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Müller A, Hebben F, Dillen K, Dunkl V, Goereci Y, Voltz R, Löcherbach P, Warnke C, Golla H. "So at least now I know how to deal with things myself, what I can do if it gets really bad again"-experiences with a long-term cross-sectoral advocacy care and case management for severe multiple sclerosis: a qualitative study. BMC Health Serv Res 2024; 24:453. [PMID: 38600493 PMCID: PMC11007872 DOI: 10.1186/s12913-024-10851-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Persons with severe Multiple Sclerosis (PwsMS) face complex needs and daily limitations that make it challenging to receive optimal care. The implementation and coordination of health care, social services, and support in financial affairs can be particularly time consuming and burdensome for both PwsMS and caregivers. Care and case management (CCM) helps ensure optimal individual care as well as care at a higher-level. The goal of the current qualitative study was to determine the experiences of PwsMS, caregivers and health care specialists (HCSs) with the CCM. METHODS In the current qualitative sub study, as part of a larger trial, in-depth semi-structured interviews with PwsMS, caregivers and HCSs who had been in contact with the CCM were conducted between 02/2022 and 01/2023. Data was transcribed, pseudonymized, tested for saturation and analyzed using structuring content analysis according to Kuckartz. Sociodemographic and interview characteristics were analyzed descriptively. RESULTS Thirteen PwsMS, 12 caregivers and 10 HCSs completed interviews. Main categories of CCM functions were derived deductively: (1) gatekeeper function, (2) broker function, (3) advocacy function, (4) outlook on CCM in standard care. Subcategories were then derived inductively from the interview material. 852 segments were coded. Participants appreciated the CCM as a continuous and objective contact person, a person of trust (92 codes), a competent source of information and advice (on MS) (68 codes) and comprehensive cross-insurance support (128 codes), relieving and supporting PwsMS, their caregivers and HCSs (67 codes). CONCLUSIONS Through the cross-sectoral continuous support in health-related, social, financial and everyday bureaucratic matters, the CCM provides comprehensive and overriding support and relief for PwsMS, caregivers and HCSs. This intervention bears the potential to be fine-tuned and applied to similar complex patient groups. TRIAL REGISTRATION The study was approved by the Ethics Committee of the University of Cologne (#20-1436), registered at the German Register for Clinical Studies (DRKS00022771) and in accordance with the Declaration of Helsinki.
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Affiliation(s)
- Anne Müller
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Fabian Hebben
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Kim Dillen
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Center for Health Services Research, University of Cologne, Cologne, Germany
| | - Peter Löcherbach
- German Society of Care and Case Management E.V. (DGCC), Münster, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Kümpfel T, Giglhuber K, Aktas O, Ayzenberg I, Bellmann-Strobl J, Häußler V, Havla J, Hellwig K, Hümmert MW, Jarius S, Kleiter I, Klotz L, Krumbholz M, Paul F, Ringelstein M, Ruprecht K, Senel M, Stellmann JP, Bergh FT, Trebst C, Tumani H, Warnke C, Wildemann B, Berthele A. Correction to: Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management. J Neurol 2024:10.1007/s00415-024-12288-2. [PMID: 38578500 DOI: 10.1007/s00415-024-12288-2] [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: 04/06/2024]
Affiliation(s)
- Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Judith Bellmann-Strobl
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Markus Krumbholz
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
| | - Friedemann Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille University, CNRS, CRMBM, Marseille, France
| | | | - Corinna Trebst
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | - Clemens Warnke
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Brigitte Wildemann
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany.
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Duchow A, Bellmann-Strobl J, Friede T, Aktas O, Angstwurm K, Ayzenberg I, Berthele A, Dawin E, Engels D, Fischer K, Flaskamp M, Giglhuber K, Grothe M, Havla J, Hümmert MW, Jarius S, Kaste M, Kern P, Kleiter I, Klotz L, Korporal-Kuhnke M, Kraemer M, Krumbholz M, Kümpfel T, Lohmann L, Ringelstein M, Rommer P, Schindler P, Schubert C, Schwake C, Senel M, Then Bergh F, Tkachenko D, Tumani H, Trebst C, Vardakas I, Walter A, Warnke C, Weber MS, Wickel J, Wildemann B, Winkelmann A, Paul F, Stellmann JP, Häußler V. Time to Disability Milestones and Annualized Relapse Rates in NMOSD and MOGAD. Ann Neurol 2024; 95:720-732. [PMID: 38086777 DOI: 10.1002/ana.26858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To investigate accumulation of disability in neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) in a changing treatment landscape. We aimed to identify risk factors for the development of disability milestones in relation to disease duration, number of attacks, and age. METHODS We analyzed data from individuals with NMOSD and MOGAD from the German Neuromyelitis Optica Study Group registry. Applying survival analyses, we estimated risk factors and computed time to disability milestones as defined by the Expanded Disability Status Score (EDSS). RESULTS We included 483 patients: 298 AQP4-IgG+ NMOSD, 52 AQP4-IgG-/MOG-IgG- NMOSD patients, and 133 patients with MOGAD. Despite comparable annualized attack rates, disability milestones occurred earlier and after less attacks in NMOSD patients than MOGAD patients (median time to EDSS 3: AQP4-IgG+ NMOSD 7.7 (95% CI 6.6-9.6) years, AQP4-IgG-/MOG-IgG- NMOSD 8.7) years, MOGAD 14.1 (95% CI 10.4-27.6) years; EDSS 4: 11.9 (95% CI 9.7-14.7), 11.6 (95% lower CI 7.6) and 20.4 (95% lower CI 14.1) years; EDSS 6: 20.1 (95% CI 16.5-32.1), 20.7 (95% lower CI 11.6), and 37.3 (95% lower CI 29.4) years; and EDSS 7: 34.2 (95% lower CI 31.1) for AQP4-IgG+ NMOSD). Higher age at onset increased the risk for all disability milestones, while risk of disability decreased over time. INTERPRETATION AQP4-IgG+ NMOSD, AQP4-IgG-/MOG-IgG- NMOSD, and MOGAD patients show distinctive relapse-associated disability progression, with MOGAD having a less severe disease course. Investigator-initiated research has led to increasing awareness and improved treatment strategies appearing to ameliorate disease outcomes for NMOSD and MOGAD. ANN NEUROL 2024;95:720-732.
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Affiliation(s)
- Ankelien Duchow
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Judith Bellmann-Strobl
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klemens Angstwurm
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Eva Dawin
- Department of Neurology with Institute of translational Neurology, University of Münster, Münster, Germany
| | - Daniel Engels
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Katinka Fischer
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martina Flaskamp
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Grothe
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Kaste
- Department of Neurology, Nordwest Hospital Sanderbusch, Sande, Germany
| | - Peter Kern
- Department of Neurology, Asklepios Expert Clinic Teupitz, Teupitz, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of translational Neurology, University of Münster, Münster, Germany
| | - Mirjam Korporal-Kuhnke
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Markus Kraemer
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
| | - Markus Krumbholz
- Department of Neurology and Pain Treatment, Multiple Sclerosis Center, Center for Translational Medicine, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Lisa Lohmann
- Department of Neurology with Institute of translational Neurology, University of Münster, Münster, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Centre for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Patrick Schindler
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Charlotte Schubert
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg -Eppendorf, Hamburg, Germany
| | - Carolin Schwake
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Daria Tkachenko
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Annette Walter
- Department of Neurology, Herford Hospital, Herford, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Göttingen, Germany
| | - Martin S Weber
- Institute of Neuropathology, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Fraunhofer Institute for Translational Medicine and, Pharmacology, Göttingen, Jena, Germany
| | - Jonathan Wickel
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Hamburg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | - Friedemann Paul
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg -Eppendorf, Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg -Eppendorf, Hamburg, Germany
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Frahm N, Ellenberger D, Stahmann A, Fneish F, Lüftenegger D, Salmen HC, Schirduan K, Schaak TPA, Flachenecker P, Kleinschnitz C, Paul F, Krefting D, Zettl UK, Peters M, Warnke C. Treatment switches of disease-modifying therapies in people with multiple sclerosis: long-term experience from the German MS Registry. Ther Adv Neurol Disord 2024; 17:17562864241239740. [PMID: 38560408 PMCID: PMC10981260 DOI: 10.1177/17562864241239740] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Background The spectrum of disease-modifying therapies (DMTs) for people with multiple sclerosis (PwMS) has expanded over years, but data on treatment strategies is largely lacking. DMT switches are common clinical practice. Objective To compare switchers and non-switchers, characterize the first DMT switch and identify reasons and predictors for switching the first DMT. Methods Data on 2722 PwMS from the German MS Registry were retrospectively analyzed regarding sociodemographic/clinical differences between 1361 switchers (PwMS discontinuing the first DMT) and non-switchers matched according to age, sex, and observation period. Frequencies of first and second DMTs were calculated and switch reasons identified. Predictors for DMT switches were revealed using univariable and multivariable regression models. Results Switchers and non-switchers differed significantly regarding time to first DMT, education, calendar period of the first DMT start (2014-2017 versus 2018-2021), first DMT class used [mild-to-moderate efficacy (MME) versus high-efficacy (HE) DMT], time on first DMT, and disease activity at first DMT start or cessation/last follow-up. The majority of PwMS started with MME DMTs (77.1%), with the most common being glatiramer acetate, dimethyl/diroximel fumarate, and beta-interferon variants. Switchers changed treatment more often to HE DMTs (39.6%), most commonly sphingosine-1-phosphate receptor modulators, anti-CD20 monoclonal antibodies, and natalizumab. Fewer PwMS switched to MME DMTs (35.9%), with the most common being dimethyl/diroximel fumarate, teriflunomide, or beta-interferon. Among 1045 PwMS with sufficient data (76.8% of 1361 switchers), the most frequent reasons for discontinuing the first DMT were disease activity despite DMT (63.1%), adverse events (17.1%), and patient request (8.3%). Predictors for the first DMT switch were MME DMT as initial treatment [odds ratio (OR) = 2.83 (1.76-4.61), p < 0.001; reference: HE DMT], first DMT initiation between 2014 and 2017 [OR = 11.55 (6.93-19.94), p < 0.001; reference: 2018-2021], and shorter time on first DMT [OR = 0.22 (0.18-0.27), p < 0.001]. Conclusion The initial use of MME DMTs was among the strongest predictors of DMT discontinuation in a large German retrospective MS cohort, arguing for the need for prospective treatment strategy trials, not only but also on the initial broad use of HE DMTs in PwMS.
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Affiliation(s)
- Niklas Frahm
- German MS Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), Krausenstr. 50, Hannover, Niedersachsen 30171, Germany
| | - David Ellenberger
- German MS Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), Hannover, Germany
| | - Alexander Stahmann
- German MS Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), Hannover, Germany
| | - Firas Fneish
- German MS Registry, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), Hannover, Germany
| | | | | | | | | | | | - Christoph Kleinschnitz
- Department of Neurology and Center of Translational and Behavioral Neurosciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dagmar Krefting
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Uwe K. Zettl
- Department of Neurology, Neuroimmunological Section, University Medical Center of Rostock, Rostock, Germany
| | - Melanie Peters
- German MS Registry, Gesellschaft für Versorgungsforschung mbH (Society for Health Care Research [GfV]), Hannover, Germany
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
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Goereci Y, Ellenberger D, Rommer P, Dunkl V, Golla H, Zettl U, Stahmann A, Warnke C. Persons with multiple sclerosis older than 55 years: an analysis from the German MS registry. J Neurol 2024:10.1007/s00415-024-12286-4. [PMID: 38517521 DOI: 10.1007/s00415-024-12286-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Persons with MS (PwMS) ≥ 55 years are underrepresented in therapy studies leading to a lack of evidence. OBJECTIVE AND METHODS To study the subgroup of PwMS ≥ 55 years in the German MS registry in comparison with PwMS < 55 years. Endpoints of interest were the grade of disability, leading symptoms, clinical and magnetic resonance imaging activity, and use of disease modifying therapy. RESULTS At the time of analysis, data from 40,428 PwMS were available for analysis. In PwMS aged ≥ 65 and PwMS aged ≥ 55 to 64 years, compared with PwMS aged < 55 years, the mean Expanded Disability Status Scale Scores were higher (5.3, 4.2 and 2.7, respectively), while the proportion of individuals with current use of disease modifying therapy was lower (42.6%, 60.9% and 76.7%, respectively). The older patient groups were more likely to be labeled with progressive MS and the frequency of occupational invalidity was high (38.8% in PwMS aged ≥ 55 to 64 years). Gait disorder, fatigue, bladder dysfunction, and spasticity were among the leading symptoms in PwMS aged ≥ 55 years. CONCLUSION PwMS ≥ 55 years have a high degree of disability, but a large proportion do not receive disease modifying therapy, exposing an unmet need.
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Affiliation(s)
- Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - David Ellenberger
- German MS Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hannover, Germany
| | - Paulus Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Veronika Dunkl
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Uwe Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Alexander Stahmann
- German MS Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hannover, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Stahmann A, Craig E, Ellenberger D, Fneish F, Frahm N, Marrie RA, Middleton R, Nicholas R, Rodgers J, Warnke C, Salter A. Disease-modifying therapy initiation patterns in multiple sclerosis in three large MS populations. Ther Adv Neurol Disord 2024; 17:17562864241233044. [PMID: 38495364 PMCID: PMC10943712 DOI: 10.1177/17562864241233044] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024] Open
Abstract
Background Treatment guidelines recommend early disease-modifying therapy (DMT) initiation after diagnosis of multiple sclerosis (MS). Multinational comparative studies that assess time to DMT initiation in MS may allow detection of barriers inherent to healthcare systems to explain potential adverse systematic delays in commencing DMTs. Objectives To investigate and compare the time to first DMT and its association with sociodemographic and clinical variables after MS diagnosis in three large MS registries. Design This observational study was conducted using data from the German MS Registry (GMSR), the North American Research Committee on MS Registry (NARCOMS, US data only), and the United Kingdom MS Registry (UKMSR, both self- and clinician-reported). Methods Data from relapsing people with MS (PwMS), with a diagnosis of MS between 2014 and 2019, and available DMT and disability status were pooled using a meta-analytic approach. Results A total of 5395 PwMS were included in the analysis (GMSR: n = 2658; NARCOMS: n = 447; UKMSR: n = 2290). Kaplan-Meier estimates for the time to first DMT [median months (95% CI)] were 2.0 (1.9-2.0), 3.0 (2-4), and 9.0 (7.7-10.6) for GMSR, NARCOMS, and UKMSR, respectively. Pooled multivariable Cox regression demonstrated shorter time to first DMT for PwMS diagnosed after 2017 [1.65 (1.42-1.92), p < 0.01], and longer time to DMT when a higher-efficacy DMT was selected (0.69 (0.54-0.90), p < 0.0001]. Conclusion Time to DMT initiation differs across the populations studied, indicating that barriers may exist in early access to DMT, particularly in the United Kingdom. However, a consistent decrease in time to DMT initiation was noted since 2017 across all registries. Further studies are warranted comparing the effects of time to DMT and time to higher-efficacy DMT on long-term outcome.
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Affiliation(s)
- Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH, German MS-Registry by the German MS Society, Krausenstr. 50, Hanover 30171, Germany
| | - Elaine Craig
- Swansea University Medical School, UK MS-Registry, Swansea, UK
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs-gGmbH, German MS-Registry by the German MS Society, Hanover, Germany
| | - Firas Fneish
- MS Forschungs- und Projektentwicklungs-gGmbH, German MS-Registry by the German MS Society, Hanover, Germany
| | - Niklas Frahm
- MS Forschungs- und Projektentwicklungs-gGmbH, German MS-Registry by the German MS Society, Hanover, Germany
| | - Ruth Ann Marrie
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Rod Middleton
- Swansea University Medical School, UK MS-Registry, Swansea, UK
| | - Richard Nicholas
- Swansea University Medical School, UK MS-Registry, Swansea, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Jeff Rodgers
- Swansea University Medical School, UK MS-Registry, Swansea, UK
| | - Clemens Warnke
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
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Boesl F, Goereci Y, Schweitzer F, Finke C, Schild AK, Bittner S, Steffen F, Schröder M, Quitschau A, Heine J, Warnke C, Franke C. Cognitive decline in post-COVID-19 syndrome does not correspond with persisting neuronal or astrocytic damage. Sci Rep 2024; 14:5326. [PMID: 38438479 PMCID: PMC10912552 DOI: 10.1038/s41598-024-55881-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
Cognitive impairment is the most frequent symptom reported in post-COVID-19 syndrome (PCS). Aetiology of cognitive impairment in PCS is still to be determined. Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are increased in acute COVID-19. Their role as biomarkers in other neurological disorders is under debate. We analysed serum levels of NfL and GFAP as markers for neuronal and astrocytic damage in 53 patients presenting to a PCS Neurology outpatient clinic. Only individuals with self-reported cognitive complaints were included. In these individuals, cognitive complaints were further assessed by comprehensive neuropsychological assessment (NPA). Patients were categorized into subgroups of subjective cognitive decline, single domain impairment, or multi-domain impairment. Serum NfL was in normal range, however an increase of serum GFAP was detected in 4% of patients. Serum NfL and GFAP levels correlated with each other, even when adjusting for patient age (r = 0.347, p = 0.012). NPA showed deficits in 70%; 40% showing impairment in several tested domains. No significant differences were found between serum NfL- and GFAP-levels comparing patients with subjective cognitive decline, single domain impairment, or multi-domain impairment. Persistent neuronal or astrocytic damage did not correlate with cognitive impairment in PCS.
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Affiliation(s)
- Fabian Boesl
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Finja Schweitzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Finke
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ann-Katrin Schild
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University Mainz, Rhine-Main Neuroscience Network (rmn2), Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University Mainz, Rhine-Main Neuroscience Network (rmn2), Mainz, Germany
| | - Maria Schröder
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Anneke Quitschau
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Josephine Heine
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christiana Franke
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
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8
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Boesl F, Goereci Y, Gerhard A, Bremer B, Raeder V, Schweitzer F, Hoppmann U, Behrens J, Bellmann-Strobl J, Paul F, Wildemann B, Jarius S, Prüss H, Audebert HJ, Warnke C, Franke C. Cerebrospinal fluid findings in patients with neurological manifestations in post-COVID-19 syndrome. J Neurol 2024; 271:59-70. [PMID: 37999770 PMCID: PMC10769962 DOI: 10.1007/s00415-023-12092-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Information on cerebrospinal fluid (CSF) findings in patients with neurological manifestations in post-COVID-19 syndrome is scarce. METHODS Retrospective evaluation of 84 CSF samples in patients fulfilling post-COVID-19 criteria in two neurological post-COVID-19 outpatient clinics. RESULTS In 68% of samples, all CSF parameters were normal. The most frequent pathological CSF finding was elevation of total protein (median total protein 33.3 mg/dl [total range 18.5-116.2]) in 20 of 83 (24%) samples. The second most prevalent pathological finding was a blood-CSF barrier dysfunction as measured by elevation of QAlb (median QAlb 4.65 [2.4-13.2]) in 11/84 (13%). Pleocytosis was found in only 5/84 (6%) samples and was mild in all of them. CSF-restricted oligoclonal bands were found in 5/83 (6%) samples. Anti-neuronal autoantibodies in CSF were negative in most cases, whilst 12/68 (18%) samples were positive for anti-myelin autoantibodies in serum. PCR for herpesviridae (HSV-1/-2, VZV, EBV, CMV, HHV6) showed, if at all, only weakly positive results in CSF or EDTA whole blood/plasma. CONCLUSIONS The majority of samples did not show any pathologies. The most frequent findings were elevation of total protein and blood-CSF barrier dysfunction with no signs of intrathecal inflammation. CSF analysis still keeps its value for exclusion of differential diagnoses.
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Affiliation(s)
- Fabian Boesl
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany.
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ameli Gerhard
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Benno Bremer
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Vanessa Raeder
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Finja Schweitzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Uta Hoppmann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Janina Behrens
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Harald Prüss
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Heinrich J Audebert
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christiana Franke
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
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9
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Kümpfel T, Giglhuber K, Aktas O, Ayzenberg I, Bellmann-Strobl J, Häußler V, Havla J, Hellwig K, Hümmert MW, Jarius S, Kleiter I, Klotz L, Krumbholz M, Paul F, Ringelstein M, Ruprecht K, Senel M, Stellmann JP, Bergh FT, Trebst C, Tumani H, Warnke C, Wildemann B, Berthele A. Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management. J Neurol 2024; 271:141-176. [PMID: 37676297 PMCID: PMC10770020 DOI: 10.1007/s00415-023-11910-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023]
Abstract
This manuscript presents practical recommendations for managing acute attacks and implementing preventive immunotherapies for neuromyelitis optica spectrum disorders (NMOSD), a rare autoimmune disease that causes severe inflammation in the central nervous system (CNS), primarily affecting the optic nerves, spinal cord, and brainstem. The pillars of NMOSD therapy are attack treatment and attack prevention to minimize the accrual of neurological disability. Aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) are a diagnostic marker of the disease and play a significant role in its pathogenicity. Recent advances in understanding NMOSD have led to the development of new therapies and the completion of randomized controlled trials. Four preventive immunotherapies have now been approved for AQP4-IgG-positive NMOSD in many regions of the world: eculizumab, ravulizumab - most recently-, inebilizumab, and satralizumab. These new drugs may potentially substitute rituximab and classical immunosuppressive therapies, which were as yet the mainstay of treatment for both, AQP4-IgG-positive and -negative NMOSD. Here, the Neuromyelitis Optica Study Group (NEMOS) provides an overview of the current state of knowledge on NMOSD treatments and offers statements and practical recommendations on the therapy management and use of all available immunotherapies for this disease. Unmet needs and AQP4-IgG-negative NMOSD are also discussed. The recommendations were developed using a Delphi-based consensus method among the core author group and at expert discussions at NEMOS meetings.
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Affiliation(s)
- Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Judith Bellmann-Strobl
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Markus Krumbholz
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
| | - Friedemann Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille University, CNRS, CRMBM, Marseille, France
| | | | - Corinna Trebst
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | - Clemens Warnke
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Brigitte Wildemann
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany.
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10
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Schweitzer F, Laurent S, Cortese I, Fink GR, Silling S, Skripuletz T, Metz I, Wattjes MP, Warnke C. Progressive Multifocal Leukoencephalopathy: Pathogenesis, Diagnostic Tools, and Potential Biomarkers of Response to Therapy. Neurology 2023; 101:700-713. [PMID: 37487750 PMCID: PMC10585672 DOI: 10.1212/wnl.0000000000207622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/19/2023] [Indexed: 07/26/2023] Open
Abstract
JC polyomavirus (JCV) establishes an asymptomatic latent and/or persistent infection in most of the adult population. However, in immunocompromised individuals, JCV can cause a symptomatic infection of the brain, foremost progressive multifocal leukoencephalopathy (PML). In the past 2 decades, there has been increasing concern among patients and the medical community because PML was observed as an adverse event in individuals treated with modern (selective) immune suppressive treatments for various immune-mediated diseases, especially multiple sclerosis. It became evident that this devastating complication also needs to be considered beyond the patient populations historically at risk, including those with hematologic malignancies or HIV-infected individuals. We review the clinical presentation of PML, its variants, pathogenesis, and current diagnostic approaches. We further discuss the need to validate JCV-directed interventions and highlight current management strategies based on early diagnosis and restoring JCV-specific cellular immunity, which is crucial for viral clearance and survival. Finally, we discuss the importance of biomarkers for diagnosis and response to therapy, instrumental in defining sensitive study end points for successful clinical trials of curative or preventive therapeutics. Advances in understanding PML pathophysiology, host and viral genetics, and diagnostics in conjunction with novel immunotherapeutic approaches indicate that the time is right to design and perform definitive trials to develop preventive options and curative therapy for JCV-associated diseases.
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Affiliation(s)
- Finja Schweitzer
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
| | - Sarah Laurent
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
| | - Irene Cortese
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
| | - Gereon R Fink
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
| | - Steffi Silling
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
| | - Thomas Skripuletz
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
| | - Imke Metz
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
| | - Mike P Wattjes
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
| | - Clemens Warnke
- From the Department of Neurology (F.S., S.L., G.R.F., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Experimental Immunotherapeutics Unit (I.C.), NIH, Bethesda, MD; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Institute of Virology (S.S.), National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne; Department of Neurology (T.S.), Hannover Medical School; Institute of Neuropathology (I.M.), University Medical Center Göttingen; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany.
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Bayas A, Berthele A, Blank N, Dreger P, Faissner S, Friese MA, Gerdes LA, Grauer OM, Häussler V, Heesen C, Janson D, Korporal-Kuhnke M, Kowarik M, Kröger N, Lünemann JD, Martin R, Meier U, Meuth S, Muraro P, Platten M, Schirmer L, Stürner KH, Stellmann JP, Scheid C, Bergh FT, Warnke C, Wildemann B, Ziemssen T. Autologous haematopoietic stem cell transplantation for multiple sclerosis: a position paper and registry outline. Ther Adv Neurol Disord 2023; 16:17562864231180730. [PMID: 37780055 PMCID: PMC10540601 DOI: 10.1177/17562864231180730] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background While substantial progress has been made in the development of disease-modifying medications for multiple sclerosis (MS), a high percentage of treated patients still show progression and persistent inflammatory activity. Autologous haematopoietic stem cell transplantation (AHSCT) aims at eliminating a pathogenic immune repertoire through intense short-term immunosuppression that enables subsequent regeneration of a new and healthy immune system to re-establish immune tolerance for a long period of time. A number of mostly open-label, uncontrolled studies conducted over the past 20 years collected about 4000 cases. They uniformly reported high efficacy of AHSCT in controlling MS inflammatory disease activity, more markedly beneficial in relapsing-remitting MS. Immunological studies provided evidence for qualitative immune resetting following AHSCT. These data and improved safety profiles of transplantation procedures spurred interest in using AHSCT as a treatment option for MS. Objective To develop expert consensus recommendations on AHSCT in Germany and outline a registry study project. Methods An open call among MS neurologists as well as among experts in stem cell transplantation in Germany started in December 2021 to join a series of virtual meetings. Results We provide a consensus-based opinion paper authored by 25 experts on the up-to-date optimal use of AHSCT in managing MS based on the Swiss criteria. Current data indicate that patients who are most likely to benefit from AHSCT have relapsing-remitting MS and are young, ambulatory and have high disease activity. Treatment data with AHSCT will be collected within the German REgistry Cohort of autologous haematopoietic stem CeLl trAnsplantation In MS (RECLAIM). Conclusion Further clinical trials, including registry-based analyses, are urgently needed to better define the patient characteristics, efficacy and safety profile of AHSCT compared with other high-efficacy therapies and to optimally position it as a treatment option in different MS disease stages.
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Affiliation(s)
- Antonios Bayas
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, University of Augsburg, Augsburg
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University of Munich, Munich
| | - Norbert Blank
- Rheumatology Section, Interdisciplinary Centre for Chronic Inflammatory Diseases, Heidelberg University Hospital, Heidelberg
| | - Peter Dreger
- Spokesman German Working Group for Haematopoietic Stem Cell Transplantation and Cellular Therapy e.V., Heidelberg University Hospital, Heidelberg
| | - Simon Faissner
- Department of Neurology, University Hospital of Ruhr-University Bochum, St. Josef-Hospital, Bochum
| | - Manuel A. Friese
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS) and Department of Neurology, University Medical Center Hamburg-Eppendorf
| | - Lisa-Ann Gerdes
- Institut für Klinische Neuroimmunologie am Klinikum der Ludwig-Maximilians-Universität München, München
| | - Oliver Martin Grauer
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster
| | - Vivien Häussler
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS) and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS) and Department of Neurology University Medical Center Hamburg-Eppendorf
- Clinical and Rehabilitative MS Research, Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, D-20246 Hamburg, Germany
| | - Dietlinde Janson
- Clinic for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg
| | | | - Markus Kowarik
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Kröger
| | - Nikolaus Kröger
- Clinic for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Jan D. Lünemann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster
| | - Roland Martin
- Institute of Experimental Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Uwe Meier
- Chairman of the Professional Association of German Neurologists, Neurocentrum Grevenbroich, Grevenbroich
| | - Sven Meuth
- Medical Faculty, Department of Neurology, University Hospital Düsseldorf, Düsseldorf
| | - Paolo Muraro
- Department of Brain Sciences, Imperial College London, London, UK
| | - Michael Platten
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Heidelberg
| | - Lucas Schirmer
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Heidelberg
| | | | - Jan Patrick Stellmann
- Centre de Résonance Magnétique Biologique et Médicale, Aix-Marseille Université, Marseille
| | - Christof Scheid
- Clinic I for Internal Medicine, University Hospital Cologne, Cologne
| | | | - Clemens Warnke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic and Polyclinic of Neurology, Cologne
| | - Brigitte Wildemann
- AG Neuroimmunology, Neurological Clinic, Heidelberg University Hospital, Heidelberg
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus Dresden, Technische Universität Dresden
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12
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Grote-Levi L, Möhn N, Bonifacius A, Tischer-Zimmermann S, Schweitzer F, Mahmoudi N, Silling S, Warnke C, Maecker-Kolhoff B, Wattjes MP, Eiz-Vesper B, Höglinger GU, Skripuletz T. Adoptive Allogeneic T-Cell Therapy Improves the Clinical Outcome of JC Virus Granule Cell Neuronopathy: A Case Report. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200138. [PMID: 37385737 PMCID: PMC10474852 DOI: 10.1212/nxi.0000000000200138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES JC virus granule cell neuronopathy is a potentially fatal otherwise highly disabling disease without an approved therapeutic option. This case report presents the positive record to T-cell therapy in JC virus granule cell neuronopathy. METHODS The patient represented with subacute cerebellar symptoms. Diagnosis of JC virus granule cell neuronopathy was made because of infratentorially accentuated brain volume atrophy shown by brain MRI and the detection of JC virus DNA in the CSF. RESULTS Six doses of virus-specific T cells were administered. Within 12 months after therapy initiation, the patient showed clear clinical benefit with improvement of symptoms, and JC viral DNA load significantly declined. DISCUSSION We present the case report of a positive response to T-cell therapy in JC virus granule cell neuronopathy, leading to an improvement of symptoms.
