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Schneider A, Fasshauer E, Scheiderbauer J, Warnke C, Köpke S, Kasper J, Toussaint M, Temmes H, Hemmer B, Schiffmann I, Rahn A, Heesen C. Development and evaluation of evidence-based patient information handbooks about multiple sclerosis immunotherapies. Mult Scler Relat Disord 2022; 60:103728. [DOI: 10.1016/j.msard.2022.103728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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Grahl S, Bussas M, Wiestler B, Eichinger P, Gaser C, Kirschke J, Zimmer C, Berthele A, Hemmer B, Mühlau M. Differential Effects of Fingolimod and Natalizumab on Magnetic Resonance Imaging Measures in Relapsing-Remitting Multiple Sclerosis. Neurotherapeutics 2021; 18:2589-2597. [PMID: 34561843 PMCID: PMC8804113 DOI: 10.1007/s13311-021-01118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/24/2022] Open
Abstract
Fingolimod and natalizumab are approved disease-modifying drugs in relapsing-remitting multiple sclerosis (RRMS). The two drugs have different modes of action and may therefore influence different aspects of MS-related tissue damage. In this retrospective cohort study, we longitudinally compared patients treated with fingolimod and patients treated with natalizumab by measures based on structural magnetic resonance imaging (MRI). We included patients with RRMS given that two standardized MRI scans under the same drug were available with an interval of at least 6 months both from therapy start to baseline scan and from baseline scan to follow-up scan. After matching for age, baseline and follow-up scans from 93 patients (fingolimod, 48; natalizumab, 45) were investigated. Mean follow-up time was 1.9 years. We determined the number of new white matter lesions as well as thalamic, cortical, and whole-brain atrophy. After scaling for time of the interscan interval, measures were analyzed by group comparisons and, to account for demographic and clinical characteristics, by multiple regression models and a binary logistic regression model. Compared to natalizumab, fingolimod treatment went along with more new white matter lesions (median [interquartile range, IQR] 0.0 [0.0; 0.7] vs. 0.0 [0.0; 0.0] /year; p < 0.01) whereas whole-brain atrophy was lower (median [IQR] 0.2 [0.0; 0.5] vs. 0.5 [0.2; 1.0] %/year; p = 0.01). These significant differences were confirmed by multiple regression models and the binary logistic regression model. In conclusion, our observation is compatible with stronger neuroprotective properties of fingolimod compared to natalizumab.
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Affiliation(s)
- S Grahl
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - M Bussas
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - B Wiestler
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - P Eichinger
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - C Gaser
- Department of Psychiatry and Department of Neurology, Jena University Hospital, Jena, Germany
| | - J Kirschke
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - A Berthele
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - B Hemmer
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - M Mühlau
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- TUM Neuroimaging, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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3
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Bayas A, Berthele A, Hemmer B, Warnke C, Wildemann B. Controversy on the treatment of multiple sclerosis and related disorders: positional statement of the expert panel in charge of the 2021 DGN Guideline on diagnosis and treatment of multiple sclerosis, neuromyelitis optica spectrum diseases and MOG-IgG-associated disorders. Neurol Res Pract 2021; 3:45. [PMID: 34362474 PMCID: PMC8343915 DOI: 10.1186/s42466-021-00139-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- A Bayas
- Universitätsklinikum Augsburg, Klinik für Neurologie und klinische Neurophysiologie, Augsburg, Germany
| | - A Berthele
- Technische Universität München, Fakultät für Medizin, Klinikum rechts der Isar, Klinik für Neurologie, Munich, Germany.
| | - B Hemmer
- Technische Universität München, Fakultät für Medizin, Klinikum rechts der Isar, Klinik für Neurologie, Munich, Germany
| | - C Warnke
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät, Universitätsklinik Köln, Cologne, Germany
| | - B Wildemann
- Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Kowarik MC, Astling D, Lepennetier G, Ritchie A, Hemmer B, Owens GP, Bennett JL. Differential Effects of Fingolimod and Natalizumab on B Cell Repertoires in Multiple Sclerosis Patients. Neurotherapeutics 2021; 18:364-377. [PMID: 33258072 PMCID: PMC8116403 DOI: 10.1007/s13311-020-00975-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 12/25/2022] Open
Abstract
Natalizumab and fingolimod are effective multiple sclerosis (MS) therapies that disrupt lymphocyte migration but have differential effects on B cell maturation and trafficking. We investigated their effects on peripheral blood (PB) and cerebrospinal fluid (CSF) B cell repertoires using next-generation deep sequencing. Paired CSF and PB B cell subsets (naïve, CD27+ memory, and CD27-IgD- double-negative B cells and plasmablasts) were collected by applying flow cytometry at baseline and after 6 months of treatment and their respective heavy-chain variable region repertoires assessed by Illumina MiSeq. Treatment with fingolimod contracted, whereas natalizumab expanded circulating PB B cells. CSF B cell numbers remained stable following fingolimod treatment but decreased with natalizumab therapy. Clonal overlap between CSF and PB B cells was reduced with natalizumab treatment but remained stable with fingolimod therapy. Lineage analyses of pre- and posttreatment CSF B cell repertoires revealed large, clonally expanded B cell clusters in natalizumab-treated MS patients but no intrathecal clonal expansion following fingolimod therapy. Our findings suggest that natalizumab diminishes the exchange of peripheral and intrathecal B cells without impacting intrathecal clonal expansion. In contrast, fingolimod treatment fails to alter blood-brain barrier B cell exchange but diminishes intrathecal clonal expansion. Sphingosine-1 phosphate receptor inhibition may alter intrathecal B cell biology in MS.
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Affiliation(s)
- M C Kowarik
- Department of Neurology & Stroke and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Neurology, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - D Astling
- Department of Biochemistry and Molecular Genetics, University of Colorado, 13001 East 17th Place, Aurora, Colorado, 80045, USA
| | - G Lepennetier
- Department of Neurology, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - A Ritchie
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, Colorado, 80045, USA
| | - B Hemmer
- Department of Neurology, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - G P Owens
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, Colorado, 80045, USA
| | - Jeffrey L Bennett
- Department of Neurology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, Colorado, 80045, USA.
- Department of Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, Colorado, 80045, USA.
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Kemmerer CL, Pernpeintner V, Ruschil C, Abdelhak A, Scholl M, Ziemann U, Krumbholz M, Hemmer B, Kowarik MC. Differential effects of disease modifying drugs on peripheral blood B cell subsets: A cross sectional study in multiple sclerosis patients treated with interferon-β, glatiramer acetate, dimethyl fumarate, fingolimod or natalizumab. PLoS One 2020; 15:e0235449. [PMID: 32716916 PMCID: PMC7384624 DOI: 10.1371/journal.pone.0235449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
Background Several disease modifying drugs (DMDs) have been approved for the treatment of multiple sclerosis (MS), however, little is known about their differential impact on peripheral blood (PB) B cell subsets. Methods We performed a cross sectional study on PB B cells in MS patients treated with interferon-β (n = 25), glatiramer acetate (n = 19), dimethyl fumarate (n = 15), fingolimod (n = 16) or natalizumab (n = 22), untreated MS patients (n = 20), and in patients with non-inflammatory neurological diseases (n = 12). Besides analyzing routine laboratory data, flow cytometry was performed to analyze naïve B cells (CD19+CD20+CD27-IgD+), non-class switched (CD19+CD20+CD27+IgD+) and class-switched memory B cells (CD19+CD20+CD27+IgD-), double negative B cells (CD19+CD20lowCD27-IgD-) and plasmablasts (CD19+CD20lowCD27+CD38++). Results Treatment associated changes were found for the overall B cell pool as well as for all B cell subsets. Natalizumab increased absolute numbers and percentage of all B cells mainly by expanding the memory B cell pool. Fingolimod decreased absolute numbers of all B cell subsets and the percentage of total B cells. Fingolimod, dimethyl fumarate and interferon-β treatments were associated with an increase in the fraction of naïve B cells while class switched and non-class switched memory B cells showed decreased percentages. Conclusion Our results highlight differential effects of DMDs on the PB B cell compartment. Across the examined treatments, a decreased percentage of memory B cells was found in dimethyl fumarate, interferon-β and fingolimod treated patients which might contribute to the drugs’ mode of action in MS. Further studies are necessary to decipher the exact role of B cell subsets during MS pathogenesis.
