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Searching for a link between the L-BMAA neurotoxin and amyotrophic lateral sclerosis: a study protocol of the French BMAALS programme
  1. Aurélie Delzor1,2,
  2. Philippe Couratier1,2,3,
  3. Farid Boumédiène1,2,
  4. Marie Nicol1,2,3,
  5. Michel Druet-Cabanac1,2,3,
  6. François Paraf3,
  7. Annick Méjean4,
  8. Olivier Ploux4,
  9. Jean-Philippe Leleu1,2,
  10. Luc Brient5,
  11. Marion Lengronne5,
  12. Valérie Pichon6,7,
  13. Audrey Combès6,7,
  14. Saïda El Abdellaoui6,7,
  15. Vincent Bonneterre8,
  16. Emmeline Lagrange9,
  17. Gérard Besson9,
  18. Dominique J Bicout8,10,
  19. Jean Boutonnat9,
  20. William Camu11,12,
  21. Nicolas Pageot11,12,
  22. Raul Juntas-Morales11,12,
  23. Valérie Rigau11,12,
  24. Estelle Masseret13,
  25. Eric Abadie14,
  26. Pierre-Marie Preux1,2,3,
  27. Benoît Marin1,2
  1. 1Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
  2. 2University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
  3. 3Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France
  4. 4Interdisciplinary Laboratory for Tomorrow's Energy Pack (LIED), CNRS UMR 8236, University Paris Diderot-Paris 7, Paris, France
  5. 5UMR 6553 ECOBIO, Ecosystems—Biodiversity—Evolution, University Rennes I, Rennes, France
  6. 6Department of Analytical, Bioanalytical Sciences and Miniaturization (LSABM), UMR ESPCI-ParisTech-CNRS 8231 CBI, Paris, France
  7. 7University Sorbonne, University Pierre and Marie Curie (UPMC), Paris, France
  8. 8Environment and Health Prediction in Populations (EPSP), CNRS-TIMC-IMAG UMR 5525 UJF-Grenoble 1, Grenoble, France
  9. 9Department of Neurology, University Hospital of Grenoble, Grenoble, France
  10. 10Biomathematics and Epidemiology, Environment and Health Prediction in Populations (EPSP), VetAgro Sup, Marcy-l'Etoile, France
  11. 11Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France
  12. 12Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France
  13. 13UMR 5119 ECOSYM, Ecology of Coastal Marine Systems, UM2-CNRS-IRD-Ifremer-UM1, University Montpellier II, Montpellier, France
  14. 14Environment Resources Laboratory/Languedoc-Roussillon, Ifremer, Sète, France
  1. Correspondence to Prof. Philippe Couratier; philippe.couratier{at}


Introduction Amyotrophic lateral sclerosis (ALS) is the most common motor neurone disease. It occurs in two forms: (1) familial cases, for which several genes have been identified and (2) sporadic cases, for which various hypotheses have been formulated. Notably, the β-N-methylamino-L-alanine (L-BMAA) toxin has been postulated to be involved in the occurrence of sporadic ALS. The objective of the French BMAALS programme is to study the putative link between L-BMAA and ALS.

Methods and analysis The programme covers the period from 1 January 2003 to 31 December 2011. Using multiple sources of ascertainment, all the incident ALS cases diagnosed during this period in the area under study (10 counties spread over three French regions) were collected. First, the standardised incidence ratio will be calculated for each municipality under concern. Then, by applying spatial clustering techniques, overincidence and underincidence zones of ALS will be sought. A case–control study, in the subpopulation living in the identified areas, will gather information about patients’ occupations, leisure activities and lifestyle habits in order to assess potential risk factors to which they are or have been exposed. Specimens of drinking water, food and biological material (brain tissue) will be examined to assess the presence of L-BMAA in the environment and tissues of ALS cases and controls.

Ethics and dissemination The study has been reviewed and approved by the French ethical committee of the CPP SOOM IV (Comité de Protection des Personnes Sud-Ouest & Outre-Mer IV). The results will be published in peer-reviewed journals and presented at national and international conferences.


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