Publication

The impact of age on genetic testing decisions in amyotrophic lateral sclerosis.

Journal Paper/Review - Dec 19, 2022

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Citation
Mehta P, Iacoangeli A, Opie-Martin S, Farei-Campagna J, Al Khleifat A, Bredin A, Ossher L, Andersen P, Hardiman O, Mehta A, Fratta P, Talbot K, PROJECT MINE ALS SEQUENCING CONSORTIUM, Al-Chalabi A. The impact of age on genetic testing decisions in amyotrophic lateral sclerosis. Brain 2022; 145:4440-4447.
Type
Journal Paper/Review (English)
Journal
Brain 2022; 145
Publication Date
Dec 19, 2022
Issn Electronic
1460-2156
Pages
4440-4447
Brief description/objective

Amyotrophic lateral sclerosis (ALS) is a heterogeneous neurodegenerative syndrome. In up to 20% of cases, a family history is observed. Although Mendelian disease gene variants are found in apparently sporadic ALS, genetic testing is usually restricted to those with a family history or younger patients with sporadic disease. With the advent of therapies targeting genetic ALS, it is important that everyone treatable is identified. We therefore sought to determine the probability of a clinically actionable ALS genetic test result by age of onset, globally, but using the UK as an exemplar. Blood-derived DNA was sequenced for ALS genes, and the probability of a clinically actionable genetic test result estimated. For a UK subset, age- and sex-specific population incidence rates were used to determine the number of such results missed by restricting testing by age of onset according to UK's National Genomic Test Directory criteria. There were 6274 people with sporadic ALS, 1551 from the UK. The proportion with a clinically actionable genetic test result ranged between 0.21 [95% confidence interval (CI) 0.18-0.25] in the youngest age group to 0.15 (95% CI 0.13-0.17) in the oldest age group for a full gene panel. For the UK, the equivalent proportions were 0.23 (95% CI 0.13-0.33) in the youngest age group to 0.17 (95% CI 0.13-0.21) in the oldest age group. By limiting testing in those without a family history to people with onset below 40 years, 115 of 117 (98% of all, 95% CI 96%-101%) clinically actionable test results were missed. There is a significant probability of a clinically actionable genetic test result in people with apparently sporadic ALS at all ages. Although some countries limit testing by age, doing so results in a significant number of missed pathogenic test results. Age of onset and family history should not be a barrier to genetic testing in ALS.