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Affiliation(s)
- C. L. Kemmerer
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - V. Pernpeintner
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - C. Ruschil
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - A. Abdelhak
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - M. Scholl
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - U. Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - M. Krumbholz
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - B. Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - M. C. Kowarik
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- * E-mail:
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Aly L, Havla J, Lepennetier G, Andlauer TFM, Sie C, Strauß EM, Hoshi MM, Kümpfel T, Hiltensperger M, Mitsdoerffer M, Mühlau M, Zimmer C, Hemmer B, Korn T, Knier B. Inner retinal layer thinning in radiologically isolated syndrome predicts conversion to multiple sclerosis. Eur J Neurol 2020; 27:2217-2224. [PMID: 32589804 DOI: 10.1111/ene.14416] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with radiologically isolated syndrome (RIS) are at increased risk of converting to multiple sclerosis (MS). Early identification of later converters is crucial for optimal treatment decisions. The purpose of this study was to assess the predictive potential of optical coherence tomography (OCT) measures in individuals with RIS regarding conversion to MS. METHODS This prospective observational cohort study included 36 individuals with RIS and 36 healthy controls recruited from two German MS centers. All individuals received baseline OCT and clinical examination and were longitudinally followed over up to 6 years. The primary outcome measure was the conversion to MS. RESULTS During clinical follow-up of 46 (26-58) months (median, 25%-75% interquartile range), eight individuals with RIS converted to MS. Individuals converting to MS showed a thinning of the peripapillary retinal nerve fiber layer (pRNFL) and the common ganglion cell and inner plexiform layer (GCIP) at baseline and during follow-up. Individuals with a pRNFL of 99 µm or lower or a GCIP of 1.99 mm3 or lower were at a 7.5- and 8.0-fold risk for MS conversion, respectively, compared to individuals with higher measures. After correction for other known risk factors, Cox proportional hazards regression revealed a hazard ratio of 1.08 for conversion to MS for each 1 µm decline in pRNFL. CONCLUSIONS Reduction of the pRNFL might be a novel and independent risk factor for conversion to MS in individuals with RIS. OCT might be useful for risk stratification and therapeutic decision-making in individuals with RIS.
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Affiliation(s)
- L Aly
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - J Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany
| | - G Lepennetier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - T F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Sie
- Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - E-M Strauß
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M-M Hoshi
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Marianne-Strauß-Klinik, Berg, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - M Hiltensperger
- Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M Mitsdoerffer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - T Korn
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Knier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
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7
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Grahl S, Bussas M, Pongratz V, Kirschke JS, Zimmer C, Berthele A, Hemmer B, Mühlau M. T1-Weighted Intensity Increase After a Single Administration of a Linear Gadolinium-Based Contrast Agent in Multiple Sclerosis. Clin Neuroradiol 2020; 31:235-243. [PMID: 32055874 PMCID: PMC7943513 DOI: 10.1007/s00062-020-00882-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
Purpose Through analysis of T1-weighted (T1w) images this study investigated gadolinium (Gd) deposition in the brain after administration of a linear (gadopentetic acid) and a cyclic (gadoteric acid) gadolinium-based contrast agent (GBCA) in patients with multiple sclerosis (MS), a disorder frequently requiring magnetic resonance imaging (MRI) scans over years. Methods A total of 3233 T1w images (unenhanced with respect to the same scanning session) of 881 MS patients were retrospectively analyzed. After spatial normalization and intensity scaling using a sphere within the pons, differences of all pairs of subsequent scans were calculated and attributed to either linear (n = 2718) or cyclic (n = 385) or no GBCA (n = 130) according to the first scan. Regional analyses were performed, focusing on the dentate nucleus, and whole brain analyses. By 1‑sample t‑tests, signal intensity increases within conditions were searched for; conditions were compared by 2‑sample t‑tests. Furthermore, recent hypotheses on the reversibility of GBCA deposition were tested. Results In the dentate nucleus, a significant increase was observed only after administration of linear GBCA even after a single GBCA administration. This increase differed significantly (p < 0.001) from the other conditions (cyclic and no GBCA). Whole brain analyses revealed T1w signal increases only after administration of linear GBCA within two regions, the dentate nucleus and globus pallidus. Additional analyses did not indicate any decline of Gd deposition in the brain. Conclusion The data point towards Gd deposition in the brain after administration of linear GBCA even after a single administration.
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Affiliation(s)
- S Grahl
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - M Bussas
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - V Pongratz
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - J S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - A Berthele
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - M Mühlau
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany. .,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.
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8
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Grahl S, Pongratz V, Schmidt P, Engl C, Bussas M, Radetz A, Gonzalez-Escamilla G, Groppa S, Zipp F, Lukas C, Kirschke J, Zimmer C, Hoshi M, Berthele A, Hemmer B, Mühlau M. Evidence for a white matter lesion size threshold to support the diagnosis of relapsing remitting multiple sclerosis. Mult Scler Relat Disord 2019; 29:124-129. [PMID: 30711877 DOI: 10.1016/j.msard.2019.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The number of white matter lesions (WML) in brain MRI is the most established paraclinical tool to support the diagnosis of multiple sclerosis (MS) and to monitor its course. Diagnostic criteria have stipulated a minimum detectable diameter of 3 mm per WML, although this threshold is not evidence-based. We aimed to provide a rationale for a WML size threshold for three-dimensional MRI sequences at 3 T by comparing patients with relapsing-remitting MS (RRMS) to control subjects (CS). METHODS We analyzed MR images from two cohorts, obtained at scanners from two different vendors, each comprising patients with RRMS and CS. Both cohorts were examined with FLAIR and T1w sequences. In total, 232 patients with RRMS (Expanded Disability Status Scale: mean = 1.6 ± 1.2; age: mean = 36 ± 10) as well as 116 age- and sex-matched CS were studied. We calculated odds ratios across WML volumes. The WML size threshold, which discriminated best between patients and CS, was estimated with receiver operating characteristic curve analysis. RESULTS In both cohorts, odds ratios increased continuously with increasing WML volumes, and discriminative power was highest at a WML size threshold corresponding to a diameter of about 3 mm. CONCLUSION The stipulated WML size threshold of 3 mm in diameter for the diagnostic criteria of MS seems a reasonable choice for three-dimensional MRI sequences at 3 T.
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Affiliation(s)
- S Grahl
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - V Pongratz
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - P Schmidt
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - C Engl
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - M Bussas
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - A Radetz
- Neurology, University Medical Centre of the Johannes Gutenberg University Mainz and Neuroimaging Center of the Focus Program Translational Neuroscience (FTN-NIC), Langenbeckstr. 1, 55131, Mainz, Germany
| | - G Gonzalez-Escamilla
- Neurology, University Medical Centre of the Johannes Gutenberg University Mainz and Neuroimaging Center of the Focus Program Translational Neuroscience (FTN-NIC), Langenbeckstr. 1, 55131, Mainz, Germany
| | - S Groppa
- Neurology, University Medical Centre of the Johannes Gutenberg University Mainz and Neuroimaging Center of the Focus Program Translational Neuroscience (FTN-NIC), Langenbeckstr. 1, 55131, Mainz, Germany; German Competence Network Multiple Sclerosis (KKNMS)
| | - F Zipp
- Neurology, University Medical Centre of the Johannes Gutenberg University Mainz and Neuroimaging Center of the Focus Program Translational Neuroscience (FTN-NIC), Langenbeckstr. 1, 55131, Mainz, Germany; German Competence Network Multiple Sclerosis (KKNMS)
| | - C Lukas
- German Competence Network Multiple Sclerosis (KKNMS); Diagnostic and Interventional Radiology and Nuclear Medicine, St Josef Hospital, Ruhr, University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - J Kirschke
- Department of Neuroradiology, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - M Hoshi
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - A Berthele
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany; German Competence Network Multiple Sclerosis (KKNMS); Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - M Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81541, Munich, Germany; German Competence Network Multiple Sclerosis (KKNMS).
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9
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Montalban X, Gold R, Thompson AJ, Otero‐Romero S, Amato MP, Chandraratna D, Clanet M, Comi G, Derfuss T, Fazekas F, Hartung HP, Havrdova E, Hemmer B, Kappos L, Liblau R, Lubetzki C, Marcus E, Miller DH, Olsson T, Pilling S, Selmaj K, Siva A, Sorensen PS, Sormani MP, Thalheim C, Wiendl H, Zipp F. ECTRIMS
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EAN
guideline on the pharmacological treatment of people with multiple sclerosis. Eur J Neurol 2018; 25:215-237. [DOI: 10.1111/ene.13536] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 01/21/2023]
Affiliation(s)
- X. Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat) Department of Neurology‐Neuroimmunology Vall d'Hebron University Hospital Barcelona Spain
| | - R. Gold
- Department of Neurology Ruhr University, St Josef‐Hospital Bochum Germany
| | - A. J. Thompson
- Department of Brain Repair and Rehabilitation Faculty of Brain Sciences University College London Institute of Neurology London UK
| | - S. Otero‐Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat) Department of Neurology‐Neuroimmunology Vall d'Hebron University Hospital Barcelona Spain
- Preventive Medicine and Epidemiology Department Vall d'Hebron University Hospital Barcelona Spain
| | - M. P. Amato
- Department NEUROFARBA Section Neurosciences University of Florence Florence Italy
| | | | - M. Clanet
- Department of Neurology Toulouse University Hospital Toulouse France
| | - G. Comi
- Neurological Department Institute of Experimental Neurology (INSPE) Scientific Institute Hospital San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - T. Derfuss
- Departments of Neurology and Biomedicine University Hospital Basel Basel Switzerland
| | - F. Fazekas
- Department of Neurology Medical University of Graz Graz Austria
| | - H. P. Hartung
- Department of Neurology Medical Faculty, Multiple Sclerosis Heinrich‐Heine‐University Düsseldorf Germany
| | - E. Havrdova
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - B. Hemmer
- Department of Neurology Klinikum Rechts der Isar Technische Universität München MunichGermany
- Munich Cluster for Systems Neurology (SyNergy) Munich Germany
| | - L. Kappos
- University Hospital Basel Basel Switzerland
| | - R. Liblau
- INSERM UMR U1043 – CNRS U5282 Centre de Physiopathologie de Toulouse Purpan Université de Toulouse, UPS ToulouseFrance
| | - C. Lubetzki
- ICM‐GHU Pitié‐Salpêtrière Sorbonne Universités UPMC Univ Paris 06, UMR_S 1127 Paris France
| | - E. Marcus
- Centre for Outcomes Research and Effectiveness (CORE) Research Department of Clinical, Educational and Health Psychology University College London LondonUK
| | - D. H. Miller
- NMR Research Unit Queen Square Multiple Sclerosis Centre University College London (UCL) Institute of Neurology London UK
| | - T. Olsson
- Neuroimmunology Unit Centre for Molecular Medicine, L8:04 Karolinska University Hospital (Solna) Stockholm Sweden
| | - S. Pilling
- Centre for Outcomes Research and Effectiveness (CORE) Research Department of Clinical, Educational and Health Psychology University College London LondonUK
| | - K. Selmaj
- Department of Neurology Medical University of Lodz Lodz Poland
| | - A. Siva
- Clinical Neuroimmunology Unit and MS Clinic Department of Neurology Cerrahpasa School of Medicine Istanbul University Istanbul Turkey
| | - P. S. Sorensen
- Danish Multiple Sclerosis Centre Department of Neurology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | | | - C. Thalheim
- European Multiple Sclerosis Platform (EMSP) Schaerbeek/Brussels Belgium
| | - H. Wiendl
- Department of Neurology University of Münster MünsterGermany
| | - F. Zipp
- Department of Neurology Focus Program Translational Neuroscience (FTN) and Immunology (FZI) Rhine‐Main Neuroscience Network (rmn2) University Medical Centre of the Johannes Gutenberg University Mainz Mainz Germany
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10
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Kaminski M, Grummel V, Hoffmann D, Berthele A, Hemmer B. The spectrum of aseptic central nervous system infections in southern Germany - demographic, clinical and laboratory findings. Eur J Neurol 2017. [PMID: 28636287 DOI: 10.1111/ene.13335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Aseptic infections of the central nervous system (CNS) are frequently observed in Germany. However, no study has systematically addressed the spectrum of aseptic CNS infections in Germany. METHODS Data on 191 adult patients diagnosed from January 2007 to December 2014 with aseptic meningitis or encephalitis/meningoencephalitis at our hospital were collected by chart review and analyzed for demographic, clinical and laboratory findings. Patients were stratified according to the causative virus and findings were compared between groups. RESULTS In our cohort, meningitis was caused in 36% by enterovirus (EV), 15% by herpes simplex virus (HSV), 12% by varicella zoster virus (VZV) and 5% by tick borne encephalitis (TBE). Encephalitis/meningoencephalitis was caused in 13% by HSV, 13% by VZV, and three out of 11 tested patients were positive for TBE. The highest incidence of EV infections was between 25 and 35 years and of HSV infections between 30 and 60 years. VZV infections had a bimodal distribution peaking below 30 and above 70 years. VZV and EV infections were more frequently observed during summer, whereas HSV infections showed no seasonal preference. Inflammatory changes in cerebrospinal fluid (CSF) were highest in HSV and lowest in EV infections. CONCLUSIONS Polymerase chain reaction tests for HSV, VZV and EV in CSF and TBE serology determined the causative virus in over 60% of tested patients. The age of affected patients, seasonal distribution, disease course and inflammatory changes in CSF differ between groups of patients affected by the most common viral infections.
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Affiliation(s)
- M Kaminski
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - V Grummel
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - D Hoffmann
- Institute of Virology, Technische Universität/Helmholtz Zentrum München, Munich, Germany
| | - A Berthele
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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11
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Klotz L, Berthele A, Brück W, Chan A, Flachenecker P, Gold R, Haghikia A, Hellwig K, Hemmer B, Hohlfeld R, Korn T, Kümpfel T, Lang M, Limmroth V, Linker RA, Meier U, Meuth SG, Paul F, Salmen A, Stangel M, Tackenberg B, Tumani H, Warnke C, Weber MS, Ziemssen T, Zipp F, Wiendl H. [Monitoring of blood parameters under course-modified MS therapy : Substance-specific relevance and current recommendations for action]. Nervenarzt 2017; 87:645-59. [PMID: 26927677 DOI: 10.1007/s00115-016-0077-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With the approval of various substances for the immunotherapy of multiple sclerosis (MS), treatment possibilities have improved significantly over the last few years. Indeed, the choice of individually tailored preparations and treatment monitoring for the treating doctor is becoming increasingly more complex. This is particularly applicable for monitoring for a treatment-induced compromise of the immune system. The following article by members of the German Multiple Sclerosis Skills Network (KKNMS) and the task force "Provision Structures and Therapeutics" summarizes the practical recommendations for approved immunotherapy for mild to moderate and for (highly) active courses of MS. The focus is on elucidating the substance-specific relevance of particular laboratory parameters with regard to the mechanism of action and the side effects profile. To enable appropriate action to be taken in clinical practice, any blood work changes that can be expected, in addition to any undesirable laboratory findings and their causes and relevance, should be elucidated.
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Affiliation(s)
- L Klotz
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - A Berthele
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - W Brück
- Institut für Neuropathologie, Universitätsmedizin Göttingen der Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - A Chan
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - P Flachenecker
- Neurologisches Rehabilitationszentrum Quellenhof in Bad Wildbad GmbH, Kuranlagenallee 2, 75323, Bad Wildbad, Deutschland
| | - R Gold
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - A Haghikia
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - K Hellwig
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - B Hemmer
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - R Hohlfeld
- Institut für Klinische Neuroimmunologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - T Korn
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - T Kümpfel
- Institut für Klinische Neuroimmunologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - M Lang
- NeuroTransConcept GmbH, Centers of Excellence, Pfauengasse 8, 89073, Ulm, Deutschland
| | - V Limmroth
- Klinik für Neurologie und Palliativmedizin, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109, Köln - Merheim, Deutschland
| | - R A Linker
- Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - U Meier
- Berufsverband Deutscher Neurologen BDN, Am Ziegelkamp 1f, 41515, Grevenbroich, Deutschland
| | - S G Meuth
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - F Paul
- Institut für Neuroimmunologie, Universitätsklinikum Charité, Schumannstr. 20/21, 10117, Berlin, Deutschland
| | - A Salmen
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - M Stangel
- Klinik für Neurologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - B Tackenberg
- Klinik für Neurologie, Philipps-Universität und Universitätsklinikum Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland
| | - H Tumani
- Neurologische Universitätsklinik der Universität Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland.,Fachklinik für Neurologie Dietenbronn, Dietenbronn 7, 88477, Schwendi, Deutschland
| | - C Warnke
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - M S Weber
- Institut für Neuropathologie, Universitätsmedizin Göttingen der Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - T Ziemssen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - F Zipp
- Klinik für Neurologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - H Wiendl
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
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12
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Giovannoni G, Arnold DL, Bar-Or A, de Seze J, Hemmer B, Montalban X, Rammohan K, Wolinsky J. OCRELIZUMAB IN PRIMARY PROGRESSIVE MS: THE ORATORIO STUDY. J Neurol Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Beer A, Biberacher V, Schmidt P, Righart R, Buck D, Berthele A, Kirschke J, Zimmer C, Hemmer B, Mühlau M. Tissue damage within normal appearing white matter in early multiple sclerosis: assessment by the ratio of T1- and T2-weighted MR image intensity. J Neurol 2016; 263:1495-502. [PMID: 27178000 DOI: 10.1007/s00415-016-8156-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/11/2016] [Accepted: 04/29/2016] [Indexed: 11/24/2022]
Abstract
Histopathological and magnetic resonance imaging (MRI) studies have shown white matter (WM) damage in early stages of multiple sclerosis (MS) beyond the apparent T2-hyperintense lesions. These changes in normal appearing WM (NAWM) are important with regard to the clinical picture and prognosis. However, the detection of changes within NAWM has so far required special imaging techniques commonly not available in clinical routine and, hence, at large scale. The purpose of this study was to detect MS-related damage of NAWM by conventional MRI. As, within NAWM, the myelin content mainly drives the T1-weighted (T1w) signal, we scaled it by the T2w signal. We tested the hypothesis that the mean T1w/T2w ratio of NAWM is decreased in MS compared to healthy controls (HC) and that it correlates with clinical measures. We developed a pipeline to determine the individual mean values of this ratio within NAWM. We studied 244 patients in early disease stages of MS (mean age 37 ± 10 years, mean disease duration 3.1 ± 2.3, Expanded Disability Status Scale 1.3 ± 1), and 78 HC (mean age 31 ± 8 years). Compared to HC, the mean T1w/T2w ratio was lowered in the patient group (P < 0.001). The difference remained significant after restricting the analysis to patients with a disease duration of 5 years or less and without disease modifying drugs. Our measures also correlated with clinical scores. We believe that the mean T1w/T2w ratio is a promising candidate to assess MS-related tissue damage within NAWM at large scale.
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Affiliation(s)
- A Beer
- Department of Neurology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - V Biberacher
- Department of Neurology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - P Schmidt
- Department of Neurology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Technische Universität München, Munich, Germany.,Department of Statistics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - R Righart
- Department of Neurology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - D Buck
- Department of Neurology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - A Berthele
- Department of Neurology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - J Kirschke
- Department of Neuroradiology, Technische Universität München, Munich, Germany
| | - C Zimmer
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany.,Department of Neuroradiology, Technische Universität München, Munich, Germany
| | - B Hemmer
- Department of Neurology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany
| | - M Mühlau
- Department of Neurology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Technische Universität München, Munich, Germany. .,Munich Cluster for Systems Neurology, Munich, Germany.
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14
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Lukas C, Gold R, Fiehler J, Siemonsen S, Kleine J, Zipp F, Hemmer B, Mühlau M. Ablagerung von gadoliniumhaltigen Kontrastmitteln im Gehirn nach mehrfacher Anwendung: Konsequenzen für den Einsatz der MRT bei Diagnosestellung und Verlaufsbeurteilung der Multiplen Sklerose? Akt Neurol 2016. [DOI: 10.1055/s-0042-102953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C. Lukas
- Institut für Diagnostische und Interventionelle Radiologie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum
| | - R. Gold
- Klinik für Neurologie, St. Josef Hospital, Universität Bochum, Bochum
| | - J. Fiehler
- Neuroradiologie, University Medical Center Hamburg-Eppendorf, Hamburg
| | - S. Siemonsen
- Neuroradiologie, University Medical Center Hamburg-Eppendorf, Hamburg
| | - J. Kleine
- Abteilung für Neuroradiologie, Technische Universität, München
| | - F. Zipp
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz
| | - B. Hemmer
- Abteilung für Neurologie, Technische Universität, München
| | - M. Mühlau
- Abteilung für Neurologie, Technische Universität, München
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15
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Selter R, Hemmer B. Fampridin ist ein therapeutischer Fortschritt – Pro. Akt Neurol 2015. [DOI: 10.1055/s-0035-1552710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R. Selter
- Klinikum rechts der Isar, Klinik für Neurologie, Technische Universität München, Ismaninger Str. 22, 81675 München
| | - B. Hemmer
- Klinikum rechts der Isar, Klinik für Neurologie, Technische Universität München, Ismaninger Str. 22, 81675 München
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16
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Kolber P, Luessi F, Meuth S, Klotz L, Korn T, Trebst C, Tackenberg B, Kieseier B, Kümpfel T, Fleischer V, Tumani H, Wildemann B, Lang M, Flachenecker P, Meier U, Brück W, Limmroth V, Haghikia A, Hartung HP, Stangel M, Hohlfeld R, Hemmer B, Gold R, Wiendl H, Zipp F. Aktuelles zur Therapieumstellung bei Multipler Sklerose. Nervenarzt 2015; 86:1236-47. [DOI: 10.1007/s00115-015-4368-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Hemmer B, Calabresi PA. Complex antibody profiling to predict clinical outcome in childhood ADS. Neurology 2014; 83:2200-1. [DOI: 10.1212/wnl.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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18
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Stuve O, Hartung H, Freedman M, Li D, Hemmer B, Kappos L, Rieckmann P, Montalban X, Ziemssen T, Selmaj K. Phase 2 BOLD extension study efficacy results for siponimod (BAF312) in patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2014. [DOI: 10.1016/j.msard.2014.09.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Affiliation(s)
- R. Gold
- Neurologische Klinik im St. Josef Hospital, Klinikum der Ruhr Universität Bochum
| | - H. Wiendl
- Westfälische-Wilhelms-Universität, Neurologische Klinik, Münster
| | - B. Hemmer
- Neurologische Klinik, Technische Universität, München
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20
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Rommer PS, Zettl UK, Kieseier B, Hartung HP, Menge T, Frohman E, Greenberg BM, Hemmer B, Stüve O. Requirement for safety monitoring for approved multiple sclerosis therapies: an overview. Clin Exp Immunol 2014; 175:397-407. [PMID: 24102425 DOI: 10.1111/cei.12206] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 12/12/2022] Open
Abstract
During the last two decades, treatment options for patients with multiple sclerosis (MS) have broadened tremendously. All agents that are currently approved for clinical use have potential side effects, and a careful risk-benefit evaluation is part of a decision algorithm to identify the optimal treatment choice for an individual patient. Whereas glatiramer acetate and interferon beta preparations have been used in MS for decades and have a proven safety record, more recently approved drugs appear to be more effective, but potential risks might be more severe. The potential complications of some novel therapies might not even have been identified to their full extent. This review is aimed at the clinical neurologist in that it offers insights into potential adverse events of each of the approved MS therapeutics: interferon beta, glatiramer acetate, mitoxantrone, natalizumab, fingolimod and teriflunomide, as well as recently approved therapeutics such as dimethyl fumarate and alemtuzumab. It also provides recommendations for monitoring the different drugs during therapy in order to avoid common side effects.
