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Lenze M, Benedetti MD, Roco J, Ramírez PG, Blanco R, Yaceszen S, Corrales C, Wikinski S, Gutiérrez ML. Advancing ocular safety research: A comprehensive examination of benzocaine acute exposure without animal testing. Toxicol Lett 2024; 394:138-145. [PMID: 38458340 DOI: 10.1016/j.toxlet.2024.03.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Benzocaine is a widely employed local anaesthetic; however, there is a notable dearth of preclinical and clinical evidence regarding its safety in ophthalmological products. To address this, a comprehensive strategy incorporating in silico and in vitro methodologies was proposed for assessing benzocaine's ocular toxicity without animal testing. To collect the in silico evidence, the QSAR Toolbox (v4.5) was used. A single exposure to two benzocaine concentrations (2% and 20%) was evaluated by in vitro methods. Hen's Egg Chorioallantoic Membrane Test (HET-CAM) was performed to evaluate the effects on the conjunctiva. To study corneal integrity, Short Time Exposure test (STE) and Bovine Corneal Opacity and Permeability (BCOP) assay, followed by histopathological analysis, were carried out. Results from both in silico and in vitro methodologies categorize benzocaine as non-irritating. The histopathological analysis further affirms the safety of using benzocaine in eye drops, as no alterations were observed in evaluated corneal strata. This research proposes a useful combined strategy to provide evidence on the safety of local anaesthetics and particularly show that 2% and 20% benzocaine solutions do not induce eye irritation or corneal damage, supporting the potential use of benzocaine in the development of ophthalmic anesthetic products.
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Affiliation(s)
- M Lenze
- Instituto de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina; CONICET - Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | - M D Benedetti
- Instituto de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina; CONICET - Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | - J Roco
- Instituto de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina; CONICET - Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | - P G Ramírez
- Instituto de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina; CONICET - Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | | | | | | | - S Wikinski
- Instituto de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina; CONICET - Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | - M L Gutiérrez
- Instituto de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina; CONICET - Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina.
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Benedetti S, Benedetti MD, Tomasi D, Palmisano G, Calcagno S, Bianchi S, Giannasi G. In old anticoagulated patients with mild traumatic brain injury, a 24-h observation period should not be recommended without evidence of a clear benefit: a retrospective study of delayed hemorrhagic versus iatrogenic complications. Intern Emerg Med 2024; 19:523-534. [PMID: 37812308 DOI: 10.1007/s11739-023-03435-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/11/2023] [Indexed: 10/10/2023]
Abstract
Mild traumatic brain injury (mTBI) is a common cause of admission to the Emergency Department (ED). Many patients are elderly on oral anticoagulant therapy (OAT) at increased risk of immediate and delayed intracranial hemorrhage (ICH). To investigate the frequency of delayed ICH (DICH) in old patients with mTBI in OAT and the occurrence of complications related to the ED stay. In this single-center retrospective study, we recruited all patients in OAT aged 65 and over, admitted for mTBI to the ED of our Hospital in Florence from March 2019 to February 2021. Clinical variables were collected and cranial computed tomography (CT) scans reviewed. The primary outcome was the frequency of DICH occurring within 30 days since the trauma after a first negative CT. Secondary outcomes included need of neurosurgical intervention and death for DICH, and hospital-related complications. Statistical analyses were conducted using IBM SPSS Statistics (version 22). Among 363 enrolled patients, there were 31 acute ICH (8.5%) at the first CT scan, while in the 316 negative included patients, 10 DICH (3.2%) were identified. Among the latter, no neurosurgical treatment, or death due to ICH occurred. Overall, 25 cases (6.9%) had iatrogenic complications during the 24-h observation period, often serious, such as respiratory failure after sedation due to restlessness, or COVID-19 infection. The low frequency of DICH and the occurrence of several iatrogenic complications suggest that the risk-benefit ratio of a 24-h ED observation is not advantageous in elderly with mTBI.
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Affiliation(s)
- Saverio Benedetti
- Emergency Department, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Azienda Ospedaliera Toscana Centro, Florence, Italy.
| | - Maria Donata Benedetti
- Neurologia Clinica, Dipartimento di Neuroscienze, Università degli Studi di Verona, Biomedicina e Movimento, Verona, Italy
| | - Domenico Tomasi
- Radiology Department, Azienda Ospedaliera Toscana Centro, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Florence, Italy
| | - Giulia Palmisano
- Emergency Department, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Azienda Ospedaliera Toscana Centro, Florence, Italy
| | - Stefano Calcagno
- Emergency Department, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Azienda Ospedaliera Toscana Centro, Florence, Italy
| | - Simone Bianchi
- Emergency Department, Azienda Ospedaliera Toscana Centro, S. Maria Nuova Hospital, U.O. Medicina d'Urgenza, Florence, Italy
| | - Gianfranco Giannasi
- Emergency Department, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Azienda Ospedaliera Toscana Centro, Florence, Italy
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Tramacere I, Virgili G, Perduca V, Lucenteforte E, Benedetti MD, Capobussi M, Castellini G, Frau S, Gonzalez-Lorenzo M, Featherstone R, Filippini G. Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis. Cochrane Database Syst Rev 2023; 11:CD012186. [PMID: 38032059 PMCID: PMC10687854 DOI: 10.1002/14651858.cd012186.pub2] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease of the central nervous system that affects mainly young adults (two to three times more frequently in women than in men) and causes significant disability after onset. Although it is accepted that immunotherapies for people with MS decrease disease activity, uncertainty regarding their relative safety remains. OBJECTIVES To compare adverse effects of immunotherapies for people with MS or clinically isolated syndrome (CIS), and to rank these treatments according to their relative risks of adverse effects through network meta-analyses (NMAs). SEARCH METHODS We searched CENTRAL, PubMed, Embase, two other databases and trials registers up to March 2022, together with reference checking and citation searching to identify additional studies. SELECTION CRITERIA We included participants 18 years of age or older with a diagnosis of MS or CIS, according to any accepted diagnostic criteria, who were included in randomized controlled trials (RCTs) that examined one or more of the agents used in MS or CIS, and compared them versus placebo or another active agent. We excluded RCTs in which a drug regimen was compared with a different regimen of the same drug without another active agent or placebo as a control arm. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for data extraction and pairwise meta-analyses. For NMAs, we used the netmeta suite of commands in R to fit random-effects NMAs assuming a common between-study variance. We used the CINeMA platform to GRADE the certainty of the body of evidence in NMAs. We considered a relative risk (RR) of 1.5 as a non-inferiority safety threshold compared to placebo. We assessed the certainty of evidence for primary outcomes within the NMA according to GRADE, as very low, low, moderate or high. MAIN RESULTS This NMA included 123 trials with 57,682 participants. Serious adverse events (SAEs) Reporting of SAEs was available from 84 studies including 5696 (11%) events in 51,833 (89.9%) participants out of 57,682 participants in all studies. Based on the absolute frequency of SAEs, our non-inferiority threshold (up to a 50% increased risk) meant that no more than 1 in 18 additional people would have a SAE compared to placebo. Low-certainty evidence suggested that three drugs may decrease SAEs compared to placebo (relative risk [RR], 95% confidence interval [CI]): interferon beta-1a (Avonex) (0.78, 0.66 to 0.94); dimethyl fumarate (0.79, 0.67 to 0.93), and glatiramer acetate (0.84, 0.72 to 0.98). Several drugs met our non-inferiority criterion versus placebo: moderate-certainty evidence for teriflunomide (1.08, 0.88 to 1.31); low-certainty evidence for ocrelizumab (0.85, 0.67 to 1.07), ozanimod (0.88, 0.59 to 1.33), interferon beta-1b (0.94, 0.78 to 1.12), interferon beta-1a (Rebif) (0.96, 0.80 to 1.15), natalizumab (0.97, 0.79 to 1.19), fingolimod (1.05, 0.92 to 