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Affiliation(s)
- Lea Grote-Levi
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Nora Möhn
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Agnes Bonifacius
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Sabine Tischer-Zimmermann
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Finja Schweitzer
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Nima Mahmoudi
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Steffi Silling
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Clemens Warnke
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Britta Maecker-Kolhoff
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Mike P Wattjes
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Britta Eiz-Vesper
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Günter U Höglinger
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.)
| | - Thomas Skripuletz
- From the Department of Neurology (L.G.-L., N. Möhn, G.U.H., T.S.); Institute of Transfusion Medicine and Transplant Engineering (A.B., S.T.-Z., B.E.-V.), Hannover Medical School; Department of Neurology (F.S., C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Department of Diagnostic and Interventional Neuroradiology (N. Mahmoudi, M.P.W.), Hannover Medical School; National Reference Center for Papilloma- and Polyomaviruses (S.S.), Institute of Virology, University of Cologne; Department of Pediatric Hematology and Oncology (B.M.-K.), Hannover Medical School, Germany; and German Center for Infection Research (DZIF) (B.M.-K., B.E.-V.).
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13
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Schlagheck ML, Hübner ST, Joisten N, Walzik D, Rademacher A, Wolf F, Bansi J, Warnke C, Zimmer P. Physical activity is related to disease severity and fatigue, but not to relapse rate in persons with relapsing remitting multiple sclerosis - a self-reported questionnaire based study. Front Neurol 2023; 14:1217000. [PMID: 37583953 PMCID: PMC10423808 DOI: 10.3389/fneur.2023.1217000] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Based on theoretical models, physical activity has been introduced as a promoting method to mitigate the disease severity, fatigue and relapse rate in multiple sclerosis. The primary objective of the study was to investigate the relation between self-reported physical activity level and disease severity, fatigue and relapse rate in persons with relapsing remitting multiple sclerosis (RRMS). Methods A survey was offered to persons with RRMS from March 2019 to August 2021 (n = 253). Physical activity level, fatigue and disease severity were determined using the Godin Leisure-Time Questionnaire (GLTEQ), the Patient Determined Disease Steps (PDDS) scale and the Fatigue Scale for Motor and Cognitive Functions (FSMC). Additionally, participants' relapse rate was recorded. Results Bivariate correlations revealed an inverse relation between physical activity level and PDDS (ρ = -0.279; p < 0.001) as well as between physical activity and FSMC (r = -0.213, p < 0.001), but not between physical activity and relapse rate (r = 0.033, p > 0.05). Multiple linear regression analyses explained 12.6% and 5.2% of the variance of PDDS and FSMC. Conclusion Our findings confirm a relation between self-reported physical activity, disease severity and fatigue in persons with RRMS. However, self-reported physical activity level does not seem to affect the annualised relapse rate.
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Affiliation(s)
- Marit L. Schlagheck
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - Sven T. Hübner
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Niklas Joisten
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - David Walzik
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - Annette Rademacher
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Florian Wolf
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
- Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - Jens Bansi
- Department of Research and Development, Kliniken Valens, Valens, Switzerland
- Department of Health, OST – Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
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14
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Müller A, Dillen K, Dojan T, Ungeheuer S, Goereci Y, Dunkl V, Voltz R, Löcherbach P, Warnke C, Golla H. Development of a Long-Term Cross-Sectoral Case and Care Management Manual for Patients With Severe Multiple Sclerosis and Their Caregivers. Prof Case Manag 2023; 28:183-193. [PMID: 36518082 DOI: 10.1097/ncm.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/23/2022]
Abstract
PURPOSE/OBJECTIVES Care and case management (CCM) aims to provide optimal care for patients and their caregivers on an individual and superordinate level of health care providers and authorities. To facilitate a clear and systematic CCM process as part of a clinical study intervention, a semistructured manual is the prerequisite. PRIMARY PRACTICE SETTINGS The ongoing COCOS-MS (Communication, Coordination and Security for People with Multiple Sclerosis) study is a randomized controlled Phase II clinical intervention study. The CCM manual is being tested on the intervention group consisting of severely affected individuals with multiple sclerosis (MS; Expanded Disability Status Scale [EDSS] >5) and their caregivers receiving CCM for 12 months in addition to standard care. The intervention comprises monthly personal visits and weekly telephone calls during which the CCM manual is applied. FINDINGS/CONCLUSIONS The CCM manual has been developed on the basis of previous literature and well-established questionnaires following theoretical aspects and prior scientific work covering individual domains of life of people with MS. Within the COCOS-MS study, its feasibility is being tested meticulously. It allows for a standardized assessment while being tailored to the individual. At the end of the intervention period, it will be analyzed statistically and qualitatively. Consequently, conclusions can be drawn as to whether the CCM manual is feasible or has to be adapted for use in standard care after analyzation. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The CCM manual serves as a tool for the continuous, long-term, cross-sectoral care for patients suffering from severe MS and their caregivers. The manual provides guidance in adequately addressing patients' complex symptoms, problems, and needs, as well as assessing existing resources both at the individual patient level and at a superordinate level.
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Affiliation(s)
- Anne Müller
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Kim Dillen
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Thomas Dojan
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Solveig Ungeheuer
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Yasemin Goereci
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Veronika Dunkl
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Raymond Voltz
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Peter Löcherbach
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Clemens Warnke
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Heidrun Golla
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
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Dillen K, Goereci Y, Dunkl V, Müller A, Fink GR, Voltz R, Hocaoglu M, Warnke C, Golla H. Cultural adaptation of the Integrated Palliative care Outcome Scale for neurological symptoms - ERRATUM. Palliat Support Care 2023:1. [PMID: 37211899 DOI: 10.1017/s1478951523000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Dillen K, Goereci Y, Dunkl V, Müller A, Fink GR, Voltz R, Hocaoglu M, Warnke C, Golla H. Cultural adaptation of the Integrated Palliative care Outcome Scale for neurological symptoms. Palliat Support Care 2023:1-10. [PMID: 37039454 DOI: 10.1017/s1478951523000238] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Standardized measures for assessing neurological patients needing palliative care remain scarce. The Integrated Palliative care Outcome Scale for neurological patients in its short form (IPOS Neuro-S8) helps assess and identify patients' symptom burden and needs early but has not yet been validated in German. The aim was to culturally adapt and translate the IPOS Neuro-S8 into the German health-care context and evaluate its face and content validity. METHODS Cultural adaptation study following the first 6 out of 8 phases of the Palliative care Outcome Scale measures manual: (1) conceptual definition, (2) forward translation to German, (3) backward translation to English, (4) expert review, (5) cognitive debriefing, (6) proofreading. Neurological patients needing palliative care and clinical staff of the Department of Palliative Medicine or Neurology of the University Hospital of Cologne were included. Data were analyzed using thematic content analysis and descriptive statistics. RESULTS A total of 13 patients and 16 clinical staff participated in this study. The expert review panel (phase 4) consisted of 11 additional members. While patients (n = 9) and clinical staff (n = 11) confirmed that the IPOS Neuro-S8 is an intelligible tool that is well accepted (phase 5), some linguistic and cultural differences were found between the original English and German versions. These mainly concerned the items mouth problems and spasms. SIGNIFICANCE OF RESULTS The German version of the IPOS Neuro-S8 has demonstrated face and content validity and captures relevant symptoms of neurological patients needing palliative care. Its psychometric properties, including construct and criterion validity, will be investigated next.
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Affiliation(s)
- Kim Dillen
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Anne Müller
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (CTCC), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Hümmert MW, Bütow F, Tkachenko D, Ayzenberg I, Pakeerathan T, Hellwig K, Klotz L, Häußler V, Stellmann JP, Warnke C, Goereci Y, Etgen T, Luessi F, Bronzlik P, Gingele S, Lauenstein AS, Kleiter I, Rommer PS, Paul F, Bellmann-Strobl J, Duchow A, Then Bergh F, Pul R, Walter A, Pellkofer H, Kümpfel T, Pompsch M, Kraemer M, Albrecht P, Aktas O, Ringelstein M, Senel M, Giglhuber K, Berthele A, Jarius S, Wildemann B, Trebst C. Effects of the COVID-19 Pandemic on Patients With NMO Spectrum Disorders and MOG-Antibody-Associated Diseases: COPANMO(G)-Study. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/2/e200082. [PMID: 36693760 PMCID: PMC10108387 DOI: 10.1212/nxi.0000000000200082] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/16/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the effects of the coronavirus disease 2019 (COVID-19) pandemic on the life of patients with neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated diseases (MOGAD). METHODS This multicenter, cross-sectional study included data of 187 patients recruited from 19 different German and Austrian Neuromyelitis Optica Study Group (NEMOS) centers between July 2021 and March 2022. The effects of the pandemic on immunotherapeutic treatment and access to care, the possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and the potential effect of vaccination against SARS-CoV-2 on disease incidence and relapse risk were assessed using a patient questionnaire. Health-related quality of life (HRQoL) was measured with the EuroQoL Group 5-Dimension 5-Level Scale (EQ-5D-5L). Demographic and clinical characteristics were retrieved from the NEMOS database. RESULTS One hundred eighty-seven patients (75% women; median age 47 [range 21-86] years; median disease duration 5.5 [range 0-67] years; median Expanded Disability Status Scale 2.0 [range 0-8.0]; 51% aquaporin-4 immunoglobulin G (AQP4-IgG)-positive, 36% myelin oligodendrocyte glycoprotein (MOG)-IgG-positive 13% double-seronegative) were analyzed. Most patients maintained excellent access to healthcare services throughout the pandemic. Immunotherapy was not changed in 88% of patients. Ninety-one percent of all patients were satisfied with medical care during the pandemic. Nearly two-thirds (64%) of patients rated their risk of infection with SARS-CoV-2 as low or moderate. Among this study sample, 23 patients (12%) knowingly acquired an infection with SARS-CoV-2 and predominantly had a nonsevere course of illness (n = 22/23, 96%). The SARS-CoV-2 vaccination rate was 89%, with 4 cases of confirmed attack or first manifestation of NMOSD/MOGAD occurring in temporal association with the vaccination (range 2-9 days). The reported HRQoL did not decline compared with a prepandemic assessment (mean EQ-5D-5L index value 0.76, 95% bootstrap confidence interval [CI] 0.72-0.80; mean EQ-VAS 66.5, 95% bootstrap CI 63.5-69.3). DISCUSSION This study demonstrates that, overall, patients with NMOSD/MOGAD affiliated with specialized centers received ongoing medical care during the pandemic. Patients' satisfaction with medical care and HRQoL did not decrease.
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Affiliation(s)
- Martin W Hümmert
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Franziska Bütow
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Daria Tkachenko
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Ilya Ayzenberg
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Thivya Pakeerathan
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Kerstin Hellwig
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Luisa Klotz
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Vivien Häußler
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Jan-Patrick Stellmann
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Clemens Warnke
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Yasemin Goereci
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Thorleif Etgen
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Felix Luessi
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Paul Bronzlik
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Stefan Gingele
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Ann-Sophie Lauenstein
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Ingo Kleiter
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Paulus S Rommer
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Friedemann Paul
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Judith Bellmann-Strobl
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Ankelien Duchow
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Florian Then Bergh
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Refik Pul
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Annette Walter
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Hannah Pellkofer
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Tania Kümpfel
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Mosche Pompsch
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Markus Kraemer
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Philipp Albrecht
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Orhan Aktas
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Marius Ringelstein
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Makbule Senel
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Katrin Giglhuber
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Achim Berthele
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Sven Jarius
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
| | - Brigitte Wildemann
- From the Department of Neurology (M.W.H., F.B., D.T., S.G., C.T.), Hannover Medical School, Germany; Department of Neurology (I.A., T.P., K.H., I.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (L.K.), University of Münster, Germany; Department of Neurology and Institute of Neuroimmunology and MS (INIMS) (V.H., J.-P.S.), University Medical Center Hamburg-Eppendorf, Germany; Aix-Marseille Univ (J.-P.S.), CNRS, CRMBM, UMR 7339, Marseille Cedex, France; APHM (J.-P.S.), Hopital de La Timone, CEMEREM, Marseille, France; Department of Neurology (C.W., Y.G.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Neurology (T.E.), Kliniken Südostbayern-Klinikum Traunstein, Germany; Department of Neurology (F.L.), University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hannover Medical School (P.B.), Department of Diagnostic and Interventional Neuroradiology, Germany; Department of Neurology (A.-S.L.), German Diagnostic Clinic, DKD Helios Clinic Wiesbaden, Germany; Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Experimental and Clinical Research Center (F.P., J.B.-S., A.D.), a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany; Department of Neurology (F.P., J.B.-S., A.D.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) (F.P., J.B.-S., A.D.), Berlin, Germany; Department of Neurology (F.T.B.), University of Leipzig, Germany; Department of Neurology (R.P.), University of Essen, Germany; Department of Neurology (A.W.), Herford Hospital, Germany; Institute of Clinical Neuroimmunology (H.P., T.K.), LMU Hospital, Ludwig-Maximilians Universität München, Germany; Department of Neurology (M.P., M.K.), Alfried-Krupp-Krankenhaus Essen, Germany; Department of Neurology (M.K., P.A., O.A., M.R.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.S.), University of Ulm, Germany; Department of Neurology (K.G., A.B.), School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Germany; and Molecular Neuroimmunology Group (S.J., B.W.), Department of Neurology, University of Heidelberg, Germany
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Hümmert MW, Stern C, Paul F, Duchow A, Bellmann-Strobl J, Ayzenberg I, Schwake C, Kleiter I, Hellwig K, Jarius S, Wildemann B, Senel M, Berthele A, Giglhuber K, Luessi F, Grothe M, Klotz L, Schülke R, Gingele S, Faiss JH, Walter A, Warnke C, Then Bergh F, Aktas O, Ringelstein M, Stellmann JP, Häußler V, Havla J, Pellkofer H, Kümpfel T, Kopp B, Trebst C. Cognition in patients with neuromyelitis optica spectrum disorders: A prospective multicentre study of 217 patients (CogniNMO-Study). Mult Scler 2023:13524585231151212. [PMID: 36786424 DOI: 10.1177/13524585231151212] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND There is limited and inconsistent information on the prevalence of cognitive impairment in neuromyelitis optica spectrum disorders (NMOSD). OBJECTIVE To assess cognitive performance and changes over time in NMOSD. METHODS This study included data from 217 aquaporin-4-IgG-seropositive (80%) and double-seronegative NMOSD patients. Cognitive functions measured by Symbol Digit Modalities Test (SDMT), Paced Auditory Serial-Addition Task (PASAT), and/or Multiple Sclerosis Inventory Cognition (MuSIC) were standardized against normative data (N = 157). Intraindividual cognitive performance at 1- and 2-year follow-up was analyzed. Cognitive test scores were correlated with demographic and clinical variables and assessed with a multiple linear regression model. RESULTS NMOSD patients were impaired in SDMT (p = 0.007), MuSIC semantic fluency (p < 0.001), and MuSIC congruent speed (p < 0.001). No significant cognitive deterioration was found at follow-up. SDMT scores were related to motor and visual disability (pBon < 0.05). No differences were found between aquaporin-4-IgG-seropositive and double-seronegative NMOSD. CONCLUSIONS A subset of NMOSD patients shows impairment in visual processing speed and in semantic fluency regardless of serostatus, without noticeable changes during a 2-year observation period. Neuropsychological measurements should be adapted to physical and visual disabilities.