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Affiliation(s)
- P S Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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21
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Kappos L, Edan G, Freedman M, Montalbán X, Miller D, Polman C, Hartung HP, Hemmer B, Fox E, Barkhof F, Schippling S, Lanius V, Hermann J, Pohl C, Sandbrink R, Wicklein EM, Pleimes D. Benefit 11: Long-term follow-up study of patients with clinically isolated syndrome treated with interferon beta-1b. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Krogias C, Tsivgoulis G, Grond M, Hartung H, Hemmer B, Oertel W, Wiendl H, Gold R. Übersicht und Analyse internationaler Fall-Kontroll-Studien zu „Chronischen zerebrospinalen venösen Insuffizienz“ (CCSVI) und Multipler Sklerose. Akt Neurol 2013. [DOI: 10.1055/s-0033-1351271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- C. Krogias
- Neurologische Klinik, St. Josef-Hospital Bochum, Ruhr-Universität Bochum
| | - G. Tsivgoulis
- Klinik für Neurologie, „Attikon“ Hospital, Universität Athen, Griechenland
| | - M. Grond
- Klinik für Neurologie, Kreisklinikum Siegen
| | - H. Hartung
- Neurologische Klinik, Heinrich-Heine Universität Düsseldorf
| | - B. Hemmer
- Neurologische Klinik, Klinikum rechts der Isar, Technische Universität München
| | - W. Oertel
- Klinik für Neurologie, Philipps-Universität Marburg
| | - H. Wiendl
- Klinik für Neurologie, Universitätsklinikum Münster
| | - R. Gold
- Neurologische Klinik, St. Josef-Hospital Bochum, Ruhr-Universität Bochum
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23
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24
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Havla J, Berthele A, Kümpfel T, Krumbholz M, Jochim A, Kronsbein H, Ryschkewitsch C, Jensen P, Lippmann K, Hemmer B, Major E, Hohlfeld R. Co-occurrence of two cases of progressive multifocal leukoencephalopathy in a natalizumab "infusion group". Mult Scler 2012; 19:1213-5. [PMID: 23124790 DOI: 10.1177/1352458512466165] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We observed two cases of progressive multifocal leukoencephalopathy (PML) that occurred in the same "infusion group". The group consisted of four patients with relapsing-remitting multiple sclerosis (RRMS) who had been treated with natalizumab (NAT) in the same medical practice for more than four years at the same times and in the same room, raising concerns about viral transmission between members of the infusion group. DNA amplification and sequence comparison of the non-coding control region (NCCR) of JC virus (JCV) present in cerebrospinal fluid (CSF) samples from PML patients #1 and #2 revealed that the amplified JCV sequences differed from the JCV archetype. The NCRR of the viral DNA was unique to each patient, arguing against the possibility of viral transmission between patients. Statistical considerations predict that similar co-occurrences of PML are likely to happen in the future.
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Affiliation(s)
- J Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Germany
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Klotz L, Gold R, Hemmer B, Korn T, Zipp F, Hohlfeld R, Kieseier BC, Wiendl H. [Diagnosis of multiple sclerosis 2010 revision of the McDonald criteria]. Nervenarzt 2012; 82:1302-9. [PMID: 21681517 DOI: 10.1007/s00115-011-3283-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Knier B, Boeckh-Behrens T, Murgan I, Wörtler K, Hemmer B, Winkelmann J. [Crowned dens syndrome: a rare differential diagnosis of acute neck pain]. Nervenarzt 2012; 83:1308-11. [PMID: 22843028 DOI: 10.1007/s00115-012-3599-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gold R, Hemmer B. Interferon β-1b in Klinik und Praxis. Akt Neurol 2012. [DOI: 10.1055/s-0032-1304859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- R. Gold
- Klinik für Neurologie am St. Josefs-Hospital, Klinikum der Ruhr-Universität Bochum
| | - B. Hemmer
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München
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Hertzenberg D, Lehmann-Horn K, LaLive P, Bernard C, Zamvil S, Hemmer B, Weber M. Glatiramer Acetate Complements Anti-CD20-Mediated B-Cell Depletion in Treatment of CNS Autoimmune Disease (P04.124). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Stuve O, Selmaj K, Li D, Hartung HP, Hemmer B, Kappos L, Freedman M, Rieckmann P, Montalban X, Zhang Auberson L, Pohlmann H, Mercier F, Dahlke F, Wallstrom E. BAF312, a Selective Sphingosine-1-Phosphate Receptor Modulator Improves MRI and Clinical Outcomes in Relapsing-Remitting Multiple Sclerosis (RRMS) (S30.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Seifert C, Sprenger T, Mucke T, Forschler A, Poppert H, Hemmer B, Sellner J. Is Systemic Thrombolysis Justified in Patients with Ischemic Stroke and Recent Dental Extraction? (P03.009). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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31
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Buck D, Albrecht E, Aslam M, Hauenstein N, Jochim A, Cepok S, Grummel V, Berthele A, Lichtner P, Gieger C, Winkelmann J, Hemmer B. Genetic Determinants of IgG Synthesis in the Cerebrospinal Fluid of Patients with Multiple Sclerosis (S20.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s20.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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32
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Zepper P, Wunderlich S, Förschler A, Nadas K, Hemmer B, Sellner J. Pearls & Oy-sters: cerebral HSV-2 vasculitis presenting as hemorrhagic stroke followed by multifocal ischemia. Neurology 2012; 78:e12-5. [PMID: 22249502 DOI: 10.1212/wnl.0b013e31823fcd4d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- P Zepper
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Castrop F, Kowarik MC, Albrecht H, Krause M, Haslinger B, Zimmer C, Berthele A, Hemmer B. Severe multiple sclerosis relapse under fingolimod therapy: incident or coincidence? Neurology 2012; 78:928-30. [PMID: 22402856 DOI: 10.1212/wnl.0b013e31824c46ad] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F Castrop
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Sander K, Poppert H, Etgen T, Hemmer B, Sander D. Dynamics of intracranial venous flow patterns in patients with idiopathic intracranial hypertension. Eur Neurol 2011; 66:334-8. [PMID: 22086254 DOI: 10.1159/000331002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 07/04/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the dynamics of intracranial venous flow patterns in patients with idiopathic intracranial hypertension (IIH). METHODS Nonrandomized controlled trial analyzing the difference in cerebral perfusion in 13 IIH patients and 12 healthy controls using contrast-enhanced duplex sonography. In patients, an additional 3D gradient echo magnetic resonance venography (MRV) using a new technique was performed to quantify stenosis of the cerebral sinus. The cerebral perfusion parameters, including cerebral transit time (CTT) and time to peak (TTP), were analyzed. RESULTS IIH patients had a higher BMI (29.3 [95% CI 26.4, 32.2] vs. 23.3 [95% CI 20.7, 25.9], p = 0.003) and an increased prevalence of headache, but all other clinical characteristics were comparable. The CTT did not differ significantly. The TTP was significantly longer in IIH patients compared to controls (8.5 [95% CI 7.6, 9.4] vs. 7.3 s [95% CI 6.3, 8.1], p = 0.04). Twelve of 13 (92%) IIH patients showed stenosis of the cerebral sinus. CONCLUSIONS Our study is the first to report an altered cerebral venous flow in IIH patients compared to controls using a dynamic ultrasonographic technique. A simplified MRV technique confirms the high prevalence and reliable detection of venous stenosis in IIH patients.
