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Positive effects of tertiary centres for amyotrophic lateral sclerosis on outcome and use of hospital facilities
  1. A Chiò1,
  2. E Bottacchi2,
  3. C Buffa3,
  4. R Mutani1,
  5. G Mora4,
  6. the PARALS
  1. 1Divisione di Neurologia 1, Dipartimento di Neuroscienze, Università di Torino, Torino, Italy
  2. 2Divisione di Neurologia, Ospedale Regionale di Aosta, Aosta, Italy
  3. 3Divisione di Neurologia, ALS 3, Ospedale Maria Vittoria, Torino
  4. 4Divisione di Neuroriabilitazione 2, Fondazione Salvatore Maugeri IRCCS, Istituto Scientifico di Pavia, Pavia, Italy
  1. Correspondence to:
 Dr Adriano Chiò
 Department of Neuroscience, via Cherasco 15, 10126 Torino, Italy; achio{at}


Objective: To evaluate the effects of tertiary centres for amyotrophic lateral sclerosis (ALS) on ALS outcome and the use of hospital facilities.

Methods: The study was based on the data of an epidemiological, prospective, population-based register on ALS (Piemonte and Valle d’Aosta Register for amyotrophic lateral sclerosis, PARALS). The 221 patients recruited between 1995 and 1996 were prospectively followed up for outcome and use of hospital-based services.

Results: In all, 97 patients were followed up by tertiary ALS centres and 124 by general neurological clinics. Patients followed up by tertiary ALS centres were found to be 4 years younger and underwent percutaneous endoscopic gastronomy and non-invasive positive-pressure ventilation more often. Patients followed up by tertiary ALS centres were found to have a considerably longer median survival time (1080 v 775 days), even when stratifying by age, site of onset and respiratory function at diagnosis. In Cox multivariate analysis, attending a tertiary ALS centre was observed to be an independent positive prognostic factor. Moreover, patients attending a tertiary ALS centre were admitted to hospital less often (1.2 v 3.3) and were more frequently admitted for planned interventions. Conversely, patients followed up by general neurological clinics were more frequently admitted for acute events. Also, the hospital stay was considerably shorter for patients attending tertiary ALS centres (5.8 v 12.4 days).

Conclusions: Improved survival was seen in patients with ALS attending tertiary ALS centres, independently from all other known prognostic factors, possibly through a better implementation of supportive treatments. Moreover, because of these centres, the hospitalisation rate was markedly reduced, thus offering a cost-effective service to patients with ALS and to the community as a whole.

  • ALS, amyotrophic lateral sclerosis
  • FVC, forced vital capacity
  • NIV, non-invasive ventilation
  • PARALS, Piemonte and Valle d’Aosta Register for amyotrophic lateral sclerosis
  • PEG, percutaneous endoscopic gastronomy

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  • Published Online First 13 April 2006

  • Competing interests: None declared.

  • Piemonte and Valle d’Aosta Register for ALS (PARALS): Coordinating centre: 2nd Division of Neurology, Department of Neuroscience, University of Torino, Italy; Project coordinators: A Chiò; Study monitors: A Calvo, N Di Vito and P Ghiglione; Scientific Committee: E Bottacchi, A Chiò, D Cocito, MT Giordana, M Leone, L Mazzini and G Mora; Collaborating centres: A Chiò, AA Terreni, D Schiffer, R Mutani, D Cocito, B Bergamasco and I Rainero (Department of Neuroscience, Section of Neurology, University of Torino, and Azienda Ospedaliera San Giovanni Battista, Torino); A Bertolotto, A Tribolo, R Sciolla, F Mondino and MT Giordana (Department of Neuroscience, Section of Neurology, University of Torino, and Azienda Ospedaliera San Luigi Gonzaga, Orbassano); M Leone, P Gaviani, L Mazzini and F Monaco (Department of Neurology, Amedeo Avogadro University, Novara); R Comitangelo (Department of Neurology, Azienda Ospedaliera San Giovanni, Torino); L Sosso and M Gionco (Department of Neurology, Ospedale Mauriziano, Torino); U Morino and M Nobili (Department of Neurology, Ospedale Martini, Torino); L Appendino and C Buffa (Department of Neurology, Ospedale Maria Vittoria, Torino); D Piazza and C Ravetti (Department of Neurology, Ospedale S Giovanni Bosco, Torino); E Oddenino and W Liboni (Department of Neurology, Ospedale Gradenigo, Torino); G Ferrari (Department of Neurology, Ivrea); M Favero and C Doriguzzi Bozzo (Department of Neurology, Pinerolo); P Santamaria (Department of Neurology, Vercelli); U Massazza (Department of Neurology, Biella); A Villani and R Conti (Department of Neurology, Domodossola), G Mora, C Balzarini (Department of Neurological Rehabilitation, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Scientific Institute of Veruno and Pavia); M Palermo (Department of Neurology, Alessandria); F Vergnano,(Department of Neurology, Casale Monferrato); M Aguggia (Department of Neurology, Novi Ligure); MT Penza (Department of Neurology, Tortona); F Fassio, N Di Vito and W Troni (Department of Neurology, Asti); P Meineri (Department of Neurology, Azienda Ospedaliera Santa Croce e Carle, Cuneo); A Dutto and D Seliak (Department of Neurology, Savigliano); G Asteggiano and M Dutto (Department of Neurology, Alba); and G Corso nad E Bottacchi (Department of Neurology, Aosta).

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