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Mahler C, Schumacher AM, Unterrainer M, Kaiser L, Höllbacher T, Lindner S, Havla J, Ertl-Wagner B, Patzig M, Seelos K, Neitzel J, Mäurer M, Krumbholz M, Metz I, Brück W, Stadelmann C, Merkler D, Gass A, Milenkovic V, Bartenstein P, Albert NL, Kümpfel T, Kerschensteiner M. TSPO PET imaging of natalizumab-associated progressive multifocal leukoencephalopathy. Brain 2021; 144:2683-2695. [PMID: 33757118 DOI: 10.1093/brain/awab127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/10/2021] [Accepted: 03/01/2021] [Indexed: 01/31/2023] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a severe infection of the central nervous system caused by the polyomavirus JC (JCV) that can occur in multiple sclerosis (MS) patients treated with natalizumab. Clinical management of patients with natalizumab-associated PML is challenging not the least because current imaging tools for the early detection, longitudinal monitoring and differential diagnosis of PML lesions are limited. Here we evaluate whether TSPO positron emission tomography (PET) imaging can be applied to monitor the inflammatory activity of PML lesions over time and differentiate them from MS lesions. For this monocenter pilot study we followed 8 patients with natalizumab-associated PML with PET imaging using the TSPO radioligand [18F]GE-180 combined with frequent 3 T MRI imaging. In addition we compared TSPO PET signals in PML lesions with the signal pattern of MS lesions from 17 independent MS patients. We evaluated the standardized uptake value ratio (SUVR) as well as the morphometry of the TSPO uptake for putative PML and MS lesions areas compared to a radiologically unaffected pseudo-reference region in the cerebrum. Furthermore TSPO expression in situ was immunohistochemically verified by determining the density and cellular identity of TSPO-expressing cells in brain sections from four patients with early natalizumab-associated PML as well as five patients with other forms of PML and six patients with inflammatory demyelinating CNS lesions (clinically isolated syndrome/MS). Histological analysis revealed a reticular accumulation of TSPO expressing phagocytes in PML lesions, while such phagocytes showed a more homogenous distribution in putative MS lesions. TSPO PET imaging showed an enhanced tracer uptake in natalizumab-associated PML lesions that was present from the early to the chronic stages (up to 52 months after PML diagnosis). While gadolinium enhancement on MRI rapidly declined to baseline levels, TSPO tracer uptake followed a slow one phase decay curve. A TSPO-based 3-dimensional diagnostic matrix taking into account the uptake levels as well as the shape and texture of the TSPO signal differentiated more than 96% of PML and MS lesions. Indeed, treatment with rituximab after natalizumab-associated PML in three patients did not affect tracer uptake in the assigned PML lesions but reverted tracer uptake to baseline in the assigned active MS lesions. Taken together our study suggests that TSPO PET imaging can reveal CNS inflammation in natalizumab-associated PML. TSPO PET may facilitate longitudinal monitoring of disease activity and help to distinguish recurrent MS activity from PML progression.
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Affiliation(s)
- Christoph Mahler
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Adrian-Minh Schumacher
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Lena Kaiser
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Thomas Höllbacher
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Simon Lindner
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Birgit Ertl-Wagner
- Institute of Clinical Radiology, University Hospital Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Maximilian Patzig
- Institute of Neuroradiology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Klaus Seelos
- Institute of Neuroradiology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | | | - Markus Krumbholz
- Department of Neurology & Stroke and Hertie-Institute for Clinical Brain Research, Eberhard Karl University of Tübingen, Tübingen, Germany
| | - Imke Metz
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Doron Merkler
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland.,Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Achim Gass
- Department of Neurology, University Hospital Mannheim, Mannheim, Germany
| | - Vladimir Milenkovic
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Martin Kerschensteiner
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
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Anadani N, Hyland M, Cruz RA, Lisak R, Costello K, Major EO, Jassam Y, Meltzer E, Varkey TC, Parsons MS, Goodman AD, Graves JS, Newsome S, Zamvil SS, Frohman EM, Frohman TC. Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 1: From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 8:8/1/e929. [PMID: 33411672 PMCID: PMC7803340 DOI: 10.1212/nxi.0000000000000929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Nidhiben Anadani
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Megan Hyland
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Roberto Alejandro Cruz
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Robert Lisak
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Kathleen Costello
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Eugene O Major
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Yasir Jassam
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Ethan Meltzer
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Thomas C Varkey
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Matthew S Parsons
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Andrew D Goodman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Jennifer S Graves
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott Newsome
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott S Zamvil
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Elliot M Frohman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
| | - Teresa C Frohman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
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Maillart E, Taoufik Y, Gasnault J, Stankoff B. Leucoencefalopatia multifocale progressiva. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)89404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mancinelli CR, Scarpazza C, Santuccio G, De Rossi N, Capra R. Dealing with highly active multiple sclerosis after natalizumab-associated PML: could rituximab be of help? Neurol Sci 2018; 39:965-966. [PMID: 29302813 DOI: 10.1007/s10072-017-3228-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Chiara Rosa Mancinelli
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018, Montichiari, Brescia, Italy.
| | - C Scarpazza
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018, Montichiari, Brescia, Italy
| | - G Santuccio
- Multiple Sclerosis Centre, Sondrio Hospital, ASST Valtellina-Alto Lario, 23100, Sondrio, Italy
| | - N De Rossi
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018, Montichiari, Brescia, Italy
| | - R Capra
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018, Montichiari, Brescia, Italy
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Schneider R, Bellenberg B, Hoepner R, Kolb EM, Ellrichmann G, Haghikia A, Gold R, Lukas C. Metabolic profiles by 1H-magnetic resonance spectroscopy in natalizumab-associated post-PML lesions of multiple sclerosis patients who survived progressive multifocal leukoencephalopathy (PML). PLoS One 2017; 12:e0176415. [PMID: 28445498 PMCID: PMC5405920 DOI: 10.1371/journal.pone.0176415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/09/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Early diagnosis and treatment of multiple sclerosis-related progressive multifocal leukoencephalopathy (PML) significantly improve clinical outcomes. However, there is a lack of information regarding the restart of immunomodulatory therapy in the post-PML setting, when multiple sclerosis activity reappears. We aimed at the examination of metabolic differences using 1H-magnetic resonance spectroscopy (1H-MRS) in multiple sclerosis patients at various post-PML stages and at the exploration of differences according to their disease and JC virus (JCV) status. METHODS 1H-MRS of PML lesions was carried out on 15 relapsing-remitting multiple sclerosis patients with natalizumab-associated PML. Patients were grouped according to their stage after PML infection as early post-PML, less than 19 months after PML onset (n = 5), or late post-PML group, more than 23 months after PML onset (n = 10). The latter group was further categorized according to persisting JCV load in the cerebrospinal fluid. RESULTS Early post-PML patients showed significantly higher Lipid/Creatine ratios within PML lesions than late post-PML (p = 0.036). Furthermore, N-Acetyl-Aspartate/Creatine and N-Acetyl-Aspartate/Choline were significantly reduced in early post-PML and late post-PML lesions relative to normal-appearing white matter. In late post-PML, virus-positive patients showed significantly higher ratios of Choline/Creatine (p = 0.019) and consequently a reduced N-Acetyl- Aspartate/Choline ratio (p = 0.010) in contrast to virus-negative patients. In late post-PML patients with persisting viral load, an elevated Choline/Creatine ratio correlated significantly with higher disability. CONCLUSIONS 1H-MRS may provide additional information related to underlying PML disease activity in various post-PML stages. In particular, Choline/Creatine levels, Lipid levels, and N-Acetyl- Aspartate/Choline are relevant markers in the post-PML setting, taking also the JCV status into account.
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Affiliation(s)
- Ruth Schneider
- Department of Neurology of the Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
- * E-mail:
| | - Barbara Bellenberg
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine of the Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Robert Hoepner
- Department of Neurology of the Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Eva-Maria Kolb
- Department of Neurology of the Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Gisa Ellrichmann
- Department of Neurology of the Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Aiden Haghikia
- Department of Neurology of the Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Ralf Gold
- Department of Neurology of the Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Carsten Lukas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine of the Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
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Maillart E, Vidal JS, Brassat D, Stankoff B, Fromont A, de Sèze J, Taithe F, Clavelou P, Bourre B, Delvaux V, Rico A, Labauge P, Tourbah A, Lebrun C, Pelletier J, Moreau T, Louapre C, Lubetzki C, Papeix C. Natalizumab-PML survivors with subsequent MS treatment: Clinico-radiologic outcome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e346. [PMID: 28616447 PMCID: PMC5462603 DOI: 10.1212/nxi.0000000000000346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/03/2017] [Indexed: 02/04/2023]
Abstract
Objective: To describe the clinico-radiologic outcome of MS patients with natalizumab-related progressive multifocal leukoencephalopathy (Nz-PML) surviving and receiving disease-modifying therapy (DMT). Methods: We describe clinical and radiologic evolution of Nz-PML survivors in an observational retrospective multicenter cohort to clarify the effect of different subsequent MS DMT strategies. Twenty-three patients from 11 centers were analyzed. Outcomes were (1) clinical efficacy of post-PML MS DMT, (2) radiologic efficacy of post-PML MS DMT, (3) radiologic evolution of PML lesion, and (4) disability progression. Results: There was no clinical worsening of PML symptoms with a stability of Expanded Disability Status Scale at the last follow-up. No relapse was reported with fingolimod and dimethyl fumarate. No radiologic worsening of Nz-PML lesion was observed at the end of the follow-up. Conclusion: In this large cohort of patients with Nz-PML, MS therapies given after Nz discontinuation were not associated with PML worsening. A larger cohort with longer follow-up will be necessary to confirm this therapeutic strategy.
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Affiliation(s)
- Elisabeth Maillart
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Jean-Sebastien Vidal
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - David Brassat
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Bruno Stankoff
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Agnès Fromont
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Jérôme de Sèze
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Frédéric Taithe
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Pierre Clavelou
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Bertrand Bourre
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Valérie Delvaux
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Audrey Rico
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Pierre Labauge
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Ayman Tourbah
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Christine Lebrun
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Jean Pelletier
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Thibault Moreau
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Céline Louapre
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Catherine Lubetzki
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
| | - Caroline Papeix
- Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France
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