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Affiliation(s)
- K Sander
- Department of Neurology, Technische Universität München, Munich, Germany.
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Pellkofer HL, Krumbholz M, Berthele A, Hemmer B, Gerdes LA, Havla J, Bittner R, Canis M, Meinl E, Hohlfeld R, Kuempfel T. Long-term follow-up of patients with neuromyelitis optica after repeated therapy with rituximab. Neurology 2011; 76:1310-5. [PMID: 21482945 DOI: 10.1212/wnl.0b013e3182152881] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Neuromyelitis optica (NMO) is a severe autoimmune disease targeting optic nerves and spinal cord. The monoclonal anti-CD20 B-cell antibody rituximab is an emerging therapeutic option in NMO. However, neither long-term efficacy or safety of rituximab, nor the correlation between B-cell counts, B-cell fostering cytokines, aquaporin-4 antibodies (AQP4-ab), and disease activity in NMO, have been investigated prospectively. METHODS We performed a prospective long-term cohort study of 10 patients with NMO who were treated up to 5 times with rituximab as a second-line therapy. Clinical examinations, B-cell counts, and serum concentrations of BAFF (B-cell activating factor of the TNF family; also called TNFSF13b), APRIL (a proliferation-inducing ligand; also called TNFSF13), AQP4-ab, and immunoglobulin levels were measured every 3 months. RESULTS Repeated treatment with rituximab led to sustained clinical stabilization in most patients with NMO. Disease activity correlated with B-cell depletion, but not clearly with AQP4-ab or levels of APRIL. BAFF levels increased after application of rituximab and indicated persisting efficacy of the drug but did not correlate with disease activity. Overall, rituximab was well-tolerated even after up to 5 consecutive treatment courses; however, we observed several severe adverse reactions. CONCLUSION Our data indicate that long-term therapy with rituximab is effective in NMO as a second-line therapy and has an acceptable safety profile. Retreatment with rituximab should be applied before reappearance of circulating B cells. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that repeated doses of rituximab result in stabilization in most patients.
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Affiliation(s)
- H L Pellkofer
- Institute of Clinical Neuroimmunology, Ludwig Maximilians University, D-81377 Munich, Germany.
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Nischwitz S, Cepok S, Kroner A, Wolf C, Knop M, Müller-Sarnowski F, Pfister H, Rieckmann P, Hemmer B, Ising M, Uhr M, Bettecken T, Holsboer F, Müller-Myhsok B, Weber F. More CLEC16A gene variants associated with multiple sclerosis. Acta Neurol Scand 2011; 123:400-6. [PMID: 20849399 DOI: 10.1111/j.1600-0404.2010.01421.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Recently, associations of several single-nucleotide polymorphisms (SNPs) within the CLEC16A gene with multiple sclerosis (MS), type-I diabetes, and primary adrenal insufficiency were reported. METHODS We performed linkage disequilibrium (LD) fine mapping with 31 SNPs from this gene, searching for the region of highest association with MS in a German sample consisting of 603 patients and 825 controls. RESULTS Four SNPs located in intron 19 of the CLEC16A gene were found associated. We could replicate the finding for SNP rs725613 and were able to show for the first time the association of rs2041670, rs2080272 and rs998592 with MS. CONCLUSION All described base polymorphisms are mapping to one LD block of approximately 50 kb within intron 19 of the CLEC16A gene, suggesting a pivotal role of this region for susceptibility of MS and possibly also for other autoimmune diseases.
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Affiliation(s)
- S Nischwitz
- Max Planck Institute of Psychiatry, Munich, Germany.
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Kowarik MC, Pellkofer HL, Cepok S, Korn T, Kümpfel T, Buck D, Hohlfeld R, Berthele A, Hemmer B. Differential effects of fingolimod (FTY720) on immune cells in the CSF and blood of patients with MS. Neurology 2011; 76:1214-21. [PMID: 21464424 DOI: 10.1212/wnl.0b013e3182143564] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The oral immunomodulator fingolimod (FTY720) has recently been shown to be highly effective in relapsing-remitting multiple sclerosis (MS). Fingolimod is a functional antagonist of the sphingosine-1-phosphate receptor 1 and thereby inhibits sphingosine-1-phosphate-dependent lymphocyte egress from secondary lymphoid tissues, resulting in a pronounced lymphopenia in the peripheral blood. The effects of fingolimod treatment on the CSF of patients with MS have not been studied so far. METHODS We analyzed the leukocyte count, albumin quotient, immunoglobulin G (IgG) index, and oligoclonal bands in the CSF of fingolimod-treated patients with MS. Moreover, we performed immunophenotyping of CSF and peripheral blood leukocytes by flow cytometry. The results were compared to those from treatment-naive or natalizumab-treated patients with MS and patients with other inflammatory and noninflammatory neurologic diseases. RESULTS Fingolimod therapy significantly decreased CSF leukocyte counts, but had little impact on the extent of intrathecal IgG synthesis and presence of oligoclonal bands in the CSF. Fingolimod decreased the proportion of CSF CD4+ T cells but to a lesser extent than in the peripheral blood. While fingolimod strongly reduced B cells in the periphery, it had little impact on B cells in the CSF. The percentage of CSF CD8+ T cells, NK cells, and monocytes increased compared to treatment-naive patients. The CD4+/CD8+ T-cell ratio in CSF reversed in most of the patients. CONCLUSION Fingolimod treatment has a profound impact on CSF, which to some extent differs from the peripheral effects of the drug.
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Affiliation(s)
- M C Kowarik
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Weber F, Cepok S, Wolf C, Berthele A, Uhr M, Bettecken T, Buck D, Hartung HP, Holsboer F, Müller-Myhsok B, Hemmer B. Single-nucleotide polymorphisms in HLA- and non-HLA genes associated with the development of antibodies to interferon-β therapy in multiple sclerosis patients. Pharmacogenomics J 2011; 12:238-45. [PMID: 21502966 DOI: 10.1038/tpj.2011.14] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Interferons-β (IFN-β) are the most widely used immunomodulatory drugs for treatment of multiple sclerosis (MS). The development of neutralizing antibodies (NABs) against IFN-β is one of the main reasons for treatment failure. While formulation of the drug has a proven impact on the development of NABs, the genetic predisposition to develop antibodies is poorly understood. We performed genome-wide single-nucleotide polymorphism (SNP) genotyping in 362 MS patients of whom 178 had developed and 184 had not developed antibodies on IFN-β therapy. Four candidate SNPs were validated in an independent cohort of 350 antibody-positive and 468 antibody-negative MS patients. One SNP within the human leucocyte antigen (HLA) region (rs9272105, P-value: 3.56 × 10⁻¹⁰) and one SNP in an intergenic region on chromosome 8q24.3 (rs4961252, P-value: 2.92 × 10⁻⁸ showed a genome-wide significant association with the anti-IFN-β antibody titers. We found no interaction between the genome-wide significant SNPs (rs9272105 and rs4961252) in our study and the previously described HLA-DR*0401 or *0408 alleles, indicating an additive effect of SNPs and HLA alleles. Testing for these SNPs and the HLA-DR*0401 or *0408 alleles allows to identify patients at risk to develop antibodies to IFN-β and may provide helpful information for individual treatment decisions.
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Affiliation(s)
- F Weber
- Max Planck Institute of Psychiatry, Munich, Germany
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Kraus V, Leiz S, Burdach S, Baethmann M, Makowski C, Strotmann P, Hemmer B. Plasmapheresis therapy in children with inflammatory demyelinating disorders of the CNS. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Feurer R, Sadikovic S, Sepp D, Esposito L, Schleef M, Bockelbrink A, Schwarze J, Hemmer B, Sander D, Poppert H. Patent foramen ovale is not associated with an increased risk of stroke recurrence. Eur J Neurol 2011; 17:1339-45. [PMID: 20412294 DOI: 10.1111/j.1468-1331.2010.03015.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Despite numerous studies suggesting a relationship between paradoxical embolism from a patent foramen ovale (PFO) and stroke, the role of PFO as a risk factor for cerebral ischaemia remains controversial. We therefore sought to determine the association between a RLS detected by contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and recurrent stroke in an unselected population sample. METHODS We analyzed the records of 763 patients with diagnosis of cerebral ischaemia at our institution. All patients had undergone TCD-based detection of RLS. Embolic signals have been measured both under resting conditions and after performing a Valsalva maneuver. For follow-up, all patients were contacted by mail, which included a standardized questionnaire. Endpoints of follow-up were defined as recurrence of cerebral ischaemia, occurrence of myocardial infarction or death from any cause. RESULTS Follow-up data were available in 639 patients (83.7%). At baseline, a RLS was detected in 140 (28%) men and in 114 (42%) women. Ten shunt-carriers (1.6%) and 32 patients (5.0%) without RLS had suffered a recurrent stroke. After adjustment for age, sex, and atrial fibrillation, the hazard ratio of RLS for stroke recurrence was 0.86 (95% CI 0.41-1.79). The condition of RLS at rest adjusted for age, sex, stroke subtype, and cardiovascular risk factors was not found to increase the risk of stroke substantially (HR 1.16 [95% CI 0.41-3.29]) CONCLUSION Our data suggest that the risk of recurrent stroke in subjects with PFO is not significantly increased in comparison with subject without it.
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Affiliation(s)
- R Feurer
- Department of Neurology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
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Dinkel A, Hausteiner C, Hoshi M, Hemmer B, Henningsen P. Progredienzangst und psychischer Distress bei Multipler Sklerose. Psychother Psych Med 2011. [DOI: 10.1055/s-0031-1272367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dinkel A, Hausteiner C, Hoshi M, Hemmer B, Henningsen P. Fatigue bei Multipler Sklerose. Psychother Psych Med 2011. [DOI: 10.1055/s-0031-1272366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Esposito L, Saam T, Heider P, Bockelbrink A, Pelisek J, Sepp D, Feurer R, Winkler C, Liebig T, Holzer K, Pauly O, Sadikovic S, Hemmer B, Poppert H. MRI plaque imaging reveals high-risk carotid plaques especially in diabetic patients irrespective of the degree of stenosis. BMC Med Imaging 2010; 10:27. [PMID: 21118504 PMCID: PMC3004802 DOI: 10.1186/1471-2342-10-27] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 11/30/2010] [Indexed: 12/03/2022] Open
Abstract
Background Plaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis. It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Type 2 diabetes mellitus (DM 2) represents a known risk factor for atherosclerosis, but its specific influence on plaque vulnerability is not fully understood. This study investigates whether MRI-plaque imaging can reveal differences in carotid plaque features of diabetic patients compared to nondiabetics. Methods 191 patients with moderate to high-grade carotid artery stenosis were enrolled after written informed consent was obtained. Each patient underwent MRI-plaque imaging using a 1.5-T scanner with phased-array carotid coils. The carotid plaques were classified as lesion types I-VIII according to the MRI-modified AHA criteria. For 36 patients histology data was available. Results Eleven patients were excluded because of insufficient MR-image quality. DM 2 was diagnosed in 51 patients (28.3%). Concordance between histology and MRI-classification was 91.7% (33/36) and showed a Cohen's kappa value of 0.81 with a 95% CI of 0.98-1.15. MRI-defined high-risk lesion types were overrepresented in diabetic patients (n = 29; 56.8%). Multiple logistic regression analysis revealed association between DM 2 and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15-5.81]), independent of the degree of stenosis. Conclusion DM 2 seems to represent a predictor for the development of vulnerable carotid plaques irrespective of the degree of stenosis and other risk factors. MRI-plaque imaging represents a new tool for risk stratification of diabetic patients. See Commentary: http://www.biomedcentral.com/1741-7015/8/78/abstract
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Affiliation(s)
- L Esposito
- Department of Neurology, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
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Chan A, Decard BF, Franke C, Grummel V, Zhou D, Schottstedt V, Toyka KV, Hemmer B, Gold R. Serum antibodies to conformational and linear epitopes of myelin oligodendrocyte glycoprotein are not elevated in the preclinical phase of multiple sclerosis. Mult Scler 2010; 16:1189-92. [DOI: 10.1177/1352458510376406] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: The proposed predictive value of serum anti-myelin antibodies for the development of multiple sclerosis after a first clinically isolated syndrome was recently challenged. Objective: To investigate myelin autoantibodies before first disease manifestation using different detection methods. Methods: Patients with multiple sclerosis who had donated blood at a time prior to development of clinically isolated syndrome were identified via the German National Multiple Sclerosis Society. Control sera were obtained from age- and gender-matched blood donors. IgG-/IgM-antibodies against the extracellular part of native, cell surface-expressed myelin oligodendrocyte glycoprotein were detected by flow cytometry. Antibodies against linear epitopes were identified by immunoblot using recombinant myelin oligodendrocyte glycoprotein (aa1-125) and human myelin basic protein preparations. Results: Fifty eight serum samples from 25 patients covering an interval of 7.3 years—2 months prior to disease onset were available. Longitudinal investigations were performed in 19 patients (2—14 samples per patient, 7 years—2 months prior to disease onset). No significant differences in the prevalence or titres of anti-myelin antibodies were detected between sera of preclinical individuals and healthy donors by either flow cytometry or immunoblot. There was no correlation between interval before clinically isolated syndrome and autoantibody status. Occurrence of antibodies was not associated with symptomatology/severity of clinically isolated syndrome. Conclusion: Neither anti-myelin autoantibodies against cell surface-expressed native myelin oligodendrocyte glycoprotein nor against linear epitopes have a predictive or discriminative role during the preclinical disease phase for developing clinically isolated syndrome or multiple sclerosis later in life.
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Affiliation(s)
- A. Chan
- Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany
| | - BF Decard
- Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany
| | - C. Franke
- Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany, Institute for MS Research, Medical Faculty, University of Göttingen and Gemeinnützige Hertie Stiftung, Göttingen, Germany
| | - V. Grummel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - D. Zhou
- Department of Neurology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - V. Schottstedt
- German Red Cross Blood Transfusion Service West, Central Laboratory, Hagen, Germany
| | - KV Toyka
- Department of Neurology, Clinical Research Group for Multiple Sclerosis and Neuroimmunology, University of Würzburg, Germany
| | - B. Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität, Munich, Germany,
| | - R. Gold
- Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany,
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Sellner J, Boggild M, Clanet M, Hintzen RQ, Illes Z, Montalban X, Du Pasquier RA, Polman CH, Sorensen PS, Hemmer B. EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol 2010; 17:1019-32. [PMID: 20528913 DOI: 10.1111/j.1468-1331.2010.03066.x] [Citation(s) in RCA: 293] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Neuromyelitis optica (NMO) or Devic's disease is a rare inflammatory and demyelinating autoimmune disorder of the central nervous system (CNS) characterized by recurrent attacks of optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM), which is distinct from multiple sclerosis (MS). The guidelines are designed to provide guidance for best clinical practice based on the current state of clinical and scientific knowledge. SEARCH STRATEGY Evidence for this guideline was collected by searches for original articles, case reports and meta-analyses in the MEDLINE and Cochrane databases. In addition, clinical practice guidelines of professional neurological and rheumatological organizations were studied. RESULTS Different diagnostic criteria for NMO diagnosis [Wingerchuk et al. Revised NMO criteria, 2006 and Miller et al. National Multiple Sclerosis Society (NMSS) task force criteria, 2008] and features potentially indicative of NMO facilitate the diagnosis. In addition, guidance for the work-up and diagnosis of spatially limited NMO spectrum disorders is provided by the task force. Due to lack of studies fulfilling requirement for the highest levels of evidence, the task force suggests concepts for treatment of acute exacerbations and attack prevention based on expert opinion. CONCLUSIONS Studies on diagnosis and management of NMO fulfilling requirements for the highest levels of evidence (class I-III rating) are limited, and diagnostic and therapeutic concepts based on expert opinion and consensus of the task force members were assembled for this guideline.
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Affiliation(s)
- J Sellner
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
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Selter RC, Brilot F, Grummel V, Kraus V, Cepok S, Dale RC, Hemmer B. Antibody responses to EBV and native MOG in pediatric inflammatory demyelinating CNS diseases. Neurology 2010; 74:1711-5. [DOI: 10.1212/wnl.0b013e3181e04096] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sargsyan SA, Shearer AJ, Ritchie AM, Burgoon MP, Anderson S, Hemmer B, Stadelmann C, Gattenlöhner S, Owens GP, Gilden D, Bennett JL. Absence of Epstein-Barr virus in the brain and CSF of patients with multiple sclerosis. Neurology 2010; 74:1127-35. [PMID: 20220124 DOI: 10.1212/wnl.0b013e3181d865a1] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Epstein-Barr virus (EBV) is a ubiquitous human herpesvirus that becomes latent in B-lymphocytes and has been implicated in the pathogenesis of multiple sclerosis (MS). We searched for latent and active EBV infection in MS brain and CSF. METHODS Nested and non-nested real-time PCR were used to detect cell-specific and EBV-specific transcripts in 15 fresh-frozen and 5 formalin-fixed paraffin-embedded MS plaques and in single MS CSF B-lymphocytes and plasma cells. Intrathecal anti-EBV antibody synthesis was measured by ELISA. Immunocytochemistry was used to detect binding of MS CSF and recombinant antibodies (rAbs) generated from clonally expanded plasma cells in MS CSF to EBV-infected cells. RESULTS No EBV RNA was found in MS CSF B-lymphocytes or plasma cells. In active MS plaques, EBV-encoded RNA (EBER)-1 was the only and rarely detected transcript. The frequency of detected intrathecal anti-EBV antibody synthesis in patients with MS did not differ from that in non-MS inflammatory CNS disease control patients. Anti-EBV antibodies were detected in the CSF of patients with MS, but MS rAbs did not react with EBV. CONCLUSIONS Application of real-time PCR to multiple sclerosis brain and single B-lymphocytes in CSF did not reveal any evidence of active Epstein-Barr virus infection.
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Affiliation(s)
- S A Sargsyan
- Department of Neurology,University of Colorado Denver School of Medicine, Aurora, CO 80045, USA
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Teunissen CE, Tumani HT, Bennett JL, Berven FS, Brundin L, Comabella M, Franciotta D, Federiksen JL, Fleming JO, Furlan R, Hintzen RQ, Hughes SG, Johnson MH, Krasulova E, Kuhle J, Magnone MC, Petzold A, Rajda C, Rejdak K, Schmidt HK, van Pesch V, Waubant E, Wolf C, Hemmer B, Deisenhammer F, Giovannoni G. Short commentary on ‘a consensus protocol for the standardization of cerebrospinal fluid collection and biobanking’. Mult Scler 2009; 16:129-32. [DOI: 10.1177/1352458509356368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- CE Teunissen
- Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands,
| | - HT Tumani
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | - JL Bennett
- Departments of Neurology & Ophthalmology, University of Colorado, Denver, Aurora, CO, USA
| | - FS Berven
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - L. Brundin
- Department Clinical Neuroscience, div Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - M. Comabella
- Neurology, Centre d'Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D. Franciotta
- Laboratory of Neuroimmunology, IRCCS, 'C. Mondino Neurological Institute' , Pavia, Italy
| | - JL Federiksen
- Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | - JO Fleming
- Department of Neurology, University of Wisconsin, Madison, WI, USA
| | - R. Furlan
- Neuroimmunology Unit, Institute of Experimental Neurology 'San Raffaele Scientific Institute, Milan, Italy
| | - RQ Hintzen
- Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - SG Hughes
- Medical Research, Biogen Idec, Maidenhead, UK
| | - MH Johnson
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E. Krasulova
- Department of Neurology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - J. Kuhle
- Neurology and Clinical Neuroimmunology, University Hospital, University of Basel, Basel, Switzerland
| | - Maria-Chiara Magnone
- Clinical Research and Exploratory Development, F. Hoffmann - La Roche Pharma, Basel, Switzerland
| | - A. Petzold
- Department of Neuroimmunology, Institute of Neurology, UCL, London, UK
| | - C. Rajda
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - K. Rejdak
- Neurology, Medical University of Lublin, Poland/Experimental Pharmacology, Medical Research Center, Warsaw, Poland
| | - HK Schmidt
- Accelerated Cure Project for Multiple Sclerosis, Waltham, MA, USA
| | - V. van Pesch
- Neurology Department UCL, Université Catholique de Louvain, Louvain, Belgium
| | - E. Waubant
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - C. Wolf
- Clinical Development, UCB Pharma SA, Braine l'Alleud, Belgium
| | - B. Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - F. Deisenhammer
- Department of Clinical Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - G. Giovannoni
- Queen Mary University of London, Neuroimmunology Unit, Neuroscience & Trauma Centre, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK
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Teunissen CE, Petzold A, Bennett JL, Berven FS, Brundin L, Comabella M, Franciotta D, Frederiksen JL, Fleming JO, Furlan R, Hintzen RQ, Hughes SG, Johnson MH, Krasulova E, Kuhle J, Magnone MC, Rajda C, Rejdak K, Schmidt HK, van Pesch V, Waubant E, Wolf C, Giovannoni G, Hemmer B, Tumani H, Deisenhammer F. A consensus protocol for the standardization of cerebrospinal fluid collection and biobanking. Neurology 2009; 73:1914-22. [PMID: 19949037 DOI: 10.1212/wnl.0b013e3181c47cc2] [Citation(s) in RCA: 553] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There is a long history of research into body fluid biomarkers in neurodegenerative and neuroinflammatory diseases. However, only a few biomarkers in CSF are being used in clinical practice. One of the most critical factors in CSF biomarker research is the inadequate powering of studies because of the lack of sufficient samples that can be obtained in single-center studies. Therefore, collaboration between investigators is needed to establish large biobanks of well-defined samples. Standardized protocols for biobanking are a prerequisite to ensure that the statistical power gained by increasing the numbers of CSF samples is not compromised by preanalytical factors. Here, a consensus report on recommendations for CSF collection and biobanking is presented, formed by the BioMS-eu network for CSF biomarker research in multiple sclerosis. We focus on CSF collection procedures, preanalytical factors, and high-quality clinical and paraclinical information. The biobanking protocols are applicable for CSF biobanks for research targeting any neurologic disease.
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Affiliation(s)
- C E Teunissen
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands.
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Feurer R, Sadikovic S, Esposito L, Schwarze J, Bockelbrink A, Hemmer B, Sander D, Poppert H. Lesion patterns in patients with cryptogenic stroke with and without right-to-left-shunt. Eur J Neurol 2009; 16:1077-82. [DOI: 10.1111/j.1468-1331.2009.02692.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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