1.20) and laquinimod (1.06, 0.83 to 1.34); very low-certainty evidence for daclizumab (0.83, 0.68 to 1.02). Non-inferiority with placebo was not met due to imprecision for the other drugs: low-certainty evidence for cladribine (1.10, 0.79 to 1.52), siponimod (1.20, 0.95 to 1.51), ofatumumab (1.26, 0.88 to 1.79) and rituximab (1.01, 0.67 to 1.52); very low-certainty evidence for immunoglobulins (1.05, 0.33 to 3.32), diroximel fumarate (1.05, 0.23 to 4.69), peg-interferon beta-1a (1.07, 0.66 to 1.74), alemtuzumab (1.16, 0.85 to 1.60), interferons (1.62, 0.21 to 12.72) and azathioprine (3.62, 0.76 to 17.19). Withdrawals due to adverse events Reporting of withdrawals due to AEs was available from 105 studies (85.4%) including 3537 (6.39%) events in 55,320 (95.9%) patients out of 57,682 patients in all studies. Based on the absolute frequency of withdrawals, our non-inferiority threshold (up to a 50% increased risk) meant that no more than 1 in 31 additional people would withdraw compared to placebo. No drug reduced withdrawals due to adverse events when compared with placebo. There was very low-certainty evidence (meaning that estimates are not reliable) that two drugs met our non-inferiority criterion versus placebo, assuming an upper 95% CI RR limit of 1.5: diroximel fumarate (0.38, 0.11 to 1.27) and alemtuzumab (0.63, 0.33 to 1.19). Non-inferiority with placebo was not met due to imprecision for the following drugs: low-certainty evidence for ofatumumab (1.50, 0.87 to 2.59); very low-certainty evidence for methotrexate (0.94, 0.02 to 46.70), corticosteroids (1.05, 0.16 to 7.14), ozanimod (1.06, 0.58 to 1.93), natalizumab (1.20, 0.77 to 1.85), ocrelizumab (1.32, 0.81 to 2.14), dimethyl fumarate (1.34, 0.96 to 1.86), siponimod (1.63, 0.96 to 2.79), rituximab (1.63, 0.53 to 5.00), cladribine (1.80, 0.89 to 3.62), mitoxantrone (2.11, 0.50 to 8.87), interferons (3.47, 0.95 to 12.72), and cyclophosphamide (3.86, 0.45 to 33.50). Eleven drugs may have increased withdrawals due to adverse events compared with placebo: low-certainty evidence for teriflunomide (1.37, 1.01 to 1.85), glatiramer acetate (1.76, 1.36 to 2.26), fingolimod (1.79, 1.40 to 2.28), interferon beta-1a (Rebif) (2.15, 1.58 to 2.93), daclizumab (2.19, 1.31 to 3.65) and interferon beta-1b (2.59, 1.87 to 3.77); very low-certainty evidence for laquinimod (1.42, 1.01 to 2.00), interferon beta-1a (Avonex) (1.54, 1.13 to 2.10), immunoglobulins (1.87, 1.01 to 3.45), peg-interferon beta-1a (3.46, 1.44 to 8.33) and azathioprine (6.95, 2.57 to 18.78); however, very low-certainty evidence is unreliable. Sensitivity analyses including only studies with low attrition bias, drug dose above the group median, or only patients with relapsing remitting MS or CIS, and subgroup analyses by prior disease-modifying treatments did not change these figures. Rankings No drug yielded consistent P scores in the upper quartile of the probability of being better than others for primary and secondary outcomes. AUTHORS' CONCLUSIONS We found mostly low and very low-certainty evidence that drugs used to treat MS may not increase SAEs, but may increase withdrawals compared with placebo. The results suggest that there is no important difference in the occurrence of SAEs between first- and second-line drugs and between oral, injectable, or infused drugs, compared with placebo. Our review, along with other work in the literature, confirms poor-quality reporting of adverse events from RCTs of interventions. At the least, future studies should follow the CONSORT recommendations about reporting harm-related issues. To address adverse effects, future systematic reviews should also include non-randomized studies.
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Affiliation(s)
- Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Ophthalmology, IRCCS - Fondazione Bietti, Rome, Italy
| | - Vittorio Perduca
- Université Paris Cité, CNRS, MAP5, F-75006 Paris, France
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Ersilia Lucenteforte
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Maria Donata Benedetti
- UOC Neurologia B - Policlinico Borgo Roma, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Capobussi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Greta Castellini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | | | - Marien Gonzalez-Lorenzo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Oncology, Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Graziella Filippini
- Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy
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Gajofatto A, Cardobi N, Gobbin F, Calabrese M, Turatti M, Benedetti MD. Resting-state functional connectivity in multiple sclerosis patients receiving nabiximols for spasticity. BMC Neurol 2023; 23:128. [PMID: 36991352 DOI: 10.1186/s12883-023-03171-0] [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: 11/09/2021] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Nabiximols (Sativex®) is a cannabinoid approved for multiple sclerosis (MS)-related spasticity. Its mechanism of action is partially understood, and efficacy is variable. OBJECTIVE To conduct an exploratory analysis of brain networks connectivity changes on resting state (RS) functional MRI (fMRI) of MS patients treated with nabiximols. METHODS We identified a group of MS patients treated with Sativex® at Verona University Hospital, who underwent RS brain fMRI in the 4 weeks before (T0) and 4-8 weeks after (T1) treatment start. Sativex® response was defined as ≥ 20% spasticity Numerical Rating Scale score reduction at T1 vs. T0. Connectivity changes on fMRI were compared between T0 and T1 in the whole group and according to response status. ROI-to-ROI and seed-to-voxel connectivity were evaluated. RESULTS Twelve MS patients (7 males) were eligible for the study. Seven patients (58.3%) resulted Sativex® responders at T1. On fMRI analysis, Sativex® exposure was associated with global brain connectivity increase (particularly in responders), decreased connectivity of motor areas, and bidirectional connectivity changes of the left cerebellum with a number of cortical areas. CONCLUSIONS Nabiximols administration is associated with brain connectivity increase of MS patients with spasticity. Modulation of sensorimotor cortical areas and cerebellum connectivity could play a role in nabiximols effect.
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Affiliation(s)
- Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy.
- Unit of Neurology, Regional Multiple Sclerosis Center, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Nicolò Cardobi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Francesca Gobbin
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
- Unit of Neurology, Regional Multiple Sclerosis Center, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
- Unit of Neurology, Regional Multiple Sclerosis Center, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Turatti
- Unit of Neurology, Regional Multiple Sclerosis Center, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Donata Benedetti
- Unit of Neurology, Regional Multiple Sclerosis Center, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Orlandi R, Mariotto S, Ferrari S, Gobbin F, Sechi E, Capra R, Mancinelli CR, Bombardi R, Zuliani L, Zoccarato M, Rossi F, Camera V, Ferraro D, Benedetti MD, Reindl M, Gajofatto A. Diagnostic features of initial demyelinating events associated with serum MOG-IgG. J Neuroimmunol 2020; 344:577260. [PMID: 32442864 DOI: 10.1016/j.jneuroim.2020.577260] [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: 04/17/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG)-IgG associated disorders are increasingly recognized as a distinct disease entity. However, diagnostic sensitivity and specificity of serum MOG-IgG as well as recommendations for testing are still debated. MATERIALS AND METHODS Between October 2015 and July 2017 we tested serum MOG-IgG in 91 adult patients (49 females) with a demyelinating event (DE) not fulfilling 2010 McDonald criteria for MS at sampling, negative for neuromyelitis optica (NMO)-IgG and followed-up for at least 12 months. We assessed the sensitivity and specificity of a live-cell MOG-IgG assay for each final diagnosis at last follow-up, for the 2018 international recommendations for MOG-IgG testing, and for other combinations of clinical and laboratory characteristics. RESULTS Clinical presentations included acute myelitis (n = 48), optic neuritis (n = 36), multifocal encephalomyelitis (n = 4), and brainstem syndrome (n = 3). Twenty-four patients were MOG-IgG positive. Sensitivity and specificity of MOG-IgG test applied to the 2018 international recommendations were 28.4% and 86.7%, while they were 42.1% and 88.6% when applied to DE of unclear aetiology as defined above with two or more among: 1_no periventricular and juxtacortical MS-like lesions on brain MRI; 2_longitudinally extensive MRI optic nerve lesion; 3_no CSF-restricted oligoclonal bands; 4_CSF protein > 50 mg/dl. CONCLUSIONS Simplified requirements compared to those currently proposed for MOG-IgG testing could facilitate the applicability of the assay in the diagnosis of adults with DEs of unclear aetiology.
