Comparison of the King's and MiToS staging systems for ALS.

Fang, Ton, Al Khleifat, Ahmad, Stahl, Daniel R, Lazo La Torre, Claudia, Murphy, Caroline, Uk-Mnd LicalS, , Young, Carolyn ORCID: 0000-0001-6971-8203, Shaw, Pamela J, Leigh, P Nigel and Al-Chalabi, Ammar
(2017) Comparison of the King's and MiToS staging systems for ALS. Amyotrophic lateral sclerosis & frontotemporal degeneration, 18 (3-4). pp. 227-232.

Access the full-text of this item by clicking on the Open Access link.


To investigate and compare two ALS staging systems, King's clinical staging and Milano-Torino (MiToS) functional staging, using data from the LiCALS phase III clinical trial (EudraCT 2008-006891-31).Disease stage was derived retrospectively for each system from the ALS Functional Rating Scale-Revised subscores using standard methods. The two staging methods were then compared for timing of stages using box plots, correspondence using chi-square tests, agreement using a linearly weighted kappa coefficient and concordance using Spearman's rank correlation.For both systems, progressively higher stages occurred at progressively later proportions of the disease course, but the distribution differed between the two methods. King's stage 3 corresponded to MiToS stage 1 most frequently, with earlier King's stages 1 and 2 largely corresponding to MiToS stage 0 or 1. The Spearman correlation was 0.54. There was fair agreement between the two systems with kappa coefficient of 0.21.The distribution of timings shows that the two systems are complementary, with King's staging showing greatest resolution in early to mid-disease corresponding to clinical or disease burden, and MiToS staging having higher resolution for late disease, corresponding to functional involvement. We therefore propose using both staging systems when describing ALS.

Item Type: Article
Uncontrolled Keywords: Uk-Mnd LicalS, Humans, Amyotrophic Lateral Sclerosis, Disease Progression, Survival Analysis, Retrospective Studies, Reproducibility of Results, Algorithms, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Clinical Trials, Phase III as Topic, Kaplan-Meier Estimate
Depositing User: Symplectic Admin
Date Deposited: 14 May 2019 07:32
Last Modified: 19 Jan 2023 00:46
DOI: 10.1080/21678421.2016.1265565
Open Access URL:
Related URLs: