ALSFRS and Appel ALS scores: Discordance with disease progression

Andrei Voustianiouk, Gregory Seidel, Janki Panchal, Mark Sivak, Adam Czaplinski, Albert Yen, Stanley H. Appel, Dale J. Lange

    Research output: Contribution to journalArticlepeer-review

    30 Scopus citations


    Progression of disease and effectiveness of therapy in patients with amyotrophic lateral sclerosis (ALS) are determined by both questionnaire- and examination-based measures. To determine whether both types of measurement tools are equally predictive at all stages of disease, we compared questionnaire-based ALS Functional Rating Scale (ALSFRS) scores to the examination-based Appel ALS (AALS) scores at different stages of disease. Same-day scores were obtained during 174 visits in 62 patients with definite or probable ALS. Using normalized scores, correlation between the scales and predictability were best in mildly affected patients. Predictions of ALSFRS based on AALS scores were less than half as precise in the later stages of disease. Both scales showed significant change with disease progression, but ALSFRS consistently underestimated disease severity defined by AALS (P < 0.001). Questionnaire-based measurements should be compared against objective scales at all stages of disease severity before they are accepted as primary endpoint measures.

    Original languageEnglish (US)
    Pages (from-to)668-672
    Number of pages5
    JournalMuscle and Nerve
    Issue number5
    StatePublished - May 2008


    • ALS
    • ALS clinical trials
    • ALS natural history
    • ALSFRS
    • Amyotrophic lateral sclerosis
    • Appel ALS score

    ASJC Scopus subject areas

    • Clinical Neurology
    • Neuroscience(all)


    Dive into the research topics of 'ALSFRS and Appel ALS scores: Discordance with disease progression'. Together they form a unique fingerprint.

    Cite this