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Affiliation(s)
- Riccardo Orlandi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Francesca Gobbin
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elia Sechi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Montichiari, Brescia, Italy
| | | | - Roberto Bombardi
- Neurology Unit, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Luigi Zuliani
- Neurology Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | | | - Francesca Rossi
- Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | - Valentina Camera
- Department of Biomedical, Metabolic and Neurological sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurological sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Markus Reindl
- Clinical Department of Neurology, University of Innsbruck, Innsbruck, Austria
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Patti F, Chisari CG, Solaro C, Benedetti MD, Berra E, Bianco A, Bruno Bossio R, Buttari F, Castelli L, Cavalla P, Cerqua R, Costantino G, Gasperini C, Guareschi A, Ippolito D, Lanzillo R, Maniscalco GT, Matta M, Paolicelli D, Petrucci L, Pontecorvo S, Righini I, Russo M, Saccà F, Salamone G, Signoriello E, Spinicci G, Spitaleri D, Tavazzi E, Trotta M, Zaffaroni M, Zappia M. Effects of THC/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: results from a retrospective multicenter study. Neurol Sci 2020; 41:2905-2913. [PMID: 32335779 DOI: 10.1007/s10072-020-04413-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/13/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The approval of 9-δ-tetrahydocannabinol (THC)+cannabidiol (CBD) oromucosal spray (Sativex®) in Italy as an add-on medication for the management of moderate to severe spasticity in multiple sclerosis (MS) has provided a new opportunity for MS patients with drug-resistant spasticity. We aimed to investigate the improvement of MS spasticity-related symptoms in a large cohort of patients with moderate to severe spasticity in daily clinical practice. MATERIALS AND METHODS MS patients with drug-resistant spasticity were recruited from 30 Italian MS centers. All patients were eligible for THC:CBD treatment according to the approved label: ≥ 18 years of age, at least moderate spasticity (MS spasticity numerical rating scale [NRS] score ≥ 4) and not responding to the common antispastic drugs. Patients were evaluated at baseline (T0) and after 4 weeks of treatment (T1) with the spasticity NRS scale and were also asked about meaningful improvements in 6 key spasticity-related symptoms. RESULTS Out of 1615 enrolled patients, 1432 reached the end of the first month trial period (T1). Of these, 1010 patients (70.5%) reached a ≥ 20% NRS score reduction compared with baseline (initial responders; IR). We found that 627 (43.8% of 1432) patients showed an improvement in at least one spasticity-related symptom (SRSr group), 543 (86.6%) of them belonging to the IR group and 84 (13.4%) to the spasticity NRS non-responders group. CONCLUSION Our study confirmed that the therapeutic benefit of cannabinoids may extend beyond spasticity, improving spasticity-related symptoms even in non-NRS responder patients.
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Affiliation(s)
- Francesco Patti
- Department "G.F. Ingrassia", section of Neurosciences, University of Catania, Catania, Italy.
| | - Clara Grazia Chisari
- Department "G.F. Ingrassia", section of Neurosciences, University of Catania, Catania, Italy
| | - Claudio Solaro
- Department of Neurology, ASL3 Genovese, and Department of Rehabilitation, ML Novarese Hospital Moncrivello, Genoa, Italy
| | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Eliana Berra
- Neurorehabilitation Unit, Department of Neurology, Neurology Institute C. Mondino, Pavia, Italy
| | - Assunta Bianco
- Multiple Sclerosis Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Bruno Bossio
- Neurology Operating Unit and Multiple Sclerosis Center, Provincial Health Authority of Cosenza, Cosenza, Italy
| | - Fabio Buttari
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Letizia Castelli
- Neurology Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paola Cavalla
- Department Neuroscience and Mental Health, Multiple Sclerosis Centre, Health and Science City University Hospital of Turin, Turin, Italy
| | - Raffaella Cerqua
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | | | - Claudio Gasperini
- Multiple Sclerosis Centre, San Camillo-Forlanini Hospital, Rome, Italy
| | - Angelica Guareschi
- Multiple Sclerosis Center, Medicine Department, Fidenza Hospital, Fidenza, PR, Italy
| | - Domenico Ippolito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | | | - Manuela Matta
- Neurobiology Unit, Neurologia 2, CReSM (Regional Referring Center Multiple Sclerosis), San Luigi Gonzaga University Hospital & Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano, TO, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Simona Pontecorvo
- Multiple Sclerosis Center of Department of Neurology and Psychiatry of Sapienza, University of Rome, Rome, Italy
| | - Isabella Righini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Margherita Russo
- Multiple Sclerosis Centre, IRCCS-Bonino Pulejo Centre, Messina, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | | | - Elisabetta Signoriello
- Department of Clinical and Experimental Medicine, Multiple Sclerosis Center, II Division of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Spinicci
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale, San Giuseppe Moscati, Avellino, Italy
| | - Eleonora Tavazzi
- Multiple Sclerosis Center, Unit of Motor Neurorehabilitation, IRCCS Santa Maria Nascente, Fondazione Don Gnocchi, Milan, Italy
| | - Maria Trotta
- Institute of Neurology, University "Magna Graecia", Germaneto, Catanzaro, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST della Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - Mario Zappia
- Department "G.F. Ingrassia", section of Neurosciences, University of Catania, Catania, Italy
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7
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Marangi A, Farina G, Vicenzi V, Forlivesi S, Calabria F, Marchioretto F, Forgione A, Rossi F, Stenta G, Vianello M, Gajofatto A, Benedetti MD. Changing therapeutic strategies and persistence to disease-modifying treatments in a population of multiple sclerosis patients from Veneto region, Italy. Mult Scler Relat Disord 2020; 41:102004. [PMID: 32078935 DOI: 10.1016/j.msard.2020.102004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 01/18/2020] [Accepted: 02/07/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The availability of new disease-modifying treatments (DMTs) in the last years has changed the therapeutic strategies used in Multiple Sclerosis (MS). We aimed to describe trend in DMTs utilization and persistence to treatment in a large sample of patients attending 10 MS centres from four provinces of Veneto, Italy. METHODS Demographic, clinical and DMTs information of patients regularly followed from January 2011 to August 2018 were recorded and analysed. Persistence at 12, 24 months and at last follow-up was assessed by Kaplan Meier survival analysis. Multivariable Cox- proportional hazard model was used to identify predictors of persistence. RESULTS Of 3025 MS patients 65.7% were in treatment al last follow-up. Dimethylfumarate (DMF) was the most prescribed single drug among first-line and fingolimod among second-line DMTs. In the cohort of 1391 cases starting any DMT since 2011 12.9% stopped within 6 months, 24% within 12 and 40.3% within 24 months. Disease duration > 5 years at therapy start was predictive of greater risk of discontinuation, while age and sex were not. DMF use was predictive of higher persistence at 12 and 24 months, but not at last follow-up when azathioprine and glatiramer acetate showed the highest persistence compared to other DMTs. Side effects represented the main reason of discontinuation. CONCLUSION The use of the new oral DMTs greatly increased since their approval but persistence in the long-term is not better than with old drugs. The treatment choice is still a challenge both for patients and their doctors.
