Age of onset and length of survival of Queensland patients with amyotrophic lateral sclerosis: with details of subjects with early onset and subjects with long survival.

Introduction: To document the characteristics of ALS patients in Queensland, to examine factors influencing age of onset and survival, and to study those with early onset (<45 years) disease and those with long (> 5 years) survival.
Methods: We studied subjects seen at the ALS Clinic at the Royal Brisbane & Women’s Hospital. We recorded sex, age of onset, region of onset, length of survival, presence of family history, type of disease and evidence of cognitive involvement. We analysed the influence of these features on age of onset and on survival. We analysed the features of patients with early onset of disease and patients with long survival.
Results: There were 855 ALS patients (505 males) in the cohort. The age of onset was lower in males than females, in patients with a family history of ALS compared to those without and in patients with spinal onset compared to bulbar onset. Early-onset disease was seen in 10% of patients, and had a greater proportion of males, spinal onset and classical ALS phenotype compared to late onset disease. Survival was shorter in females, in patients with bulbar onset, and in patients with classical ALS. Long survival was seen in 18% of patients. Patients with long survival had younger age of onset, greater proportion of males and of spinal onset and fewer patients with classical ALS. 
Discussion / Conclusion: Our study confirms that ALS is more prevalent in males, and that spinal onset is more common than bulbar onset. Males have earlier onset but longer survival. We found that overall, patients with classical ALS have worse survival than ALS variants, but some patients who were considered to have classical ALS had long survival. This study confirms the similarity of ALS in our region to ALS in other geographical regions. 

