An issue clearly reflected in the data is asperation pneumonia . . . does the noninvasive ventilation increase risk of asperation pneumonia . . . does the pacer increase the risk of asperation pneumonia?

There may be an increase in asperation pneumonia risk with these technolgies, so be sure to incorporate routine use of pulse oxygen meter with the use of this equipment.

Here is the appendix for the Lancet DPS report:

http://www.thelancet.com/cms/attachm...10528/mmc1.pdf

The French study has resumed, US NIH Clinical Trails database now reports, "This study is ongoing, but not recruiting participants" whereas, previously reported "suspended."

While I continue to review the Lancet report I am convinced the writers ought to have identified gastronomy tube usage among the patients included in the study. Very little data on this issue appears in the report . . . one of the major reasons patients use gastronomy tubes is to decrease the risk of aspiration pneumonia.

The Lancet report also indicates 'no stimulation' is a possible 'sham stimulation,' whereas, in my estimation, 'sham stimulation' means stimulation other than 'no stimulation' or 'intended stimulation.' Its possible the complete absence of stimulation might be harmful in the presence of the implants because the implants may, in effect, cause short-circuits and thus increase the energy neurons must produce to sufficiently activation the synapse. The change in stress neurons may undergo might increase their load and thereby possibly reduce the neuron's longevity. A stimulation offsetting this effect ought to be possible - if it is needed.

The limited amount of French comment on the studies might in fact only be in reference to the Lancet report and thus the remarks implying the French study encountered trouble too is possibly only a rumor.

Possibly the most worrisome issue in the report are the two pulmonary embolisms. Until this report, I was aware of only one case, ending badly. Was this one of those two or are there now three . . . what happened of these two?

My understanding is pulmonary embolisms are always a surgical risk and people who live a sedentary lifestyle have a greater risk. So far no clear connection between the pacer and these embolisms are evident in the documentation I can find on the web. The first occurred within the thirty day surgery period; I can only find they occurred in the report, but not when, as yet.

The DiPALS report may be a study incurred of a false negative sample; In ALS a treatment group may appear to fair less successfully than the control group when the patient count is small. I have seen cases where a patient lasts only six months from disease onset to cases where a patient remains alive after fifty years from disease onset. So the patients lived less long in the treatment group; did they live longer than they would have? Efficacy is about whether they lived longer with than without the treatment.

Given a group of 37 ALS patients, we might expect to see seven slow regressors and presumably seven fast regressors (yet I know of very little literature on fast regressors).

MuonOne
I appreciate your taking the time to keep ALS patients and caregivers so very well informed. I do not have ALS, but have been diagnosedwith Parkinson's for 20+ years.

There are many similarities between ALS and PD. By studying all neurological illnesses, I believe we will come closer to finding therapies that work. I want to thank Thelma for her work in this area, also.
Peggy