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Affiliation(s)
- Antonio Marangi
- Neurology Unit, St Bortolo Hospital, Vicenza, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology B, University of Verona, Verona, Italy.
| | - Gabriele Farina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology B, University of Verona, Verona, Italy; Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Virginia Vicenzi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefano Forlivesi
- Section of Neurology A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesca Calabria
- Section of Neurology A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Antonio Forgione
- Neurology Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Francesca Rossi
- Neurology Unit, Mater Salutis Hospital (AULSS9), Legnago, Verona, Italy
| | | | | | - Alberto Gajofatto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology B, University of Verona, Verona, Italy
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8
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Mariotto S, Ferrari S, Gastaldi M, Franciotta D, Sechi E, Capra R, Mancinelli C, Schanda K, Alberti D, Orlandi R, Bombardi R, Zuliani L, Zoccarato M, Benedetti MD, Tanel R, Calabria F, Rossi F, Pavone A, Grazian L, Sechi G, Batzu L, Murdeu N, Janes F, Fetoni V, Fulitano D, Stenta G, Federle L, Cantalupo G, Reindl M, Monaco S, Gajofatto A. Neurofilament light chain serum levels reflect disease severity in MOG-Ab associated disorders. J Neurol Neurosurg Psychiatry 2019; 90:1293-1296. [PMID: 30952681 DOI: 10.1136/jnnp-2018-320287] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Sara Mariotto
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy, Pavia, Italy
| | - Elia Sechi
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Sassari, Sassari, Italy
| | - Ruggero Capra
- MS Center, Spedali Civili of Brescia, Brescia, Italy
| | | | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Alberti
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Riccardo Orlandi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Roberto Bombardi
- Neurology Unit, San Bassiano Hospital, Bassano Del Grappa, Italy
| | - Luigi Zuliani
- Department of Neurology, Ospedale Ca' Foncello, Treviso, Italy
| | | | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | | | | | - Francesca Rossi
- Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy, Verona, Italy
| | - Antonino Pavone
- Neurology Unit, Garibaldi Hospital, Catania, Italy, Catania, Italy
| | - Luisa Grazian
- Pediatric Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy, Treviso, Italy
| | - GianPietro Sechi
- Department of Clinical and Experimental Medicine, NeurologyUnit, University of Sassari, Sassari, Italy
| | - Lucia Batzu
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Sassari, Sassari, Italy
| | - Noemi Murdeu
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Sassari, Sassari, Italy
| | - Francesco Janes
- Neurology Unit, Department of Neuroscience ASUIUD, Udine, Italy, Udine, Italy
| | - Vincenza Fetoni
- Neurology Department, ASST Fatebenefratelli Sacco, Milano, Italy, Milano, Italy
| | | | - Gianola Stenta
- Multiple Sclerosis Centre, S. Bortolo Hospital, Vicenza, Italy, Vicenza, Italy
| | - Lisa Federle
- Multiple Sclerosis Centre, S. Bortolo Hospital, Vicenza, Italy, Vicenza, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Salvatore Monaco
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
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9
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Fiorini M, Bongianni M, Benedetti MD, Monaco S, Zanusso G. Reappraisal of Aβ40 and Aβ42 Peptides Measurements in Cerebrospinal Fluid of Patients with Alzheimer's Disease. J Alzheimers Dis 2019; 66:219-227. [PMID: 30282368 DOI: 10.3233/jad-180616] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cerebrospinal fluid (CSF) biomarkers are currently included in the diagnostic criteria for Alzheimer's disease (AD), in particular, decreased concentrations of amyloid-β peptide 1-42 (Aβ42) in the CSF, coupled with increased levels of tau and phosphorylated tau proteins, are supportive of AD diagnosis. To date, the quantification of Aβ42 levels with antibody-dependent immunoassay shows a marked variability among different laboratories and is also affected by different pre-analytical factors, suggesting that part of Aβ42 peptides might be aggregated and thus undetected by antibodies. To bypass an antibody-dependent measurement, we determined the Aβ40 and Aβ42 levels by immunoblot. We analyzed CSF samples from 35 patients with clinical diagnosis of probable AD and from 15 age-matched normal controls; CSF Aβ levels were determined by two different ELISA kits and by immunoblot analysis. Aβ40 levels measured by ELISA were comparable to those obtained by immunoblot, whereas CSF concentrations of Aβ42 measured by ELISA were significantly lower compared to values obtained by immunoblot quantification. Biochemical analysis, following 1D- and 2D-PAGE analysis, showed that the qualitative composition of Aβ peptides in the CSF is similar in AD and controls but different from that of AD brain tissues. Moreover, sedimentation velocity in sucrose gradient of CSF and brain homogenate from AD demonstrated that Aβ42 in CSF is different from Aβ42 in brain in terms of solubility and aggregation state.
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Affiliation(s)
- Michele Fiorini
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Matilde Bongianni
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Maria Donata Benedetti
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
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10
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Magliozzi R, Howell OW, Nicholas R, Cruciani C, Castellaro M, Romualdi C, Rossi S, Pitteri M, Benedetti MD, Gajofatto A, Pizzini FB, Montemezzi S, Rasia S, Capra R, Bertoldo A, Facchiano F, Monaco S, Reynolds R, Calabrese M. Inflammatory intrathecal profiles and cortical damage in multiple sclerosis. Ann Neurol 2019. [PMID: 29518260 DOI: 10.1002/ana.25197] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Gray matter (GM) damage and meningeal inflammation have been associated with early disease onset and a more aggressive disease course in multiple sclerosis (MS), but can these changes be identified in the patient early in the disease course? METHODS To identify possible biomarkers linking meningeal inflammation, GM damage, and disease severity, gene and protein expression were analyzed in meninges and cerebrospinal fluid (CSF) from 27 postmortem secondary progressive MS and 14 control cases. Combined cytokine/chemokine CSF profiling and 3T magnetic resonance imaging (MRI) were performed at diagnosis in 2 independent cohorts of MS patients (35 and 38 subjects) and in 26 non-MS patients. RESULTS Increased expression of proinflammatory cytokines (IFNγ, TNF, IL2, and IL22) and molecules related to sustained B-cell activity and lymphoid-neogenesis (CXCL13, CXCL10, LTα, IL6, and IL10) was detected in the meninges and CSF of postmortem MS cases with high levels of meningeal inflammation and GM demyelination. Similar proinflammatory patterns, including increased levels of CXCL13, TNF, IFNγ, CXCL12, IL6, IL8, and IL10, together with high levels of BAFF, APRIL, LIGHT, TWEAK, sTNFR1, sCD163, MMP2, and pentraxin III, were detected in the CSF of MS patients with higher levels of GM damage at diagnosis. INTERPRETATION A common pattern of intrathecal (meninges and CSF) inflammatory profile strongly correlates with increased cortical pathology, both at the time of diagnosis and at death. These results suggest a role for detailed CSF analysis combined with MRI as a prognostic marker for more aggressive MS. Ann Neurol 2018 Ann Neurol 2018;83:739-755.
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Affiliation(s)
- Roberta Magliozzi
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.,Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Owain W Howell
- Institute of Life Sciences, Swansea University, Swansea, United Kingdom
| | - Richard Nicholas
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Carolina Cruciani
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.,Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Marco Castellaro
- Department of Information Engineering, University of Padua, Padua, Italy
| | | | - Stefania Rossi
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.,Department of Oncology and Molecular Medicine, Higher Institute of Health Care, Rome, Italy
| | - Marco Pitteri
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Donata Benedetti
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Alberto Gajofatto
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca B Pizzini
- Neuroradiology and Radiology Units, Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | - Stefania Montemezzi
- Neuroradiology and Radiology Units, Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | | | | | | | - Francesco Facchiano
- Department of Oncology and Molecular Medicine, Higher Institute of Health Care, Rome, Italy
| | - Salvatore Monaco
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Richard Reynolds
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Massimiliano Calabrese
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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11
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Gobbin F, Zanoni M, Marangi A, Orlandi R, Crestani L, Benedetti MD, Gajofatto A. 2017 McDonald criteria for multiple sclerosis: Earlier diagnosis with reduced specificity? Mult Scler Relat Disord 2019; 29:23-25. [PMID: 30658260 DOI: 10.1016/j.msard.2019.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 10/24/2018] [Revised: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND McDonald criteria for multiple sclerosis (MS) diagnosis were revised in 2017. OBJECTIVE Aim of our study was to evaluate and compare the sensitivity and specificity of 2017 and 2010 McDonald criteria in patients presenting with an initial demyelinating event (IDE). METHODS We retrospectively identified patients with an IDE and collected clinical, MRI and CSF data in order to demonstrate fulfilment of 2010 and 2017 McDonald criteria. RESULTS 2017 McDonald criteria showed 100% (86.8-100%) sensitivity and 13.8% (3.9-31.7%) specificity. CONCLUSION 2017 McDonald criteria appear to have higher sensitivity but reduced specificity compared to 2010 McDonald criteria.