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Affiliation(s)
- Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Carlotta Stern
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany/ Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ankelien Duchow
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Carolin Schwake
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany/Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Felix Luessi
- Department of Neurology, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Luisa Klotz
- Department of Neurology, University of Münster, Münster, Germany
| | - Rasmus Schülke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jürgen H Faiss
- Department of Neurology, Asklepios Expert Clinic Teupitz, Teupitz, Germany
| | - Annette Walter
- Department of Neurology, Herford Hospital, Herford, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany/Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany/Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France/APHM, Hopital de la Timone, CEMEREM, Marseille, France
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany/Data Integration for Future Medicine Consortium, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany
| | - Hannah Pellkofer
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
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19
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Scharfenberg D, Schild AK, Warnke C, Maier F. A Network Perspective on Neuropsychiatric and Cognitive Symptoms of the Post-COVID Syndrome. Eur J Psychol 2022; 18:350-356. [PMID: 36605094 PMCID: PMC9780734 DOI: 10.5964/ejop.10097] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/25/2022] [Indexed: 12/05/2022]
Abstract
Many patients that were infected with SARS-CoV-2 experience cognitive and affective symptoms weeks and months after their acute COVID-19 disease, even when acute symptoms were mild to moderate. For these patients, purely neurological explanations are struggling to explain the development and maintenance of the great variety of neuropsychiatric and cognitive symptoms occurring after COVID-19. We provide a psychological perspective based on the network theory of mental disorders as an added explanation that does not displace neurological mechanism but rather complements them. We suggest viewing the SARS-CoV-2 infection as a trigger that first activates nodes in a causally connected network of neuropsychiatric and cognitive symptoms. In the following, activation will spread throughout the network that will get in a self-sustaining stable and dysfunctional state manifesting in ongoing symptoms known as post-COVID-19 syndrome. The network perspective allows to generalize explanations for persistent neuropsychiatric and cognitive symptoms to patients that experienced mild or moderate acute courses of COVID-19, but also to similar phenomena following other viral infections. In addition, it could explain why some symptoms did not occur during acute COVID-19, but develop weeks or months after it. This network perspective shifts the focus from viewing persistent symptoms as a continuation of COVID-19 to acknowledging it as a complex syndrome that indeed originates from the disease but fully unfolds after it (post-COVID). To test the presented network perspective, we will need extensive cross-sectional as well as longitudinal data on cognitive and neuropsychiatric symptoms in post-COVID patients.
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Affiliation(s)
- Daniel Scharfenberg
- Medical Psychology | Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Katrin Schild
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Franziska Maier
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Persson Berg L, Eriksson M, Longhi S, Kockum I, Warnke C, Thomsson E, Bäckström M, Olsson T, Fogdell-Hahn A, Bergström T. Serum IgG levels to Epstein-Barr and measles viruses in patients with multiple sclerosis during natalizumab and interferon beta treatment. BMJ Neurol Open 2022; 4:e000271. [PMID: 35978722 PMCID: PMC9335035 DOI: 10.1136/bmjno-2022-000271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/17/2022] [Accepted: 07/13/2022] [Indexed: 12/16/2022] Open
Abstract
Background Patients with multiple sclerosis (MS) demonstrate higher seroprevalence of Epstein-Barr virus (EBV) and increased anti-EBV IgG levels in serum compared with healthy controls. Intrathecal antibody production to measles virus (MeV) is a common finding in patients with MS. Objective To measure serum IgG reactivity to EBV glycoprotein 350 (gp350) and MeV nucleocapsid protein (NCORE) in patients with MS and healthy controls and to determine if reactivity changed in patients during interferon beta (IFNβ) and/or natalizumab (NAT) treatment. A secondary aim was to determine the seroprevalence of EBV in patients and controls. Methods Patients with MS (n=728) were included from the Swedish pharmacovigilance study for NAT. Paired serum samples from 714 patients drawn before and during NAT treatment and paired samples from 170 patients during prior IFNβ treatment were analysed. In total, 156 patients were included in both groups. Samples from 144 matched blood donors served as controls. Indirect ELISA was applied using recombinant EBVgp350 and MeV NCORE as antigens. EBVgp350 IgG seronegative samples were also analysed using EBV nuclear antigen 1 and viral capsid antigen (VCA). Results Patients with MS showed higher serum levels of anti-EBVgp350 and anti-MeV NCORE IgG compared with controls. During NAT treatment, the levels of anti-EBVgp350 and anti-MeV NCORE IgG declined, compared with the relatively stable levels noted during prior IFNβ treatment. Ten patients failed to demonstrate anti-EBVgp350 IgG but did show detectable anti-VCA IgG, indicating EBV seropositivity. In contrast, 10/144 controls were EBV seronegative. Conclusions Treatment with NAT, which is considered a selective immunosuppressive agent with a compartmentalised effect on the central nervous system, appeared to be associated with a moderate decrease in circulating IgG levels to EBVgp350 and MeV NCORE. All patients with MS were EBV IgG seropositive, supporting the potential role of EBV in the pathogenesis of MS.
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Affiliation(s)
- Linn Persson Berg
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marcus Eriksson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Sonia Longhi
- Lab. Architecture et Fonction des Macromolécules Biologiques (AFMB), UMR 7257, Aix Marseille University and Centre National de la Recherche Scientifique (CNRS), Marseille, France
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elisabeth Thomsson
- Mammalian Protein Expression Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Bäckström
- Mammalian Protein Expression Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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21
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van der Weele L, Pollastro S, van Schaik BDC, van Kampen AHC, Niewold ITG, Kuijpers TW, Warnke C, Jensen PEH, Kramer D, Ryner M, Hermanrud C, Dönnes P, Pallardy M, Spindeldreher S, Deisenhammer F, Fogdell-Hahn A, de Vries N. Longitudinal analysis of anti-drug antibody development in multiple sclerosis patients treated with interferon beta-1a (Rebif™) using B cell receptor repertoire analysis. J Neuroimmunol 2022; 370:577932. [PMID: 35853357 DOI: 10.1016/j.jneuroim.2022.577932] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 07/10/2022] [Indexed: 10/17/2022]
Abstract
A significant proportion of multiple sclerosis (MS) patients treated with interferon beta-1a (Rebif™) develop anti-drug antibodies (ADA) with a negative impact on treatment efficacy. We hypothesized that high-throughput B-cell receptor (BCR) repertoire analysis could be used to predict and monitor ADA development. To study this we analyzed 228 peripheral blood samples from 68 longitudinally followed patients starting on interferon beta-1a. Our results show that whole blood BCR analysis does not reflect, and does not predict ADA development in MS patients treated with interferon beta-1a. We propose that BCR analysis of phenotypically selected cell subsets or tissues might be more informative.
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Affiliation(s)
- Linda van der Weele
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre (ARC), Amsterdam UMC228, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Immunology, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sabrina Pollastro
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre (ARC), Amsterdam UMC228, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Immunology, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Barbera D C van Schaik
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Infection & Immunity Institute (AIII), Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Antoine H C van Kampen
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Infection & Immunity Institute (AIII), Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ilse T G Niewold
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre (ARC), Amsterdam UMC228, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University Hospital of Cologne, Germany
| | - Poul Erik H Jensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Malin Ryner
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christina Hermanrud
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Marc Pallardy
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunopathologie, Faculté Pharmacie, Châtenay-Malabry, France
| | | | | | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Niek de Vries
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre (ARC), Amsterdam UMC228, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Immunology, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
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22
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Heesen C, Mokry C, Salmen A, Hegen H, Mäurer M, Warnke C, Gehring K, Berthele A, Meier U. German guideline for diagnosis and treatment of multiple sclerosis – a survey focusing neurologists in daily practise. Mult Scler Relat Disord 2022; 63:103828. [DOI: 10.1016/j.msard.2022.103828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
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23
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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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24
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Golla H, Dillen K, Hellmich M, Dojan T, Ungeheuer S, Schmalz P, Staß A, Mildenberger V, Goereci Y, Dunkl V, Strupp J, Fink GR, Voltz R, Stock S, Cornely O, Stahmann A, Müller A, Löcherbach P, Burghaus L, Limmroth V, Bonmann E, Gerbershagen K, Nelles G, Joist T, Haas J, Temmes H, Warnke C. Communication, Coordination, and Security for People with Multiple Sclerosis (COCOS-MS): a randomised phase II clinical trial protocol. BMJ Open 2022; 12:e049300. [PMID: 35078833 PMCID: PMC8796263 DOI: 10.1136/bmjopen-2021-049300] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patients with multiple sclerosis (MS) have complex needs that range from organising one's everyday life to measures of disease-specific therapy monitoring to palliative care. Patients with MS are likely to depend on multiple healthcare providers and various authorities, which are often difficult to coordinate. Thus, they will probably benefit from comprehensive cross-sectoral coordination of services provided by care and case management (CCM). Though studies have shown that case management improves quality of life (QoL), functional status and reduces service use, such benefits have not yet been investigated in severely affected patients with MS. In this explorative phase ll clinical trial, we evaluated a CCM with long-term, cross-sectoral and outreaching services and, in addition, considered the unit of care (patients and caregivers). METHODS AND ANALYSIS Eighty patients with MS and their caregivers will be randomly assigned to either the control (standard care) or the intervention group (standard care plus CCM (for 12 months)). Regular data assessments will be done at baseline and then at 3-month intervals. As primary outcome, we will evaluate patients' QoL. Secondary outcomes are patients' treatment-related risk perception, palliative care needs, anxiety/depression, use of healthcare services, caregivers' burden and QoL, meeting patients' and caregivers' needs, and evaluating the CCM intervention. We will also evaluate CCM through individual interviews and focus groups. The sample size calculation is based on a standardised effect of 0.5, and one baseline and four follow-up assessments (with correlation 0.5). Linear mixed models for repeated measures will be applied to analyse changes in quantitative outcomes over time. Multiple imputation approaches are taken to assess the robustness of the results. The explorative approach (phase ll clinical trial) with embedded qualitative research will allow for the development of a final design for a confirmative phase lll trial. ETHICS AND DISSEMINATION The trial will be conducted under the Declaration of Helsinki and has been approved by the Ethics Commission of Cologne University's Faculty of Medicine. Trial results will be published in an open-access scientific journal and presented at conferences. TRIAL REGISTRATION NUMBER German Register for Clinical Studies (DRKS) (DRKS00022771).
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Affiliation(s)
- Heidrun Golla
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Kim Dillen
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Solveig Ungeheuer
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Petra Schmalz
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Angelika Staß
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Vanessa Mildenberger
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
- Cognitive Neuroscience, Institute of Neurosciences and Medicine, Jülich, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Oliver Cornely
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Alexander Stahmann
- MS-Registry by the German MS-Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Anne Müller
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Peter Löcherbach
- German Society for Care and Case Management (DGCC), Mainz, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist-Krankenhaus Köln, Cologne, Germany
| | | | | | | | - Gereon Nelles
- NeuroMed Campus, MedCampus Hohenlind, Cologne, Germany
| | - Thomas Joist
- Academic Teaching Practice, University of Cologne, Cologne, Germany
| | - Judith Haas
- German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
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25
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Frahm N, Fneish F, Ellenberger D, Flachenecker P, Paul F, Warnke C, Kleinschnitz C, Parciak T, Krefting D, Hellwig K, Haas J, Rommer PS, Stahmann A, Zettl UK. Therapy Switches in Fingolimod-Treated Patients with Multiple Sclerosis: Long-Term Experience from the German MS Registry. Neurol Ther 2022; 11:319-336. [PMID: 35020157 PMCID: PMC8857375 DOI: 10.1007/s40120-021-00320-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTIONS Therapy switches in patients with multiple sclerosis (MS) receiving treatment with fingolimod occur frequently in clinical practice but are not well represented in real-world data. The aim of this study was to identify and characterize treatment switches and reveal sociodemographic/clinical changes over time in fingolimod-treated people with MS (PwMS). METHODS Data on 2536 fingolimod-treated PwMS extracted from the German MS Registry during different time periods were analyzed (2010-2019). RESULTS Overall, 28.3% of PwMS were treatment-naïve before fingolimod initiation. Interferon beta (30.7%) was the most common pre-fingolimod treatment. Ocrelizumab (19.8%) was the most frequent subsequent treatment in the 944 patients on fingolimod who switched. Between 2010 and 2019, median disease duration at fingolimod initiation decreased from 8.5 to 7.1 years (p < 0.001), and patients taking fingolimod for ≥ 1 year after treatment initiation decreased from 89.6 to 80.5% (p < 0.001). Females (p < 0.001) and young patients (p = 0.003) showed a shorter time on fingolimod. The most frequent reason for switching was disease activity (relapse/MRI) despite treatment. The annualized relapse rate increased from 0.37 in patients on fingolimod to 0.47 after treatment cessation, decreasing to 0.19 after treatment with a subsequent disease-modifying drug (DMD) was initiated. CONCLUSION Treatment switches from fingolimod to subsequent DMDs currently occur after shorter treatment durations than 10 years ago, possibly due to the growing treatment spectrum. Planning adequate washout periods is essential and should be done on an individualized basis.
