advances this purpose by funding analysis into environmental causes for ALS, and by working with a few of the greatest scientists nationwide and world wide. Paul emphasizes the significance of being very open and dealing with companions each at dwelling and overseas. “You possibly can’t work in a bubble,” he says.

Ice Bucket Problem for ALS

The Ice Bucket Problem is an exercise involving the dumping of a bucket of ice and water over an individual’s head to advertise consciousness of ALS, and encourage donations to analysis. It went viral throughout July–August 2014. The instigating pressure behind the Ice Bucket Problem was Pete Frates, a baseball participant from Boston who, like Gehrig, was identified with ALS and helped garner consideration for the illness.

As a result of about 5 to 6 thousand folks die from ALS yearly, and one other 5 to 6 thousand are identified with it, Paul was gratified to see nationwide consideration known as to this devastating and deadly illness.

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“ALS is a uncommon illness, in contrast to Parkinson’s or Alzheimer’s,” says Paul, “however ALS shares some medical traits with these illnesses.” One fascinating and essential distinction is that Alzheimer’s sufferers expertise reminiscence loss, however stay bodily intact, whereas ALS sufferers retain their psychological schools, however their our bodies utterly fail them.

Wanting Forward

For the primary time in 20 years, a brand new drug, Radicava, was launched this yr to deal with sufferers with ALS. Whereas it doesn’t treatment ALS, it does sluggish the development of the illness. And for these with a genetic element for ALS, there are early medical trials underway to see if gene remedy will help decelerate the illness as effectively.

“ALS is a devastating and debilitating illness. We have to make sure that we’ve got assets obtainable each on the federal and personal degree, as a result of there may be at present no treatment,” says Paul. “On the federal degree, quite a lot of the medical trials are spearheaded by the Meals and Drug Administration. The Nationwide Institutes for Well being additionally conducts medical trials, and at CDC/ATSDR we research the influence of ALS on public well being, and who it impacts.”

Dr. Paul Mehta emphasizes that “at present there are extra unknowns than knowns about ALS, and with the Nationwide ALS Registry we need to determine the ‘why’ of ALS, who will get ALS, and the way. We’re dedicated to advancing analysis and going ahead with our companions to seek out higher therapies for and resolve the mysteries of ALS,” he says.

Extra Info:

To study extra about ALS and be part of the Registry, go to:

To study extra in regards to the Nationwide ALS Biorepository go to:

To learn the newest printed articles go to:

To see the first-ever CDC Grand Rounds on the Nationwide ALS Registry, go to:

To look at a brief video on the Nationwide ALS Registry, go to:

To study extra about ATSDR, go to

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