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Affiliation(s)
- Francesca Gobbin
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale L.A. Scuro, 10 37134 Verona, Italy.
| | - Mattia Zanoni
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale L.A. Scuro, 10 37134 Verona, Italy
| | - Antonio Marangi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale L.A. Scuro, 10 37134 Verona, Italy
| | - Riccardo Orlandi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale L.A. Scuro, 10 37134 Verona, Italy
| | | | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale L.A. Scuro, 10 37134 Verona, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale L.A. Scuro, 10 37134 Verona, Italy
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12
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Gandolfi M, Valè N, Dimitrova EK, Mazzoleni S, Battini E, Benedetti MD, Gajofatto A, Ferraro F, Castelli M, Camin M, Filippetti M, De Paoli C, Chemello E, Picelli A, Corradi J, Waldner A, Saltuari L, Smania N. Effects of High-intensity Robot-assisted Hand Training on Upper Limb Recovery and Muscle Activity in Individuals With Multiple Sclerosis: A Randomized, Controlled, Single-Blinded Trial. Front Neurol 2018; 9:905. [PMID: 30405526 PMCID: PMC6207593 DOI: 10.3389/fneur.2018.00905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 08/03/2018] [Accepted: 10/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background : Integration of robotics and upper limb rehabilitation in people with multiple sclerosis (PwMS) has rarely been investigated. Objective: To compare the effects of robot-assisted hand training against non-robotic hand training on upper limb activity in PwMS. To compare the training effects on hand dexterity, muscle activity, and upper limb dysfunction as measured with the International Classification of Functioning. Methods: This single-blind, randomized, controlled trial involved 44 PwMS (Expanded Disability Status Scale:1.5-8) and hand dexterity deficits. The experimental group (n = 23) received robot-assisted hand training; the control group (n = 21) received non-robotic hand training. Training protocols lasted for 5 weeks (50 min/session, 2 sessions/week). Before (T0), after (T1), and at 1 month follow-up (T2), a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Action Research Arm Test. Secondary outcomes: Nine Holes Peg Test; Fugl-Meyer Assessment Scale-upper extremity section; Motricity Index; Motor Activity Log; Multiple Sclerosis (MS) Quality of Life-54; Life Habits assessment-general short form and surface electromyography. Results: There were no significant between-group differences in primary and secondary outcomes. Electromyography showed relevant changes providing evidence increased activity in the extensor carpi at T1 and T2. Conclusion: The training effects on upper limb activity and function were comparable between the two groups. However, robot-assisted training demonstrated remarkable effects on upper limb use and muscle activity. https://clinicaltrials.gov NCT03561155.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Valè
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant' Anna, Polo Sant' Anna Valdera, Pontedera, Italy
| | - Elena Battini
- The BioRobotics Institute, Scuola Superiore Sant' Anna, Polo Sant' Anna Valdera, Pontedera, Italy
| | - Maria Donata Benedetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alberto Gajofatto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Ferraro
- Section of Neuromotor Rehabilitation, Department of Neuroscience, ASST Carlo Poma, Mantova, Italy
| | - Matteo Castelli
- Centro di riabilitazione Franca Martini—ATSM ONLUS, Trento, Italy
| | - Maruo Camin
- Centro di riabilitazione Franca Martini—ATSM ONLUS, Trento, Italy
| | - Mirko Filippetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carola De Paoli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Chemello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Jessica Corradi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andreas Waldner
- Department of Neurological Rehabilitation, Private Hospital Villa Melitta, Bolzano, Italy
| | - Leopold Saltuari
- Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Neurorehabilitation, AOUI Verona, Verona, Italy
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13
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Benedetti MD, Marangi A, Bozzetti S, Gobbin F, Turatti M, Pea M, Gajofatto A, Mocella S. HPV-related papillary squamous cell carcinoma of the tonsil during treatment with fingolimod. Mult Scler Relat Disord 2018; 23:24-26. [DOI: 10.1016/j.msard.2018.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
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14
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Gajofatto A, Nourbakhsh B, Benedetti MD, Waubant E. Performance of 2010 McDonald criteria and 2016 MAGNIMS guidelines in the diagnosis of primary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:550-552. [PMID: 28939685 DOI: 10.1136/jnnp-2017-316911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/27/2017] [Accepted: 08/30/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Alberto Gajofatto
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Bardia Nourbakhsh
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, California, USA
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15
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Marangi A, Gajofatto A, Marastoni D, Gobbin F, Guiotto F, Tonin P, Benedetti MD. A case of multiple sclerosis and necrotizing autoimmune myopathy with anti-SRP antibodies. Mult Scler Relat Disord 2017; 19:118-120. [PMID: 29195113 DOI: 10.1016/j.msard.2017.11.015] [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: 07/23/2017] [Revised: 11/01/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
Only few reports exist regarding the coexistence of multiple sclerosis (MS) and autoimmune myopathies. We describe the case of a man with a long history of undiagnosed left lower limb motor impairment who was hospitalized for subacute onset of a myopathic syndrome. In addition, neurological examination revealed sensory impairment and pyramidal signs in the left limbs. Muscle biopsy revealed a necrotizing myopathy and serum anti-signal recognition particle (SRP) antibodies were found. Brain and spinal cord MRI displayed several non-enhancing demyelinating lesions, and CSF-restricted oligoclonal bands were detected. Multimodal evoked potentials showed increased latency of central conduction. Total body PET-CT did not reveal malignancies. A final diagnosis of anti-SRP necrotizing autoimmune myopathy (NAM) and MS was made, and subsequent therapy with azathioprine resulted in a complete stability for both diseases during the follow up. To the best of our knowledge this is the first reported case of concomitant NAM and MS.
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Affiliation(s)
- Antonio Marangi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Alberto Gajofatto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Damiano Marastoni
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Gobbin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Paola Tonin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Donata Benedetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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16
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Mariotto S, Ferrari S, Monaco S, Benedetti MD, Schanda K, Alberti D, Farinazzo A, Capra R, Mancinelli C, De Rossi N, Bombardi R, Zuliani L, Zoccarato M, Tanel R, Bonora A, Turatti M, Calabrese M, Polo A, Pavone A, Grazian L, Sechi G, Sechi E, Urso D, Delogu R, Janes F, Deotto L, Cadaldini M, Bianchi MR, Cantalupo G, Reindl M, Gajofatto A. Clinical spectrum and IgG subclass analysis of anti-myelin oligodendrocyte glycoprotein antibody-associated syndromes: a multicenter study. J Neurol 2017; 264:2420-2430. [PMID: 29063242 PMCID: PMC5688213 DOI: 10.1007/s00415-017-8635-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [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: 08/28/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 12/24/2022]
Abstract
Anti-myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) recently emerged as a potential biomarker in patients with inflammatory demyelinating diseases of the central nervous system. We here compare the clinical and laboratory findings observed in a cohort of MOG-Ab seropositive and seronegative cases and describe IgG subclass analysis results. Consecutive serum samples referred to Verona University Neuropathology Laboratory for aquaporin-4 (AQP4)-Ab and/or MOG-Ab testing were analysed between March 2014 and May 2017. The presence of AQP4-Ab was determined using a cell-based assay. A live cell immunofluorescence assay was used for the detection of MOG-IgG and IgG subclass analysis. Among 454 analysed samples, 29 were excluded due to AQP4-Ab positivity or to the final demonstration of a disorder not compatible with MOG-Ab. We obtained clinical data in 154 out of 425 cases. Of these, 22 subjects resulted MOG-Ab positive. MOG-Ab positive patients were mainly characterised by the involvement of the optic nerve and/or spinal cord. Half of the cases presented relapses and the recovery was usually partial. Brain MRI was heterogeneous while short lesions were the prevalent observation on spinal cord MRI. MOG-Ab titre usually decreased in non-relapsing cases. In all MOG-IgG positive cases, we observed IgG1 antibodies, which were predominant in most subjects. IgG2 (5/22), IgG3 (9/22) and IgG4 (3/22) antibodies were also detectable. We confirm that MOG-Ab-related syndromes have distinct features in the spectrum of demyelinating conditions, and we describe the possible role of the different IgG subclasses in this condition.