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Affiliation(s)
- Niklas Frahm
- MS Forschungs- Und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), Krausenstr. 50, 30171 Hannover, Germany
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Firas Fneish
- MS Forschungs- Und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), Krausenstr. 50, 30171 Hannover, Germany
| | - David Ellenberger
- MS Forschungs- Und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), Krausenstr. 50, 30171 Hannover, Germany
| | - Peter Flachenecker
- Neurological Rehabilitation Center Quellenhof, Kuranlagenallee 2, 75323 Bad Wildbad, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité–Universitätsmedizin Berlin, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center of Translational and Behavioral Neurosciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Tina Parciak
- Department of Medical Informatics, University Medical Center Göttingen, Von-Siebold-Str. 3, 37075 Göttingen, Germany
| | - Dagmar Krefting
- Department of Medical Informatics, University Medical Center Göttingen, Von-Siebold-Str. 3, 37075 Göttingen, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Joseph and St. Elisabeth Hospital–Ruhr University, Gudrunstr. 56, 44791 Bochum, Germany
| | - Judith Haas
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German Multiple Sclerosis Society [DMSG], Federal Association), Krausenstr. 50, 30171 Hannover, Germany
| | - Paulus S. Rommer
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Alexander Stahmann
- MS Forschungs- Und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH [MSFP]), Krausenstr. 50, 30171 Hannover, Germany
| | - Uwe K. Zettl
- Neuroimmunological Section, Department of Neurology, University Medical Center of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
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26
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Mokry C, Warnke C, Gehring K, Hegen H, Salmen A, Kraemer M, Kleiter I, Fasshauer E, Scheiderbauer J, Lühmann D, Köpke S, Berthele A, Heesen C. Implementation study of the 2021 German guideline for diagnosis and treatment of multiple sclerosis. Mult Scler Relat Disord 2021; 57:103434. [PMID: 34920249 DOI: 10.1016/j.msard.2021.103434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/19/2021] [Revised: 11/19/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In May 2021, a new guideline on the diagnosis and treatment of multiple sclerosis and related disorders was released in Germany. Since the success of a guideline depends on how it integrates into everyday clinical practice, the German Society for Neurology (DGN) has launched a multimethod implementation project. Here we report on the results based on the consultation version of the guideline. METHODS We used qualitative and quantitative data analyses to capture the nature and extent of barriers and facilitating factors to the implementation. We centered on the guideline's chapter A on diagnosis, relapse therapy, and immunotherapy of multiple sclerosis. We performed nine online focus group discussions and a web-based survey and analyzed emails and letters with comments from stakeholders and independent parties that were sent spontaneously or by invitation. RESULTS 94 neurologists answered the survey, and ≥70% agreed with the recommendations of the guideline on each major content topic. Barriers to implementation were detected in group discussions and written input. The most controversial issues of the guideline were "early treatment", "criteria for starting or switching therapy", "stepwise escalation versus early aggressive treatment", "classification of drugs into three categories of efficacy" and the scenarios on "treatment cessation". Some appreciated the highly structured recommendations, but others felt that the guideline restricts the free choice of therapy, or they were afraid of recourse claims. Some considered the guideline as too cautious regarding treatment initiation, possibly delaying necessary therapies. Others appreciated that conflicts of interests of the guideline's authoring group were minimized and thought that the new guideline is clearer, more extensive and practical. CONCLUSION In contrast to the survey, feedback in the focus group discussions and from individuals was diverse and sometimes more critical. Based on the overall feedback rate of about 250 people in relation to the number of 6500 board-certified neurologists in Germany, the overall appreciation of the guideline can only be considered as an indicator and not proof of acceptance. Results of this analysis were incorporated into several adjustments to the final guideline of 2021. Since the guideline is to be updated regularly under the auspices of a "living guideline", active interaction with users will continue to matter and help to improve it.
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Affiliation(s)
- C Mokry
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - K Gehring
- Neurocentre at Klosterforst, Itzehoe, Germany
| | - H Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - A Salmen
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - M Kraemer
- Department of Neurology, Alfried Krupp Hospital Essen, Essen, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - I Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gemeinnützige GmbH, Germany
| | - E Fasshauer
- German Multiple Sclerosis Society (DMSG), Bundesverband e.V., Hannover, Germany
| | - J Scheiderbauer
- Stiftung für Selbstbestimmung und Selbstvertretung von MS-Betroffene, Trier, Germany
| | - D Lühmann
- Department of Family medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Köpke
- Department for Nursing Sciences, Medical Faculty, University of Cologne, Cologne, Germany
| | - A Berthele
- School of Medicine, Dept. Of Neurology, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - C Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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27
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Schweitzer F, Goereci Y, Franke C, Silling S, Bösl F, Maier F, Heger E, Deiman B, Prüss H, Onur OA, Klein F, Fink GR, Di Cristanziano V, Warnke C. Cerebrospinal Fluid Analysis Post-COVID-19 Is Not Suggestive of Persistent Central Nervous System Infection. Ann Neurol 2021; 91:150-157. [PMID: 34724243 PMCID: PMC8653324 DOI: 10.1002/ana.26262] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/11/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Abstract
This study was undertaken to assess whether SARS-CoV-2 causes a persistent central nervous system infection. SARS-CoV-2-specific antibody index and SARS-CoV-2 RNA were studied in cerebrospinal fluid following COVID-19. Cerebrospinal fluid was assessed between days 1 and 30 (n = 12), between days 31 and 90 (n = 8), or later than 90 days (post-COVID-19, n = 20) after COVID-19 diagnosis. SARS-CoV-2 RNA was absent in all patients, and in none of the 20 patients with post-COVID-19 syndrome were intrathecally produced anti-SARS-CoV-2 antibodies detected. The absence of evidence of SARS-CoV-2 in cerebrospinal fluid argues against a persistent central nervous system infection as a cause of neurological or neuropsychiatric post-COVID-19 syndrome. ANN NEUROL 2021.
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Affiliation(s)
- Finja Schweitzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christiana Franke
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steffi Silling
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Fabian Bösl
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Franziska Maier
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Heger
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Birgit Deiman
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems and Department of Biomedical Engineering, Laboratory of Chemical Biology, Eindhoven University of Technology, Eindhoven, the Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Harald Prüss
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,German Center for Neurodegenerative Diseases Berlin, Berlin, Germany
| | - Oezguer A Onur
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Florian Klein
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Szepanowski F, Warnke C, Meyer Zu Hörste G, Mausberg AK, Hartung HP, Kleinschnitz C, Stettner M. Secondary Immunodeficiency and Risk of Infection Following Immune Therapies in Neurology. CNS Drugs 2021; 35:1173-1188. [PMID: 34657228 PMCID: PMC8520462 DOI: 10.1007/s40263-021-00863-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
Secondary immunodeficiencies (SIDs) are acquired conditions that may occur as sequelae of immune therapy. In recent years a number of disease-modifying therapies (DMTs) has been approved for multiple sclerosis and related disorders such as neuromyelitis optica spectrum disorders, some of which are frequently also used in- or off-label to treat conditions such as chronic inflammatory demyelinating polyneuropathy (CIDP), myasthenia gravis, myositis, and encephalitis. In this review, we focus on currently available immune therapeutics in neurology to explore their specific modes of action that might contribute to SID, with particular emphasis on their potential to induce secondary antibody deficiency. Considering evidence from clinical trials as well as long-term observational studies related to the patients' immune status and risks of severe infections, we delineate long-term anti-CD20 therapy, with the greatest data availability for rituximab, as a major risk factor for the development of SID, particularly through secondary antibody deficiency. Alemtuzumab and cladribine have relevant effects on circulating B-cell counts; however, evidence for SID mediated by antibody deficiency appears limited and urgently warrants further systematic evaluation. To date, there has been no evidence suggesting that treatment with fingolimod, dimethyl fumarate, or natalizumab leads to antibody deficiency. Risk factors predisposing to development of SID include duration of therapy, increasing age, and pre-existing low immunoglobulin (Ig) levels. Prevention strategies of SID comprise awareness of risk factors, individualized treatment protocols, and vaccination concepts. Immune supplementation employing Ig replacement therapy might reduce morbidity and mortality associated with SIDs in neurological conditions. In light of the broad range of existing and emerging therapies, the potential for SID warrants urgent consideration among neurologists and other healthcare professionals.
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Affiliation(s)
- Fabian Szepanowski
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Cologne, Germany
| | | | - Anne K Mausberg
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Medical University Vienna, Vienna, Austria
- Department of Neurology, Palacky University, Olomouc, Czech Republic
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Mark Stettner
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
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Goereci Y, Kleineberg NN, Madlener M, Neuschmelting H, Fink GR, Warnke C, Stetefeld H. Successful treatment of thromboses of major arteries after ChAdOx1 nCov-19 vaccination. Neurol Res Pract 2021; 3:52. [PMID: 34602097 PMCID: PMC8487755 DOI: 10.1186/s42466-021-00151-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/24/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
The ChAdOx1 nCoV-19 adenoviral vector vaccine to prevent contracting Covid-19 caused by infection with SARS-CoV-2 has been associated with vaccine-induced immune thrombotic thrombocytopenia (VITT) primarily leading to venous thromboses. Here, we report two cases of major arterial occlusions after ChAdOx1 nCov-19 vaccination, comprising a 42-year-old woman with thrombotic occlusion of the left carotid artery, and a 62-year-old man with occlusion of distal aorta and iliac arteries. Both were successfully treated with intravenous immunoglobulins and non-heparin anticoagulant agents leading to a beneficial short-term outcome of 6 weeks in case 1 and four months in case 2.
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Affiliation(s)
- Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Nina N Kleineberg
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Marie Madlener
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hannah Neuschmelting
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henning Stetefeld
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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30
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Frahm N, Ellenberger D, Fneish F, Christoph K, Warnke C, Zettl UK, Friedemann F, Rauser B, Stahmann A, Vogelmann V, Flachenecker P. Characteristics of secondary progressive multiple sclerosis: Disease activity and provision of care in Germany - A registry-based/multicentric cohort study. Mult Scler Relat Disord 2021; 56:103281. [PMID: 34624644 DOI: 10.1016/j.msard.2021.103281] [Citation(s) in RCA: 5] [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] [Received: 03/24/2021] [Revised: 09/02/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The tailored immunomodulatory treatment strategy for secondary progressive multiple sclerosis (SPMS) depends on disease activity. OBJECTIVE To assess the real-world situation in monitoring disease activity in SPMS patients and to identify associations of resulting subgroups with demographics, symptomatology, and therapy METHODS: This study included 4,263 SPMS patients from the German MS register (GMSR). For the classification into 'active' and 'inactive' according to relapse activity and MRI findings during the year prior to the latest clinical visit, we used the following definitions: active - gadolinium enhancing (Gd+)/new T2 lesions or ≥1 relapse, inactive - neither Gd+/new T2 lesions nor relapses. The active, inactive, and unclassifiable patients were compared in terms of clinical data, socio-demographics, symptomatology, healthcare, and DMT. RESULTS Classification was possible for 1,513 (35.5%) SPMS patients, with 467 classified as active and 1,046 as inactive. For the classification, MRI data was available for 33.2% of the 4,263 patients. Higher MRI frequencies were observed for younger patients (OR 1.22 [1.12,1.33] per 10 years) with short disease duration (OR 1.19 [1.09, 1.30] per 10 years) (p < 0.001). CONCLUSION MRI coverage was low, especially in elderly SPMS patients. Roughly one third of the SPMS patients presented markers of disease activity in the last year. Overall, the clinical differences (concerning symptomatology and care) between patients with active and inactive SPMS were small.
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Affiliation(s)
- Niklas Frahm
- MS Forschungs- und Projektentwicklungs- gGmbH (MS Research and Project Development gGmbH [MSFP]), Hannover, Germany.
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs- gGmbH (MS Research and Project Development gGmbH [MSFP]), Hannover, Germany.
| | - Firas Fneish
- MS Forschungs- und Projektentwicklungs- gGmbH (MS Research and Project Development gGmbH [MSFP]), Hannover, Germany.
| | - Kleinschnitz Christoph
- Department of Neurology and Center of Translational and Behavioral Neurosciences (C-TNBS), University Hospital Essen, Essen, Germany.
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University Hospital of Cologne, Cologne, Germany.
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany.
| | - Friedemann Friedemann
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs- gGmbH (MS Research and Project Development gGmbH [MSFP]), Hannover, Germany.
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31
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Vay SU, Werner JM, Kabbasch C, Schmidt M, Drzezga A, Fink GR, Galldiks N, Warnke C. Uncovering an Optic Nerve Sheath Meningioma Using 68Ga-DOTATATE PET/CT. Clin Nucl Med 2021; 46:e464-e465. [PMID: 33826577 DOI: 10.1097/rlu.0000000000003619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/27/2022]
Abstract
ABSTRACT A 56-year-old woman was initially diagnosed with optic neuritis. However, several "red flags" were present: older age at presentation, no multiple sclerosis suspicious findings on MRI, and negative oligoclonal bands. 68Ga-DOTATATE PET/CT confirmed the differential diagnosis of an optic sheath meningioma. Our case stresses the value of the somatostatin receptor ligand PET/CT in patients with suspected optic neuritis if the diagnostic workup does not support immune-mediated pathogenesis.
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Affiliation(s)
| | | | | | - Matthias Schmidt
- Nuclear Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne
| | - Alexander Drzezga
- Nuclear Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne
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32
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Blaschke SJ, Ellenberger D, Flachenecker P, Hellwig K, Paul F, Pöhlau D, Kleinschnitz C, Rommer PS, Rueger MA, Zettl UK, Stahmann A, Warnke C. Time to diagnosis in multiple sclerosis: Epidemiological data from the German Multiple Sclerosis Registry. Mult Scler 2021; 28:865-871. [PMID: 34449299 DOI: 10.1177/13524585211039753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
OBJECTIVE To investigate the time to diagnosis in multiple sclerosis (MS) in Germany. METHODS Analysis of real-world registry data from the German Multiple Sclerosis Registry (GMSR) and performing a primary analysis in patients where month-specific registration of the dates of onset and diagnosis was available. RESULTS As of January 2020, data of a total of 28,658 patients with MS were extracted from the GMSR, with 9836 patients included in the primary analysis. The mean time to diagnosis was shorter following the introduction of the first magnetic resonance imaging (MRI)-based McDonald criteria in 2001. This effect was most pronounced in younger adults below the age of 40 years with relapsing onset multiple sclerosis (ROMS), with a decrease from 1.9 years in 2010 to 0.9 years in 2020, while unchanged in patients aged 40-50 years (1.4 years in 2010 and 1.3 years in 2020). In the limited number of paediatric onset MS patients, the time to diagnosis was longer and did not change (2.9 years). CONCLUSION The current sensitive MRI-based diagnostic criteria have likely contributed to an earlier diagnosis of MS in Germany in younger adults aged 18-39 years with ROMS. Whether this translated to earlier initiation of disease-modifying treatment or had a beneficial effect on patient outcomes remains to be demonstrated.
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Affiliation(s)
- Stefan J Blaschke
- Department of Neurology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs-gGmbH (MSFP), German MS Register by the German MS Society, Hanover, Germany
| | | | - Kerstin Hellwig
- Katholisches Klinikum Bochum, Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Christoph Kleinschnitz
- Department of Neurology and Center of Translational and Behavioral Neurosciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Paulus S Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Maria A Rueger
- Department of Neurology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Uwe K Zettl
- Neuroimmunological Section, Department of Neurology, University of Rostock, Rostock, Germany
| | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH (MSFP), German MS Register by the German MS Society, Hanover, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
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33
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Kleineberg NN, Knauss S, Gülke E, Pinnschmidt HO, Jakob CEM, Lingor P, Hellwig K, Berthele A, Höglinger G, Fink GR, Endres M, Gerloff C, Klein C, Stecher M, Classen AY, Rieg S, Borgmann S, Hanses F, Rüthrich MM, Hower M, Tometten L, Haselberger M, Piepel C, Merle U, Dolff S, Degenhardt C, Jensen BEO, Vehreschild MJGT, Erber J, Franke C, Warnke C. Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS). Eur J Neurol 2021; 28:3925-3937. [PMID: 34411383 PMCID: PMC8444823 DOI: 10.1111/ene.15072] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 12/30/2022]
Abstract
Background and purpose During acute coronavirus disease 2019 (COVID‐19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real‐world data from a multinational registry. Methods We analyzed COVID‐19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS‐Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. Results A total of 6537 COVID‐19 patients (97.7% PCR‐confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB; 2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20–1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07–1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short‐term outcome of COVID‐19. Conclusion Our data on mostly hospitalized COVID‐19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short‐term outcome. ICB in critical COVID‐19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life‐threatening systemic viral infection.