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Affiliation(s)
- Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy.
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Alberti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Alessia Farinazzo
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Chiara Mancinelli
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Roberto Bombardi
- Neurology Unit, St Bassano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Luigi Zuliani
- Neurology Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | | | | | | | - Marco Turatti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Alberto Polo
- Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | | | - Luisa Grazian
- Pediatric Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - GianPietro Sechi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Elia Sechi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Daniele Urso
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Rachele Delogu
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Francesco Janes
- Neurology Unit, Department of Neuroscience, ASUIUD, Udine, Italy
| | | | | | | | | | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
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Gobbin F, Marangi A, Orlandi R, Richelli S, Turatti M, Calabrese M, Forgione A, Alessandrini F, Benedetti MD, Monaco S, Gajofatto A. A case of acute fulminant multiple sclerosis treated with alemtuzumab. Mult Scler Relat Disord 2017; 17:9-11. [PMID: 29055482 DOI: 10.1016/j.msard.2017.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 11/28/2022]
Abstract
We describe the case of a woman who came to our attention for acute onset and very rapidly worsening left hemiplegia, vision loss and cognitive impairment. MRI, laboratory and clinical investigations were highly suggestive of an active inflammatory demyelinating disease. Following exclusion of other possible etiologies, a diagnosis of Marburg's variant multiple sclerosis was made. After repeated high-dose steroids and plasma-exchange, the patient was treated with a first course of alemtuzumab followed by improvement of the clinical and MRI picture. This is the first reported case of Marburg type multiple sclerosis treated with alemtuzumab.
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Affiliation(s)
- F Gobbin
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - A Marangi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - R Orlandi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - S Richelli
- Unit of Intensive Rehabilitation, Ospedale Sacro Cuore, Negrar, Verona, Italy
| | - M Turatti
- Unit of Neurology B, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Calabrese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - A Forgione
- Unit of Neurology, Casa di Cura Pederzoli, Peschiera del Garda, Verona, Italy
| | - F Alessandrini
- Unit of Neuroradiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M D Benedetti
- Unit of Neurology B, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - S Monaco
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - A Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
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Farina G, Magliozzi R, Pitteri M, Reynolds R, Rossi S, Gajofatto A, Benedetti MD, Facchiano F, Monaco S, Calabrese M. Increased cortical lesion load and intrathecal inflammation is associated with oligoclonal bands in multiple sclerosis patients: a combined CSF and MRI study. J Neuroinflammation 2017; 14:40. [PMID: 28222766 PMCID: PMC5319028 DOI: 10.1186/s12974-017-0812-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although IgG oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) are a frequent phenomenon in multiple sclerosis (MS) patients, their relationship with grey matter lesions, intrathecal/meningeal inflammation and clinical evolution has not been clarified yet. The aim of our study was to assess the relationship between the OCBs, the inflammatory/neurodegenerative CSF profile at diagnosis, the cortical lesion load and the clinical evolution after 10 years. METHODS This is a 10-year observational, cross-sectional study based on a combined MRI, cognitive and CSF profiling of the examined patients. Forty consecutive OCB-negative (OCB-) and 50 OCB-positive (OCB+) MS patients were included in this study. Both groups had mean disease duration of 10 years and were age and gender matched. Each patient underwent neurological and neuropsychological evaluation and 3-T MRI. Analysis of the presence and levels of 28 inflammatory mediators was performed in the CSF obtained from 10 OCB- MS, 11 OCB+ MS and 10 patients with other neurological conditions. RESULTS Increased number of CLs was found in OCB+ compared to OCB- patients (p < 0.0001), whereas no difference was found in white matter lesion (WML) load (p = 0.36). The occurrence of OCB was also associated with increased levels of neurofilament light chains and of several inflammatory mediators linked to B lymphocyte activity and lymphoid-neogenesis (CXCL13, CXCL12, CXCL10, TNFSF13, TNFSF13B, IL6, IL10) and other pro-inflammatory molecules, such as IFN-γ, TNF, MMP2, GM-CSF, osteopontin and sCD163. Finally, the occurrence of OCB was found associated with poor prognosis, from both physical and cognitive points of view. CONCLUSIONS OCB at MS onset are associated with more severe GM pathology and with a more severe physical disability and cognitive impairment after 10 years. Increased levels of cytokines linked to B cell activation, lymphoid-neogenesis, and pro-inflammatory immune response in the CSF of OCB+ patients support the hypothesis of crucial role played by compartmentalized, intrathecal B cell response in the pathogenesis of CLs and OCB production.
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Affiliation(s)
- Gabriele Farina
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.,Unit of Neurology, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Roberta Magliozzi
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.,Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Marco Pitteri
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Richard Reynolds
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stefania Rossi
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.,Department EOMM, Istituto Superiore di Sanità, Rome, Italy
| | - Alberto Gajofatto
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Maria Donata Benedetti
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | | | - Salvatore Monaco
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
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Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory condition of the central nervous system with heterogeneous features. Primary progressive (PP) MS is a rare disease subtype characterized by continuous disability worsening from onset. No disease-modifying therapy is currently approved for PP MS due to the negative or inconsistent results of clinical trials conducted on a wide range of interventions, which are reviewed in the present paper. Areas covered: The features and results of randomized trials of disease-modifying treatments for PP MS are discussed, including immunosuppressants, immunomodulators, monoclonal antibodies, and putative neuroprotective agents. Expert commentary: The recent encouraging results of the ocrelizumab trial in PP MS, the first to reach the primary disability endpoint, indicate B cells as a promising therapeutic target to prevent disease progression. Other emerging treatment strategies include cell metabolism modulation and inflammatory pathways inhibition, which are being investigated in several ongoing phase II and III placebo-controlled trials. Future PP MS trials will need to systematically include efficacy endpoints other than physical disability alone, such as cognition, quality of life, advanced MRI measures and molecular biomarkers.
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Affiliation(s)
- Alberto Gajofatto
- a Department of Neuroscience, Biomedicine and Movement Sciences , University of Verona , Verona , Italy
| | - Marco Turatti
- b Department of Neuroscience , Azienda Ospedaliera Universitaria Integrata Verona , Verona , Italy
| | - Maria Donata Benedetti
- b Department of Neuroscience , Azienda Ospedaliera Universitaria Integrata Verona , Verona , Italy
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Calabrese M, Castellaro M, Bertoldo A, De Luca A, Pizzini FB, Ricciardi GK, Pitteri M, Zimatore S, Magliozzi R, Benedetti MD, Manganotti P, Montemezzi S, Reynolds R, Gajofatto A, Monaco S. Epilepsy in multiple sclerosis: The role of temporal lobe damage. Mult Scler 2016; 23:473-482. [DOI: 10.1177/1352458516651502] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Although temporal lobe pathology may explain some of the symptoms of multiple sclerosis (MS), its role in the pathogenesis of seizures has not been clarified yet. Objectives: To investigate the role of temporal lobe damage in MS patients suffering from epilepsy, by the application of advanced multimodal 3T magnetic resonance imaging (MRI) analysis. Methods: A total of 23 relapsing remitting MS patients who had epileptic seizures (RRMS/E) and 23 disease duration matched RRMS patients without any history of seizures were enrolled. Each patient underwent advanced 3T MRI protocol specifically conceived to evaluate grey matter (GM) damage. This includes grey matter lesions (GMLs) identification, evaluation of regional cortical thickness and indices derived from the Neurite Orientation Dispersion and Density Imaging model. Results: Regional analysis revealed that in RRMS/E, the regions most affected by GMLs were the hippocampus (14.2%), the lateral temporal lobe (13.5%), the cingulate (10.0%) and the insula (8.4%). Cortical thinning and alteration of diffusion metrics were observed in several regions of temporal lobe, in insular cortex and in cingulate gyrus of RRMS/E compared to RRMS ( p< 0.05 for all comparisons). Conclusions: Compared to RRMS, RRMS/E showed more severe damage of temporal lobe, which exceeds what would be expected on the basis of the global GM damage observed.
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Affiliation(s)
- M Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M Castellaro
- Department of Information Engineering, University of Padova, Padova, Italy
| | - A Bertoldo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - A De Luca
- Department of Information Engineering, University of Padova, Padova, Italy/Scientific Institute, IRCCS “Eugenio Medea”, Neuroimaging Lab, Bosisio Parini, LC, Italy
| | - FB Pizzini
- Neuroradiology and Radiology Units, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - GK Ricciardi
- Neuroradiology and Radiology Units, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - M Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - S Zimatore
- Neuroradiology and Radiology Units, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - R Magliozzi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy/Division of Brain Sciences, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - MD Benedetti
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - P Manganotti
- Neurology Section, University Hospital of Trieste, Trieste, Italy
| | - S Montemezzi
- Neuroradiology and Radiology Units, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - R Reynolds
- Division of Brain Sciences, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - A Gajofatto
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - S Monaco
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Tramacere I, Benedetti MD, Capobussi M, Castellini G, Citterio A, Del Giovane C, Frau S, Gonzalez-Lorenzo M, La Mantia L, Moja L, Nuzzo S, Filippini G. Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Irene Tramacere
- Fondazione IRCCS Istituto Neurologico Carlo Besta; Neuroepidemiology Unit; Via Giovanni Celoria, 11 Milan Italy 20133
| | - Maria Donata Benedetti
- Azienda Ospedaliera Universitaria Integrata; UOC Neurologia B - Policlinico Borgo Roma; Piazzale La Scuro , 10 Verona Verona Italy 37135
| | - Matteo Capobussi
- University of Milan; Department of Biomedical Sciences for Health; Via Pascal, 36 Milan Italy 20100
| | - Greta Castellini
- University of Milan; Department of Biomedical Sciences for Health; Via Pascal, 36 Milan Italy 20100
- IRCCS Galeazzi Orthopaedic Institute; Unit of Clinical Epidemiology; Milan Italy
| | - Antonietta Citterio
- IRCCS National Neurological Institute C. Mondino; Scientific Direction; Via Mondino 2 Pavia Italy 27100
| | - Cinzia Del Giovane
- University of Modena and Reggio Emilia; Italian Cochrane Centre, Department of Diagnostic, Clinical and Public Health Medicine; Modena Italy
| | | | - Marien Gonzalez-Lorenzo
- University of Milan; Department of Biomedical Sciences for Health; Via Pascal, 36 Milan Italy 20100
| | - Loredana La Mantia
- IRCCS. Santa Maria Nascente - Fondazione Don Gnocchi; Unit of Neurorehabilitation - Multiple Sclerosis Center; Via Capecelatro, 66 Milan Italy 20148
| | - Lorenzo Moja
- University of Milan; Department of Biomedical Sciences for Health; Via Pascal, 36 Milan Italy 20100
- IRCCS Galeazzi Orthopaedic Institute; Clinical Epidemiology Unit; Milan Italy
| | - Sara Nuzzo
- Fondazione IRCCS. Istituto Neurologico Carlo Besta; Via Celoria, 11 Milan Italy 20133
| | - Graziella Filippini
- Fondazione IRCCS. Istituto Neurologico Carlo Besta; Scientific Direction; via Celoria, 11 Milan Italy 20133
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Gajofatto A, Turatti M, Monaco S, Benedetti MD. Clinical efficacy, safety, and tolerability of fingolimod for the treatment of relapsing-remitting multiple sclerosis. Drug Healthc Patient Saf 2015; 7:157-67. [PMID: 26715860 PMCID: PMC4686225 DOI: 10.2147/dhps.s69640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Fingolimod is a selective immunosuppressive agent approved worldwide for the treatment of relapsing-remitting multiple sclerosis (MS), a chronic and potentially disabling neurological condition. Randomized double-blind clinical trials have shown that fingolimod significantly reduces relapse rate and ameliorates a number of brain MRI measures, including cerebral atrophy, compared to both placebo and intramuscular interferon-β1a. The effect on disability progression remains controversial, since one Phase III trial showed a significant benefit of treatment while two others did not. Although fingolimod has a very convenient daily oral dosing, the possibility of serious cardiac, ocular, infectious, and other rare adverse events justified the decision of the European Medicines Agency to approve the drug as a second-line treatment for MS patients not responsive to first-line therapy, or those with rapidly evolving course. In the United States, fingolimod is instead authorized as a first-line treatment. The aim of this review is to describe and discuss the characteristics of fingolimod concerning its efficacy, safety, and tolerability in the clinical context of multiple sclerosis management.
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Affiliation(s)
- Alberto Gajofatto
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy ; Division of Neurology B, Verona University Hospital, Verona, Italy
| | - Marco Turatti
- Division of Neurology B, Verona University Hospital, Verona, Italy
| | - Salvatore Monaco
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy ; Division of Neurology B, Verona University Hospital, Verona, Italy
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Benedetti MD, Pugliatti M, D''Alessandro R, Beghi E, Chiò A, Logroscino G, Filippini G, Galeotti F, Massari M, Santuccio C, Raschetti R. A Multicentric Prospective Incidence Study of Guillain-Barré Syndrome in Italy. The ITANG Study. Neuroepidemiology 2015; 45:90-9. [DOI: 10.1159/000438752] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 07/10/2015] [Indexed: 11/19/2022] Open
Abstract
Background: To assess Guillain-Barré syndrome (GBS) incidence we relied on the Italian Network for the study of GBS (ITANG) established in 2010 in 7 Italian regions to analyse the association between influenza vaccination and GBS. Methods: All individuals aged ≥18 years, presenting with clinical manifestations that suggested GBS according to the universally accepted Asbury's diagnostic criteria (1990) were prospectively notified to a centralised database by ITANG neurologists over the period October 1, 2010-September 30, 2011. Through a telephone survey, 9 trained interviewers followed up the cases to diagnosis and then for 1 year since hospital discharge. Validation of case reporting was performed with the support of administrative data in 5 regions. Results: We found 365 cases fulfilling the definition for GBS or one of its variants over 19,846,068 population ≥18 years of age, yielding an annual incidence rate of 1.84 per 100,000 (95% CI 1.65-2.03), 2.30 (95% CI 1.99-2.60) in men and 1.41 (95% CI 1.18-1.64) in women. A highly significant peak of incidence was observed in February 2011 as compared to reference month (September 2011, rate ratio 3.3:1, p < 0.01). Conclusions: In Italy, GBS incidence was among the highest reported in Europe and higher than previously observed in Italian studies.
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Calabrese M, Reynolds R, Magliozzi R, Castellaro M, Morra A, Scalfari A, Farina G, Romualdi C, Gajofatto A, Pitteri M, Benedetti MD, Monaco S. Regional Distribution and Evolution of Gray Matter Damage in Different Populations of Multiple Sclerosis Patients. PLoS One 2015; 10:e0135428. [PMID: 26267665 PMCID: PMC4534410 DOI: 10.1371/journal.pone.0135428] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/21/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Both gray-matter (GM) atrophy and lesions occur from the earliest stages of Multiple Sclerosis (MS) and are one of the major determinants of long-term clinical outcomes. Nevertheless, the relationship between focal and diffuse GM damage has not been clarified yet. Here we investigate the regional distribution and temporal evolution of cortical thinning and how it is influenced by the local appearance of new GM lesions at different stages of the disease in different populations of MS patients. METHODS We studied twenty MS patients with clinically isolated syndrome (CIS), 27 with early relapsing-remitting MS (RRMS, disease duration <5 years), 29 with late RRMS (disease duration ≥ 5 years) and 20 with secondary-progressive MS (SPMS). The distribution and evolution of regional cortical thickness and GM lesions were assessed during 5-year follow-up. RESULTS The results showed that new lesions appeared more frequently in hippocampus and parahippocampal gyri (9.1%), insula (8.9%), cingulate cortex (8.3%), superior frontal gyrus (8.1%), and cerebellum (6.5%). The aforementioned regions showed the greatest reduction in thickness/volume, although (several) differences were observed across subgroups. The correlation between the appearance of new cortical lesions and cortical thinning was stronger in CIS (r2 = 50.0, p<0.001) and in early RRMS (r2 = 52.3, p<0.001), compared to late RRMS (r2 = 25.5, p<0.001) and SPMS (r2 = 6.3, p = 0.133). CONCLUSIONS We conclude that GM atrophy and lesions appear to be different signatures of cortical disease in MS having in common overlapping spatio-temporal distribution patterns. However, the correlation between focal and diffuse damage is only moderate and more evident in the early phase of the disease.