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Affiliation(s)
- Nina N Kleineberg
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Samuel Knauss
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Eileen Gülke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Institute of Medical Biometry, Epidemiology University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin E M Jakob
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Paul Lingor
- Department of Neurology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Kerstin Hellwig
- Department of Neurology, Katholisches Klinikum Bochum, Klinikum der Ruhr Universität, Bochum, Germany
| | - Achim Berthele
- Department of Neurology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Günter Höglinger
- Department of Neurology with Clinical Neurophysiology, Hannover Medical School, Hannover, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany.,ExcellenceCluster NeuroCure, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck and University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Melanie Stecher
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Annika Y Classen
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany.,Department of Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Maria M Rüthrich
- Department of Internal Medicine II, Hematology and Medical Oncology, University Hospital Jena, Jena, Germany.,Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute, Jena, Germany
| | - Martin Hower
- Department of Internal Medicine, Klinikum Dortmund, Dortmund, Germany
| | - Lukas Tometten
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Christiane Piepel
- Department of Internal Medicine I, Hospital Bremen Central, Bremen, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johanna Erber
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, University Hospital Rechts der Isar, Munich, Germany
| | - Christiana Franke
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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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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Frenken P, Hartung HP, Olsson T, Adams O, Warnke C. Type O blood group associates with higher anti-JC polyomavirus antibody levels. Brain Behav 2021; 11:e2298. [PMID: 34291599 PMCID: PMC8413794 DOI: 10.1002/brb3.2298] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with multiple sclerosis (MS) and high anti-JC polyomavirus (JCPyV) antibodies in blood have an increased risk for the development of progressive multifocal leukoencephalopathy (PML) when treated for MS. To test the hypothesis that type O blood group associates with anti-JCPyV antibody levels and the risk of developing PML, we characterized ABO blood group antigen on blood samples of 62 patients with PML, and 64 MS controls without PML. METHODS Monocentric retrospective cohort study. Anti-JCPyV antibody levels in arbitrary units (AU) were determined in sera using an ELISA-based method, and blood group specific antibodies using standardised test erythrocytes. RESULTS Anti-JCPyV antibody levels were higher in individuals with blood group O compared with all other blood groups (O: median AU: 129; not O: median AU: 53; p = .005). This association was not observed for the closely related BK virus. Of the 62 patients with PML, 29 (47%, 95% confidence interval (CI) 35%-59%) were of blood group O, which showed a nonsignificant trend to differ from the expected distribution in the German population (41%), and the MS controls studied (36%, 95% CI 25%-48%). CONCLUSION The ABO blood group O antigen associates with higher anti-JCPyV antibody levels and may impact the risk of the later development of PML. The overrepresentation of blood group O in cases with PML was in line with a previous publication. Larger studies are warranted to assess a potential value of host genetic markers, such as the ABO status, for PML risk prediction during immunotherapy.
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Affiliation(s)
- Pia Frenken
- Institute for Virologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tomas Olsson
- Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Ortwin Adams
- Institute for Virologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Neurology, University Hospital of Cologne, Cologne, Germany
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Adler C, Onur OA, Braumann S, Gramespacher H, Bittner S, Falk S, Fink GR, Baldus S, Warnke C. Absolute serum neurofilament light chain levels and its early kinetics predict brain injury after out-of-hospital cardiac arrest. J Neurol 2021; 269:1530-1537. [PMID: 34328545 PMCID: PMC8857108 DOI: 10.1007/s00415-021-10722-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/10/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Objectives To test if the early kinetics of neurofilament light (NFL) in blood adds to the absolute values of NFL in the prediction of outcome, and to evaluate if NFL can discriminate individuals with severe hypoxic–ischemic brain injury (sHIBI) from those with other causes of poor outcome after out-of-hospital cardiac arrest (OHCA). Design and setting Monocentric retrospective study involving individuals following non-traumatic OHCA between April 2014 and April 2016. NFL concentrations were determined on a SiMoA HD-1 device using NF-Light Advantage Kits. Participants Of 73 patients screened, 53 had serum samples available for NFL measurement at three timepoints (after 3, 24, and 48 h of admission). Of these 53 individuals, 43.4% had poor neurologic outcome at discharge as assessed by Glasgow–Pittsburgh cerebral performance categories, and, according to a current prognostication algorithm, poor outcome due to sHIBI in 20.7%. Main outcome measure Blood NFL and its early kinetics for prognostication of outcome and prediction of sHIBI after OHCA. Results An absolute NFL > 508.6 pg/ml 48 h after admission, or a change in NFL > 494 pg/ml compared with an early baseline value predicted outcome, and discriminated severe sHIBI from other causes of unfavorable outcome after OHCA with high sensitivity (100%, 95%CI 70.0–100%) and specificity (91.7%, 95%CI 62.5–100%). Conclusions Not only absolute values of NFL, but also early changes in NFL predict the outcome following OHCA, and may differentiate sHIBI from other causes of poor outcome after OHCA with high sensitivity and specificity. Our study adds to published data, overall corroborating that NFL measured in blood should be implemented in prognostication algorithms used in clinical routine.
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Affiliation(s)
- Christoph Adler
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, 50937, Cologne, Germany.,Fire Department City of Cologne, Institute for Security Science and Rescue Technology, Cologne, Germany
| | - Oezguer A Onur
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Simon Braumann
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, 50937, Cologne, Germany
| | - Hannes Gramespacher
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Steffen Falk
- Department of Neurology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, 50937, Cologne, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
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Rolfes L, Pawlitzki M, Pfeuffer S, Nelke C, Lux A, Pul R, Kleinschnitz C, Kleinschnitz K, Rogall R, Pape K, Bittner S, Zipp F, Warnke C, Goereci Y, Schroeter M, Ingwersen J, Aktas O, Klotz L, Ruck T, Wiendl H, Meuth SG. Ocrelizumab Extended Interval Dosing in Multiple Sclerosis in Times of COVID-19. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/5/e1035. [PMID: 34261812 PMCID: PMC8362352 DOI: 10.1212/nxi.0000000000001035] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/22/2021] [Indexed: 12/26/2022]
Abstract
Objective To evaluate the clinical consequences of extended interval dosing (EID) of ocrelizumab in relapsing-remitting multiple sclerosis (RRMS) during the coronavirus disease 2019 (COVID-19) pandemic. Methods In our retrospective, multicenter cohort study, we compared patients with RRMS on EID (defined as ≥4-week delay of dose interval) with a control group on standard interval dosing (SID) at the same period (January to December 2020). Results Three hundred eighteen patients with RRMS were longitudinally evaluated in 5 German centers. One hundred sixteen patients received ocrelizumab on EID (median delay [interquartile range 8.68 [5.09–13.07] weeks). Three months after the last ocrelizumab infusion, 182 (90.1%) patients following SID and 105 (90.5%) EID patients remained relapse free (p = 0.903). Three-month confirmed progression of disability was observed in 18 SID patients (8.9%) and 11 EID patients (9.5%, p = 0.433). MRI progression was documented in 9 SID patients (4.5%) and 8 EID patients (6.9%) at 3-month follow-up (p = 0.232). Multivariate logistic regression showed no association between treatment regimen and no evidence of disease activity status at follow-up (OR: 1.266 [95% CI: 0.695–2.305]; p = 0.441). Clinical stability was accompanied by persistent peripheral CD19+ B-cell depletion in both groups (SID vs EID: 82.6% vs 83.3%, p = 0.463). Disease activity in our cohort was not associated with CD19+ B-cell repopulation. Conclusion Our data support EID of ocrelizumab as potential risk mitigation strategy in times of the COVID-19 pandemic. Classification of Evidence This study provides Class IV evidence that for patients with RRMS, an EID of at least 4 weeks does not diminish effectiveness of ocrelizumab.
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Affiliation(s)
- Leoni Rolfes
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Marc Pawlitzki
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Steffen Pfeuffer
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Christopher Nelke
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Anke Lux
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Refik Pul
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Christoph Kleinschnitz
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Konstanze Kleinschnitz
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Rebeca Rogall
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Katrin Pape
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Stefan Bittner
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Frauke Zipp
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Clemens Warnke
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Yasemin Goereci
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Michael Schroeter
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Jens Ingwersen
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Orhan Aktas
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Luisa Klotz
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Tobias Ruck
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Heinz Wiendl
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany
| | - Sven G Meuth
- From the Department of Neurology with Institute of Translational Neurology (L.R., M.P., S.P., C.N., L.K., H.W.), University Hospital Muenster, Germany; Institute for Biometrics and Bioinformatic (A.L.), Otto-von-Guericke University, Magdeburg, Germany; Department for Neurology (R.P., C.K., K.K., R.R.), University Hospital Essen, Germany; Focus Program Translational Neurosciences (FTN) and Immunology (FZI) (K.P., S.B., F.Z.), Rhine Main Neuroscience Network (rmn2), Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Department of Neurology (C.W., Y.G., M.S.), University Hospital Cologne, Germany; and Department of Neurology (J.I., O.A., T.R., S.G.M.), Heinrich-Heine University, Duesseldorf, Germany.
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Schweitzer F, Laurent S, Fink GR, Barnett MH, Hartung HP, Warnke C. Effects of disease-modifying therapy on peripheral leukocytes in patients with multiple sclerosis. J Neurol 2021; 268:2379-2389. [PMID: 32036423 PMCID: PMC8217029 DOI: 10.1007/s00415-019-09690-6] [Citation(s) in RCA: 19] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022]
Abstract
Modern disease-modifying therapies (DMTs) in multiple sclerosis (MS) have variable modes of action and selectively suppress or modulate the immune system. In this review, we summarize the predicted and intended as well as unwanted adverse effects on leukocytes in peripheral blood as a result of treatment with DMTs for MS. We link changes in laboratory tests to the possible therapeutic risks that include secondary autoimmunity, infections, and impaired response to vaccinations. Profound knowledge of the intended effects on leukocyte counts, in particular lymphocytes, explained by the mode of action, and adverse effects which may require additional laboratory and clinical vigilance or even drug discontinuation, is needed when prescribing DMTs to treat patients with MS.
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Affiliation(s)
- F Schweitzer
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - S Laurent
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - G R Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Michael H Barnett
- Department of Neurology, Royal Prince Alfred Hospital, and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - H P Hartung
- Department of Neurology, Medical Faculty, and Center for Neurology and Neuropsychiatry, LVR Klinikum, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - C Warnke
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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Ohle LM, Ellenberger D, Flachenecker P, Friede T, Haas J, Hellwig K, Parciak T, Warnke C, Paul F, Zettl UK, Stahmann A. Chances and challenges of a long-term data repository in multiple sclerosis: 20th birthday of the German MS registry. Sci Rep 2021; 11:13340. [PMID: 34172792 PMCID: PMC8233364 DOI: 10.1038/s41598-021-92722-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 03/31/2021] [Accepted: 06/15/2021] [Indexed: 01/25/2023] Open
Abstract
In 2001, the German Multiple Sclerosis Society, facing lack of data, founded the German MS Registry (GMSR) as a long-term data repository for MS healthcare research. By the establishment of a network of participating neurological centres of different healthcare sectors across Germany, GMSR provides observational real-world data on long-term disease progression, sociodemographic factors, treatment and the healthcare status of people with MS. This paper aims to illustrate the framework of the GMSR. Structure, design and data quality processes as well as collaborations of the GMSR are presented. The registry’s dataset, status and results are discussed. As of 08 January 2021, 187 centres from different healthcare sectors participate in the GMSR. Following its infrastructure and dataset specification upgrades in 2014, more than 196,000 visits have been recorded relating to more than 33,000 persons with MS (PwMS). The GMSR enables monitoring of PwMS in Germany, supports scientific research projects, and collaborates with national and international MS data repositories and initiatives. With its recent pharmacovigilance extension, it aligns with EMA recommendations and helps to ensure early detection of therapy-related safety signals.
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Affiliation(s)
- Lisa-Marie Ohle
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Projectdevelopment gGmbH [MSFP]), Krausenstr 50, 30171, Hannover, Germany
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Projectdevelopment gGmbH [MSFP]), Krausenstr 50, 30171, Hannover, Germany
| | | | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Judith Haas
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German Multiple Sclerosis Society, Federal Association), Hannover, Germany
| | - Kerstin Hellwig
- Department of Neurology, Katholisches Klinikum, St. Joseph Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tina Parciak
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University Medical Center Rostock, Rostock, Germany
| | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Projectdevelopment gGmbH [MSFP]), Krausenstr 50, 30171, Hannover, Germany.
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40
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Garcia Borrega J, Heindel K, Göreci Y, Warnke C, Onur OA, Kochanek M, Schub N, Ayuk F, Wichmann D, Böll B. [Erratum to: Toxicity after chimeric antigen receptor T-cell therapy]. Internist (Berl) 2021; 62:694. [PMID: 34115144 DOI: 10.1007/s00108-021-01087-w] [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: 12/01/2022]
Affiliation(s)
- Jorge Garcia Borrega
- Klinik I für Innere Medizin, Hämatologie-Onkologie und Internistische Intensivmedizin, Klinikum der Universität Köln, Köln, Deutschland
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Klinikum der Universität zu Köln, Köln, Deutschland
| | - Katrin Heindel
- Klinik I für Innere Medizin, Hämatologie-Onkologie und Internistische Intensivmedizin, Klinikum der Universität Köln, Köln, Deutschland
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Klinikum der Universität zu Köln, Köln, Deutschland
| | - Yasemin Göreci
- Klinik für Neurologie, Universitätsklinikum Köln, Köln, Deutschland
| | - Clemens Warnke
- Klinik für Neurologie, Universitätsklinikum Köln, Köln, Deutschland
| | - Oezguer A Onur
- Klinik für Neurologie, Universitätsklinikum Köln, Köln, Deutschland
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Hämatologie-Onkologie und Internistische Intensivmedizin, Klinikum der Universität Köln, Köln, Deutschland
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Klinikum der Universität zu Köln, Köln, Deutschland
| | - Natalie Schub
- Medizinische Klinik II, Universitätsklinik Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Francis Ayuk
- Interdisziplinäre Klinik und Poliklinik für Stammzelltransplantation, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Dominic Wichmann
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Boris Böll
- Klinik I für Innere Medizin, Hämatologie-Onkologie und Internistische Intensivmedizin, Klinikum der Universität Köln, Köln, Deutschland.
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Klinikum der Universität zu Köln, Köln, Deutschland.
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Garcia Borrega J, Heindel K, Göreci Y, Warnke C, Onur OA, Kochanek M, Schub N, Ayuk F, Wichmann D, Böll B. [Toxicity after chimeric antigen receptor T-cell therapy : Overview and management of early and late onset side effects]. Internist (Berl) 2021; 62:611-619. [PMID: 34032877 DOI: 10.1007/s00108-021-01046-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The transfusion of chimeric antigen receptor (CAR) T‑cells has become established as a new treatment option in oncology; however, this is regularly associated with immune-mediated side effects, which can also run a severe course and necessitate a specific treatment and intensive medical treatment. MATERIAL AND METHODS A literature review was carried out on CAR T-cell therapy, toxicities and the management of side effects. RESULTS The cytokine release syndrome (CRS) and the immune effector cell-associated neurotoxicity syndrome (ICANS) regularly occur shortly after CAR T-cell treatment. The symptoms of CRS can range from mild flu-like symptoms to multiorgan failure. In addition to mild symptoms, such as disorientation and aphasia, ICANS can also lead to convulsive seizures and brain edema. The management of CRS and ICANS is based on the severity according to the grading of the American Society for Transplantation and Cellular Therapy (ASTCT). Tocilizumab and corticosteroids are recommended for CRS and corticosteroids are used for ICANS. In the further course persisting hypogammaglobulinemia and cytopenia are frequent even months after the initial treatment and promote infections even months after CAR T‑cell therapy. DISCUSSION Potentially severe complications regularly occur after CAR T-cell therapy. An interdisciplinary cooperation between intensive care physicians, hematologists, neurologists and specialists in other disciplines is of decisive importance for the optimal care of patients after CAR T‑cell therapy.
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Affiliation(s)
- Jorge Garcia Borrega
- Klinik I für Innere Medizin, Hämatologie-Onkologie und Internistische Intensivmedizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Klinikum der Universität zu Köln, Köln, Deutschland
| | - Katrin Heindel
- Klinik I für Innere Medizin, Hämatologie-Onkologie und Internistische Intensivmedizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Klinikum der Universität zu Köln, Köln, Deutschland
| | - Yasemin Göreci
- Klinik für Neurologie, Universitätsklinikum Köln, Köln, Deutschland
| | - Clemens Warnke
- Klinik für Neurologie, Universitätsklinikum Köln, Köln, Deutschland
| | - Oezguer A Onur
- Klinik für Neurologie, Universitätsklinikum Köln, Köln, Deutschland
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Hämatologie-Onkologie und Internistische Intensivmedizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Klinikum der Universität zu Köln, Köln, Deutschland
| | - Natalie Schub
- Medizinische Klinik II, Universitätsklinik Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Francis Ayuk
- Interdisziplinäre Klinik und Poliklinik für Stammzelltransplantation, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Dominic Wichmann
- Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Boris Böll
- Klinik I für Innere Medizin, Hämatologie-Onkologie und Internistische Intensivmedizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland. .,Klinik I für Innere Medizin, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Klinikum der Universität zu Köln, Köln, Deutschland.
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Joisten N, Rademacher A, Warnke C, Proschinger S, Schenk A, Walzik D, Knoop A, Thevis M, Steffen F, Bittner S, Gonzenbach R, Kool J, Bloch W, Bansi J, Zimmer P. Exercise Diminishes Plasma Neurofilament Light Chain and Reroutes the Kynurenine Pathway in Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/3/e982. [PMID: 33782190 PMCID: PMC8054957 DOI: 10.1212/nxi.0000000000000982] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine acute (single-bout) and training effects of high-intensity interval training (HIIT) vs standard exercise therapy (moderate continuous training [MCT]) on plasma neurofilament light chain (pNfL) and kynurenine (KYN) pathway of tryptophan degradation metabolites in persons with multiple sclerosis (pwMS). METHODS Sixty-nine pwMS (Expanded Disability Status Scale score 3.0-6.0) were randomly assigned to a HIIT or an MCT group. Changes in pNfL and KYN pathway metabolites measured in blood plasma were assessed before, after, and 3 hours after the first training session as well as after the 3-week training intervention. RESULTS Acute exercise reduced pNfL and increased the KYN pathway flux toward the neuroprotective kynurenic acid (KA). Changes in pNfL correlated positively with changes in KA and negatively with the quinolinic acid-to-KA ratio. HIIT consistently led to greater effects than MCT. Following the 3-week training intervention, the KYN pathway was activated in HIIT compared with MCT. CONCLUSION Future studies and clinical assessments of pNfL should consider acute exercise as confounding factor for measurement reliability. Moreover, exercise-induced KYN pathway rerouting might mediate neuroprotection, potentially underlying the benefits in rehabilitation for pwMS. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that acute HIIT diminishes pNfL and increases KA levels, and 3 weeks of HIIT activate the KYN pathway in pwMS. TRIAL REGISTRATION INFORMATION Clinical trial registration number: NCT03652519.
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Affiliation(s)
- Niklas Joisten
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Annette Rademacher
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Clemens Warnke
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Sebastian Proschinger
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Alexander Schenk
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - David Walzik
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Andre Knoop
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Mario Thevis
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Falk Steffen
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Stefan Bittner
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Roman Gonzenbach
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Jan Kool
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Wilhelm Bloch
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Jens Bansi
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland
| | - Philipp Zimmer
- From the Department of "Performance and Health (Sports Medicine)" (N.J., A.S., D.W., P.Z.), Institute of Sport and Sport Science, Technical University Dortmund; Department for Molecular and Cellular Sports Medicine (A.R., S.P., W.B.), Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne; Department of Neurology (C.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Preventive Doping Research/Institute of Biochemistry (A.K., M.T.), German Sport University Cologne; Department of Neurology (F.S., S.B.), Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University, Germany; and Department of Neurology (R.G., J.K., J.B.), Clinics of Valens, Rehabilitation Centre Valens, Switzerland.
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Ellenberger D, Flachenecker P, Fneish F, Frahm N, Hellwig K, Paul F, Stahmann A, Warnke C, Rommer PS, Zettl UK. Aggressive multiple sclerosis: a matter of measurement and timing. Brain 2021; 143:e97. [PMID: 33175163 PMCID: PMC7719018 DOI: 10.1093/brain/awaa306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- David Ellenberger
- German MS-Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hanover, Germany
| | | | - Firas Fneish
- German MS-Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hanover, Germany
| | - Niklas Frahm
- German MS-Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hanover, Germany.,Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef-Hospital, University clinic of the Ruhr-University Bochum, Bochum, Germany
| | - Friedemann Paul
- Charité - Universitatsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, NeuroCure Clinical Research Center NCRC and Experimental and Clinical Research Center ECRC, Berlin, Germany
| | - Alexander Stahmann
- German MS-Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hanover, Germany
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Paulus S Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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44
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Eckardt C, Vay SU, Warnke C, Flossdorf P, Weinert M. [Dysphagia in Multiple Sclerosis - an underestimated symptom?]. Fortschr Neurol Psychiatr 2021; 89:168-177. [PMID: 33571999 DOI: 10.1055/a-1268-8070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is estimated that 240,000 people suffer from multiple sclerosis in Germany. In addition to sensory, motor, vegetative, and neuropsychological functional deficits, dysphagia is a highly relevant and disabling, although not well studied symptom of MS. OBJECTIVES The purpose of this article is to provide an overview of the scientific background, increase awareness of the symptoms of dysphagia, and to introduce diagnostic tools for its management, overall aiming at alleviating symptoms of dysphagia in persons with MS, and improving their quality of life. METHODS A structured literature review was conducted of what is currently known on the development, manifestation, diagnosis and treatment options for MS-related dysphagia. Due to the lack of class 1 evidence, in particular for diagnosis and treatment options of dysphagia, also smaller studies or pilot projects were included and discussed in this review. RESULTS Data from imaging methods such as Flexible Endoscopic Evaluation of Swallowing and Videofluoroscopic Swallowing Evaluation enabled the diagnosis. There was a high variablity in the reported frequency of dysphagia in published studies, largely related to differences in methodology to evaluate the swallowing (from 38 % up to 81 %). Overall, dysphagia as a symptom of multiple sclerosis was underestimated at the patient and the physician level. According to current data from the German MS register, specific treatments were only carried out in 30% of the affected patients.
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Affiliation(s)
| | | | | | - Pia Flossdorf
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
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45
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Garcia Borrega J, Heindel K, Kochanek M, Warnke C, Stemmler J, von Bergwelt-Baildon M, Liebregts T, Böll B. [The critically ill CAR T-cell patient : Relevant toxicities, their management and challenges in critical care]. Med Klin Intensivmed Notfmed 2021; 116:121-128. [PMID: 33564900 DOI: 10.1007/s00063-021-00780-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/19/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND CAR‑T cell therapy has been implemented as clinical routine treatment option during the last decade. Despite beneficial outcomes in many patients severe side effects and toxicities are seen regularly that can compromise the treatment success. METHODS Literature review: CAR T‑cell therapy, toxicities and their management RESULTS: The cytokine release syndrome (CRS) and the immune effector cell-associated neurotoxicity syndrome (ICANS) are seen regularly after CAR T‑cell treatment. CRS symptoms can range from mild flu-like symptoms to severe organ dysfunction requiring vasopressor therapy, mechanical ventilation and other intensive care support. ICANS symptoms usually develop later and can range from disorientation and aphasia to potentially life-threatening brain edema. IL‑6 is a key factor in the pathophysiology of CRS. The pathophysiology of ICANS is not fully understood. The ASTCT consensus grading is recommended to stratify patients for different management options. An interdisciplinary team including hematologist, intensivist, neurologists and other specialties is needed to optimize the treatment. DISCUSSION Severe and potentially life-threatening toxicities occur regularly after CAR T‑cell therapy. Treatment strategies for CRS and ICANS still need to be evaluated prospectively. Due to the increasing number of patients treated with CAR T‑cells the number of patients requiring temporary intensive care management due to CRS and ICANS is expected to increase during the next years.
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Affiliation(s)
- J Garcia Borrega
- Klinik I für Innere Medizin, Schwerpunkt Internistische Intensivmedizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Klinik I für Innere Medizin, Klinikum der Universität zu Köln, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Köln, Deutschland
| | - K Heindel
- Klinik I für Innere Medizin, Schwerpunkt Internistische Intensivmedizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Klinik I für Innere Medizin, Klinikum der Universität zu Köln, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Köln, Deutschland
| | - M Kochanek
- Klinik I für Innere Medizin, Schwerpunkt Internistische Intensivmedizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Klinik I für Innere Medizin, Klinikum der Universität zu Köln, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Köln, Deutschland
| | - C Warnke
- Klinik für Neurologie, Klinikum der Universität Köln, Köln, Deutschland
| | - J Stemmler
- Medizinische Klinik und Poliklinik III, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - M von Bergwelt-Baildon
- Medizinische Klinik und Poliklinik III, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - T Liebregts
- Klinik für Innere Medizin V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - B Böll
- Klinik I für Innere Medizin, Schwerpunkt Internistische Intensivmedizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland. .,Klinik I für Innere Medizin, Klinikum der Universität zu Köln, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf (CIO ABCD), Köln, Deutschland.
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Wijburg MT, Warnke C, McGuigan C, Koralnik IJ, Barkhof F, Killestein J, Wattjes MP. Pharmacovigilance during treatment of multiple sclerosis: early recognition of CNS complications. J Neurol Neurosurg Psychiatry 2021; 92:177-188. [PMID: 33229453 DOI: 10.1136/jnnp-2020-324534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
An increasing number of highly effective disease-modifying therapies for people with multiple sclerosis (MS) have recently gained marketing approval. While the beneficial effects of these drugs in terms of clinical and imaging outcome measures is welcomed, these therapeutics are associated with substance-specific or group-specific adverse events that include severe and fatal complications. These adverse events comprise both infectious and non-infectious complications that can occur within, or outside of the central nervous system (CNS). Awareness and risk assessment strategies thus require interdisciplinary management, and robust clinical and paraclinical surveillance strategies. In this review, we discuss the current role of MRI in safety monitoring during pharmacovigilance of patients treated with (selective) immune suppressive therapies for MS. MRI, particularly brain MRI, has a pivotal role in the early diagnosis of CNS complications that potentially are severely debilitating and may even be lethal. Early recognition of such CNS complications may improve functional outcome and survival, and thus knowledge on MRI features of treatment-associated complications is of paramount importance to MS clinicians, but also of relevance to general neurologists and radiologists.
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Affiliation(s)
- Martijn T Wijburg
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands .,Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Clemens Warnke
- Department of Neurology, University Hospital Köln, University of Cologne, Köln, Germany.,Department of Neurology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Christopher McGuigan
- Department of Neurology, St Vincent's University Hospital & University College Dublin, Dublin, Ireland
| | - Igor J Koralnik
- Department of Neurological Sciences, Division of Neuroinfectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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Chen X, Laurent S, Onur OA, Kleineberg NN, Fink GR, Schweitzer F, Warnke C. A systematic review of neurological symptoms and complications of COVID-19. J Neurol 2021; 268:392-402. [PMID: 32691236 PMCID: PMC7370630 DOI: 10.1007/s00415-020-10067-3] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To study the frequency of neurological symptoms and complications in COVID-19 patients in a systematic review of the literature. METHODS Relevant studies were identified through electronic explorations of PubMed, medRxiv, and bioRxiv. Besides, three Chinese databases were searched. A snowballing method searching the bibliographies of the retrieved references was applied to identify potentially relevant articles. Articles published within 1 year prior to April 20th, 2020, were screened with no language restriction imposed. Databases were searched for terms related to SARS-CoV-2/COVID-19 and neurological manifestations, using a pre-established protocol registered on the International Prospective Register of Systematic Reviews database (ID: CRD42020187994). RESULTS A total of 2441 articles were screened for relevant content, of which 92 full-text publications were included in the analyses of neurological manifestations of COVID-19. Headache, dizziness, taste and smell dysfunctions, and impaired consciousness were the most frequently described neurological symptoms, the latter more often among patients with a severe or critical disease course. To date, only smaller cohort studies or single cases have reported cerebrovascular events, seizures, meningoencephalitis, and immune-mediated neurological diseases, not suitable for quantitative analysis. CONCLUSION The most frequent neurological symptoms reported in association with COVID-19 are non-specific for the infection with SARS-CoV-2. Although SARS-CoV-2 may have the potential to gain direct access to the nervous system, so far, SARS-CoV-2 was detected in the cerebrospinal fluid in two cases only. Standardized international registries are needed to clarify the clinical relevance of the neuropathogenicity of SARS-CoV-2 and to elucidate a possible impact of SARS-CoV-2 infection on common neurological disease, such as Alzheimer's, Parkinson's disease or multiple sclerosis.
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Affiliation(s)
- Xiangliang Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Sarah Laurent
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Oezguer A Onur
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Strasse, Jülich, 52425, Germany
| | - Nina N Kleineberg
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Strasse, Jülich, 52425, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Strasse, Jülich, 52425, Germany
| | - Finja Schweitzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
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Möhn N, Luo Y, Skripuletz T, Schwenkenbecher P, Ladwig A, Warnke C, Meuth SG, Wiendl H, Gross CC, Schröder C, Haghikia A, Stangel M. Cerebrospinal fluid analysis in 108 patients with progressive multifocal leukoencephalopathy. Fluids Barriers CNS 2020; 17:65. [PMID: 33109245 PMCID: PMC7590675 DOI: 10.1186/s12987-020-00227-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 07/21/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is caused by an opportunistic infection with JC polyoma virus (JCPyV) and mainly affects immunocompromised patients. It leads to pronounced demyelination of the central nervous system (CNS) resulting in severe disability or even death. Detection of JCPyV DNA in the cerebrospinal fluid (CSF) is usually accepted as proof for the diagnosis of PML. Routine CSF parameters, like CSF cell count, protein concentration, Qalbumin, or intrathecal immunoglobulin synthesis are mostly considered normal. However, this has not been investigated systematically. METHODS We analyzed routine CSF parameters in a cohort of 108 PML patients that were treated at four different neurological centers in Germany. The patients exhibited different underlying conditions with natalizumab-treated multiple sclerosis (n = 54) and human immunodeficiency virus (HIV)-infection (n = 25) being the most frequent. The data were collected at the respective centers in accordance with local requirements and then jointly analyzed. The total PML cohort was compared with a control group of patients with normal pressure hydrocephalus (NPH) and idiopathic intracranial hypertension (IIH). Multiple sclerosis and HIV patients were additionally compared with their own non-PML control groups. RESULTS The PML group showed an elevated cell count (p < 0.001) compared to the control group, however, this effect was mainly driven by HIV-PML patients. This subgroup also demonstrated a significantly higher proportion of patients with a disturbed blood-CSF-barrier function. CONCLUSIONS This comprehensive, retrospective study on CSF diagnostic analysis in PML patients provides insight into the CSF of those patients. It demonstrates that CSF composition in PML patients may be specific for the underlying condition that predisposes for the development of PML and thus data have to be interpreted in this context.
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Affiliation(s)
- Nora Möhn
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Yi Luo
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Skripuletz
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Philipp Schwenkenbecher
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Anne Ladwig
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Christoph Schröder
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, Germany
| | - Aiden Haghikia
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, Germany
| | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Goereci Y, Schweitzer F, Wellstein A, Silling S, Borchmann S, Tresckow B, Adams O, Martin R, Schlamann M, Schroeter M, Fink GR, Wattjes MP, Warnke C. Clearance of JC polyomavirus from cerebrospinal fluid following treatment with interleukin‐2 and pembrolizumab in an individual with progressive multifocal leukoencephalopathy and no underlying immune deficiency syndrome. Eur J Neurol 2020; 27:2375-2377. [DOI: 10.1111/ene.14435] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/26/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Y. Goereci
- Department of Neurology Medical Faculty University Hospital of Köln Köln Germany
| | - F. Schweitzer
- Department of Neurology Medical Faculty University Hospital of Köln Köln Germany
| | - A. Wellstein
- Georgetown University Medical School Washington DC USA
| | - S. Silling
- Institute for Virology Medical Faculty University Hospital of Köln KölnGermany
| | - S. Borchmann
- Department of Haematology Medical Faculty University Hospital of Köln KölnGermany
| | - B. Tresckow
- Department of Haematology University Hospital Essen EssenGermany
| | - O. Adams
- Institute for Virology Medical Faculty University Hospital of Düsseldorf Düsseldorf Germany
| | - R. Martin
- Department of Neurology University Medical Center Zürich Zürich Switzerland
| | - M. Schlamann
- Department of Radiology Medical Faculty University Hospital of Köln KölnGermany
| | - M. Schroeter
- Department of Neurology Medical Faculty University Hospital of Köln Köln Germany
| | - G. R. Fink
- Department of Neurology Medical Faculty University Hospital of Köln Köln Germany
- Cognitive Neuroscience Institute of Neuroscience and Medicine (INM‐3) Research Centre Jülich JülichGermany
| | - M. P. Wattjes
- Department of Diagnostic and Interventional Neuroradiology Hannover Medical School Hannover Germany
| | - C. Warnke
- Department of Neurology Medical Faculty University Hospital of Köln Köln Germany
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50
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Hässler S, Bachelet D, Duhaze J, Szely N, Gleizes A, Hacein-Bey Abina S, Aktas O, Auer M, Avouac J, Birchler M, Bouhnik Y, Brocq O, Buck-Martin D, Cadiot G, Carbonnel F, Chowers Y, Comabella M, Derfuss T, De Vries N, Donnellan N, Doukani A, Guger M, Hartung HP, Kubala Havrdova E, Hemmer B, Huizinga T, Ingenhoven K, Hyldgaard-Jensen PE, Jury EC, Khalil M, Kieseier B, Laurén A, Lindberg R, Loercher A, Maggi E, Manson J, Mauri C, Mohand Oumoussa B, Montalban X, Nachury M, Nytrova P, Richez C, Ryner M, Sellebjerg F, Sievers C, Sikkema D, Soubrier M, Tourdot S, Trang C, Vultaggio A, Warnke C, Spindeldreher S, Dönnes P, Hickling TP, Hincelin Mery A, Allez M, Deisenhammer F, Fogdell-Hahn A, Mariette X, Pallardy M, Broët P. Clinicogenomic factors of biotherapy immunogenicity in autoimmune disease: A prospective multicohort study of the ABIRISK consortium. PLoS Med 2020; 17:e1003348. [PMID: 33125391 PMCID: PMC7598520 DOI: 10.1371/journal.pmed.1003348] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/18/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Biopharmaceutical products (BPs) are widely used to treat autoimmune diseases, but immunogenicity limits their efficacy for an important proportion of patients. Our knowledge of patient-related factors influencing the occurrence of antidrug antibodies (ADAs) is still limited. METHODS AND FINDINGS The European consortium ABIRISK (Anti-Biopharmaceutical Immunization: prediction and analysis of clinical relevance to minimize the RISK) conducted a clinical and genomic multicohort prospective study of 560 patients with multiple sclerosis (MS, n = 147), rheumatoid arthritis (RA, n = 229), Crohn's disease (n = 148), or ulcerative colitis (n = 36) treated with 8 different biopharmaceuticals (etanercept, n = 84; infliximab, n = 101; adalimumab, n = 153; interferon [IFN]-beta-1a intramuscularly [IM], n = 38; IFN-beta-1a subcutaneously [SC], n = 68; IFN-beta-1b SC, n = 41; rituximab, n = 31; tocilizumab, n = 44) and followed during the first 12 months of therapy for time to ADA development. From the bioclinical data collected, we explored the relationships between patient-related factors and the occurrence of ADAs. Both baseline and time-dependent factors such as concomitant medications were analyzed using Cox proportional hazard regression models. Mean age and disease duration were 35.1 and 0.85 years, respectively, for MS; 54.2 and 3.17 years for RA; and 36.9 and 3.69 years for inflammatory bowel diseases (IBDs). In a multivariate Cox regression model including each of the clinical and genetic factors mentioned hereafter, among the clinical factors, immunosuppressants (adjusted hazard ratio [aHR] = 0.408 [95% confidence interval (CI) 0.253-0.657], p < 0.001) and antibiotics (aHR = 0.121 [0.0437-0.333], p < 0.0001) were independently negatively associated with time to ADA development, whereas infections during the study (aHR = 2.757 [1.616-4.704], p < 0.001) and tobacco smoking (aHR = 2.150 [1.319-3.503], p < 0.01) were positively associated. 351,824 Single-Nucleotide Polymorphisms (SNPs) and 38 imputed Human Leukocyte Antigen (HLA) alleles were analyzed through a genome-wide association study. We found that the HLA-DQA1*05 allele significantly increased the rate of immunogenicity (aHR = 3.9 [1.923-5.976], p < 0.0001 for the homozygotes). Among the 6 genetic variants selected at a 20% false discovery rate (FDR) threshold, the minor allele of rs10508884, which is situated in an intron of the CXCL12 gene, increased the rate of immunogenicity (aHR = 3.804 [2.139-6.764], p < 1 × 10-5 for patients homozygous for the minor allele) and was chosen for validation through a CXCL12 protein enzyme-linked immunosorbent assay (ELISA) on patient serum at baseline before therapy start. CXCL12 protein levels were higher for patients homozygous for the minor allele carrying higher ADA risk (mean: 2,693 pg/ml) than for the other genotypes (mean: 2,317 pg/ml; p = 0.014), and patients with CXCL12 levels above the median in serum were more prone to develop ADAs (aHR = 2.329 [1.106-4.90], p = 0.026). A limitation of the study is the lack of replication; therefore, other studies are required to confirm our findings. CONCLUSION In our study, we found that immunosuppressants and antibiotics were associated with decreased risk of ADA development, whereas tobacco smoking and infections during the study were associated with increased risk. We found that the HLA-DQA1*05 allele was associated with an increased rate of immunogenicity. Moreover, our results suggest a relationship between CXCL12 production and ADA development independent of the disease, which is consistent with its known function in affinity maturation of antibodies and plasma cell survival. Our findings may help physicians in the management of patients receiving biotherapies.
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Affiliation(s)
- Signe Hässler
- CESP, INSERM UMR 1018, Faculty of Medicine, Paris-Sud University, UVSQ, Paris-Saclay University, Villejuif, France
- Sorbonne Université, INSERM UMR 959, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi), Paris, France
- * E-mail: (SH); (PB)
| | - Delphine Bachelet
- CESP, INSERM UMR 1018, Faculty of Medicine, Paris-Sud University, UVSQ, Paris-Saclay University, Villejuif, France
- Department of Biostatistical Epidemiology and Clinical Research, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris AP-HP.Nord, INSERM CIC-EC 1425, Paris, France
| | - Julianne Duhaze
- CESP, INSERM UMR 1018, Faculty of Medicine, Paris-Sud University, UVSQ, Paris-Saclay University, Villejuif, France
- CHU Ste-Justine Research Center, Montreal, Canada
| | - Natacha Szely
- INSERM UMR 996, Faculty of Pharmacy, Paris-Sud University, Paris-Saclay University, Châtenay-Malabry, France
| | - Aude Gleizes
- INSERM UMR 996, Faculty of Pharmacy, Paris-Sud University, Paris-Saclay University, Châtenay-Malabry, France
- Clinical Immunology Laboratory, AP-HP, Le Kremlin-Bicêtre Hospital, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France
| | - Salima Hacein-Bey Abina
- Clinical Immunology Laboratory, AP-HP, Le Kremlin-Bicêtre Hospital, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France
- UTCBS, CNRS UMR 8258, INSERM U1022, Faculty of Pharmacy, Paris-Descartes-Sorbonne-Cite University, Paris, France
| | - Orhan Aktas
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
| | - Michael Auer
- Innsbruck Medical University, Department of Neurology, Innsbruck, Austria
| | - Jerôme Avouac
- Paris University, Paris Descartes University, INSERM U1016, Paris, France
- Rheumatology department, Cochin Hospital, AP-HP.CUP, Paris, France
| | - Mary Birchler
- GlaxoSmithKline, Clinical Immunology–Biopharm, Collegeville, Pennsylvania, United States of America
| | - Yoram Bouhnik
- AP-HP, Hôpital Beaujon, Paris, France
- GETAID, Paris, France
| | | | | | - Guillaume Cadiot
- GETAID, Paris, France
- Service d'hépato-gastroentérologie, University Hospital of Reims, Reims, France
| | - Franck Carbonnel
- GETAID, Paris, France
- Department of Gastroenterology, AP-HP, Hôpital Kremlin-Bicêtre, France
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel; Clinical Research Institute, Rambam Health Care Campus, Haifa, Israel
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat). Institut de Recerca Vall d’Hebron (VHIR). Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tobias Derfuss
- Departments of Biomedicine and Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Niek De Vries
- Rheumatology & Clinical Immunology, Amsterdam UMC | AMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Abiba Doukani
- Sorbonne Université, Inserm, UMS Production et Analyse des données en Sciences de la vie et en Santé, UMS 37 PASS, Plateforme Post-génomique de la Pitié-Salpêtrière, P3S, Paris, France
| | - Michael Guger
- Clinic for Neurology 2, Med Campus III, Kepler University Hospital GmbH, Linz, Austria
| | - Hans-Peter Hartung
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Bernhard Hemmer
- Department of Neurology, Technische Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Tom Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Kathleen Ingenhoven
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
| | - Poul Erik Hyldgaard-Jensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elizabeth C. Jury
- Centre for Rheumatology Research, University College London, London, United Kingdom
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Austria
| | - Bernd Kieseier
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
| | | | - Raija Lindberg
- Departments of Biomedicine and Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Amy Loercher
- GlaxoSmithKline, Clinical Immunology–Biopharm, Collegeville, Pennsylvania, United States of America
| | - Enrico Maggi
- Dipartimento di Medicina Sperimentale e Clínica, Università di Firenze, Firenze, Italy
- Immunology Area of Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Jessica Manson
- Department of Rheumatology, University College London Hospital, London, United Kingdom
| | - Claudia Mauri
- Centre for Rheumatology Research, University College London, London, United Kingdom
| | - Badreddine Mohand Oumoussa
- Sorbonne Université, Inserm, UMS Production et Analyse des données en Sciences de la vie et en Santé, UMS 37 PASS, Plateforme Post-génomique de la Pitié-Salpêtrière, P3S, Paris, France
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat). Institut de Recerca Vall d’Hebron (VHIR). Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Multiple Sclerosis, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Maria Nachury
- GETAID, Paris, France
- University hospital of Lille, Maladies de l'appareil digestif, Lille, France
| | - Petra Nytrova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Christophe Richez
- Rheumatology Department, CHU de Bordeaux-GH Pellegrin, Bordeaux, France
- UMR CNRS 5164, Bordeaux University, Bordeaux, France
| | - Malin Ryner
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claudia Sievers
- Departments of Biomedicine and Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Dan Sikkema
- GlaxoSmithKline, Clinical Immunology–Biopharm, Collegeville, Pennsylvania, United States of America
- Current address: Quanterix Corporation, Billerica, Massachusetts, United States of America
| | - Martin Soubrier
- Rheumatology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - Sophie Tourdot
- INSERM UMR 996, Faculty of Pharmacy, Paris-Sud University, Paris-Saclay University, Châtenay-Malabry, France
| | - Caroline Trang
- GETAID, Paris, France
- Institut des maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
| | - Alessandra Vultaggio
- Dipartimento di Medicina Sperimentale e Clínica, Università di Firenze, Firenze, Italy
| | - Clemens Warnke
- University of Düsseldorf, Medical Faculty, Department of Neurology, Düsseldorf, Germany
- Department of Neurology, University Hospital Köln, Köln, Germany
| | - Sebastian Spindeldreher
- Drug Metabolism Pharmacokinetics-Biologics, Novartis Institutes for Biomedical Research, Basel, Switzerland
- Integrated Biologix GmbH, Basel, Switzerland
| | | | - Timothy P. Hickling
- BioMedicine Design, Pfizer, Inc., Andover, Massachusetts, United States of America
| | | | - Matthieu Allez
- GETAID, Paris, France
- Department of Gastroenterology, Hôpital Saint-Louis, AP-HP, Université Paris-Diderot, Paris, France
| | | | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Xavier Mariette
- Centre for Immunology of Viral Infections and Autoimmune Diseases, INSERM UMR 1184, Université Paris-Saclay, AP-HP.Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marc Pallardy
- INSERM UMR 996, Faculty of Pharmacy, Paris-Sud University, Paris-Saclay University, Châtenay-Malabry, France
| | - Philippe Broët
- CESP, INSERM UMR 1018, Faculty of Medicine, Paris-Sud University, UVSQ, Paris-Saclay University, Villejuif, France
- CHU Ste-Justine Research Center, Montreal, Canada
- AP-HP, Paris-Sud University Hospitals, Paul Brousse Hospital, Villejuif, France
- * E-mail: (SH); (PB)
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