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Affiliation(s)
- Massimiliano Calabrese
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
- Neuroimaging Unit, Euganea Medica, Padova, Italy
- * E-mail:
| | - Richard Reynolds
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Roberta Magliozzi
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
- Department of Cell Biology and Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Castellaro
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Aldo Morra
- Neuroimaging Unit, Euganea Medica, Padova, Italy
| | - Antonio Scalfari
- Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories, Imperial College London, London, United Kingdom
| | - Gabriele Farina
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | | | - Alberto Gajofatto
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Pitteri
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Donata Benedetti
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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Gajofatto A, Benedetti MD. Treatment strategies for multiple sclerosis: When to start, when to change, when to stop? World J Clin Cases 2015; 3:545-555. [PMID: 26244148 PMCID: PMC4517331 DOI: 10.12998/wjcc.v3.i7.545] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/02/2015] [Accepted: 05/06/2015] [Indexed: 02/05/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory condition of the central nervous system determined by a presumed autoimmune process mainly directed against myelin components but also involving axons and neurons. Acute demyelination shows as clinical relapses that may fully or partially resolve, while chronic demyelination and neuroaxonal injury lead to persistent and irreversible neurological symptoms, often progressing over time. Currently approved disease-modifying therapies are immunomodulatory or immunosuppressive drugs that significantly although variably reduce the frequency of attacks of the relapsing forms of the disease. However, they have limited efficacy in preventing the transition to the progressive phase of MS and are of no benefit after it has started. It is therefore likely that the potential advantage of a given treatment is condensed in a relatively limited window of opportunity for each patient, depending on individual characteristics and disease stage, most frequently but not necessarily in the early phase of the disease. In addition, a sizable proportion of patients with MS may have a very mild clinical course not requiring a disease-modifying therapy. Finally, individual response to existing therapies for MS varies significantly across subjects and the risk of serious adverse events remains an issue, particularly for the newest agents. The present review is aimed at critically describing current treatment strategies for MS with a particular focus on the decision of starting, switching and stopping commercially available immunomodulatory and immunosuppressive therapies.
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Gandolfi M, Munari D, Geroin C, Gajofatto A, Benedetti MD, Midiri A, Carla F, Picelli A, Waldner A, Smania N. Sensory integration balance training in patients with multiple sclerosis: A randomized, controlled trial. Mult Scler 2015; 21:1453-62. [PMID: 25583852 DOI: 10.1177/1352458514562438] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 11/07/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impaired sensory integration contributes to balance disorders in patients with multiple sclerosis (MS). OBJECTIVE The objective of this paper is to compare the effects of sensory integration balance training against conventional rehabilitation on balance disorders, the level of balance confidence perceived, quality of life, fatigue, frequency of falls, and sensory integration processing on a large sample of patients with MS. METHODS This single-blind, randomized, controlled trial involved 80 outpatients with MS (EDSS: 1.5-6.0) and subjective symptoms of balance disorders. The experimental group (n = 39) received specific training to improve central integration of afferent sensory inputs; the control group (n = 41) received conventional rehabilitation (15 treatment sessions of 50 minutes each). Before, after treatment, and at one month post-treatment, patients were evaluated by a blinded rater using the Berg Balance Scale (BBS), Activities-specific Balance Confidence Scale (ABC), Multiple Sclerosis Quality of Life-54, Fatigue Severity Scale (FSS), number of falls and the Sensory Organization Balance Test (SOT). RESULTS The experimental training program produced greater improvements than the control group training on the BBS (p < 0.001), the FSS (p < 0.002), number of falls (p = 0.002) and SOT (p < 0.05). CONCLUSIONS Specific training to improve central integration of afferent sensory inputs may ameliorate balance disorders in patients with MS. Clinical Trial Registration (NCT01040117).
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Affiliation(s)
- Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Italy/ Department of Neurological and Movement Sciences, University of Verona, Italy
| | - Daniele Munari
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Italy/ Department of Neurological and Movement Sciences, University of Verona, Italy
| | - Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Italy/ Department of Neurological and Movement Sciences, University of Verona, Italy
| | - Alberto Gajofatto
- Department of Neurological and Movement Sciences, University of Verona, Italy
| | | | - Alessandro Midiri
- Department of Neurological and Movement Sciences, University of Verona, Italy/ School of Specialization in Physical Medicine and Rehabilitation, University of Verona, Italy
| | - Fontana Carla
- Department of Neurological and Movement Sciences, University of Verona, Italy/ School of Specialization in Physical Medicine and Rehabilitation, University of Verona, Italy
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Italy/ Department of Neurological and Movement Sciences, University of Verona, Italy
| | - Andreas Waldner
- Department of Neurological Rehabilitation, Private Hospital Villa Melitta, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Italy/ Department of Neurological and Movement Sciences, University of Verona, Italy
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Calabrese M, Gajofatto A, Gobbin F, Turri G, Richelli S, Matinella A, Oliboni ES, Benedetti MD, Monaco S. Late-onset multiple sclerosis presenting with cognitive dysfunction and severe cortical/infratentorial atrophy. Mult Scler 2014; 21:580-9. [DOI: 10.1177/1352458514542363] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: Although cognitive dysfunction is a relevant aspect of multiple sclerosis (MS) from the earliest disease phase, cognitive onset is unusual thus jeopardizing early and accurate diagnosis. Here we describe 12 patients presenting with cognitive dysfunction as primary manifestation of MS with either mild or no impairment in non-cognitive neurological domains. Methods: Twelve patients with cognitive onset who were subsequently diagnosed with MS (CI-MS) were included in this retrospective study. Twelve cognitively normal MS patients (CN-MS), 12 healthy controls and four patients having progressive supranuclear palsy (PSP) served as the reference population. Results: Ten CI-MS patients had progressive clinical course and all patients had late disease onset (median age = 49 years; range = 40–58 years). Among cognitive functions, frontal domains were the most involved. Compared to CN-MS and healthy controls, significant cortical and infratentorial atrophy characterized CI-MS patients. Selective atrophy of midbrain tegmentum with relative sparing of pons, known as “The Hummingbird sign,” was observed in eight CI-MS and in three PSP patients. Discussion: Our observation suggests that MS diagnosis should be taken into consideration in case of cognitive dysfunction, particularly when associated with slowly progressive disease course and severe cortical, cerebellar and brainstem atrophy even in the absence of other major neurological symptoms and signs.
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Affiliation(s)
| | | | - Francesca Gobbin
- Neurology Section, Department of Neurological and Movement Sciences
| | - Giulia Turri
- Neurology Section, Department of Neurological and Movement Sciences
| | - Silvia Richelli
- Neurology Section, Department of Neurological and Movement Sciences
| | - Angela Matinella
- Neurology Section, Department of Neurological and Movement Sciences
| | - Eugenio Simone Oliboni
- Institute of Radiology, Department of Pathology and Diagnostics, University of Verona, Italy
| | | | - Salvatore Monaco
- Neurology Section, Department of Neurological and Movement Sciences
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Calabrese M, Gajofatto A, Benedetti MD. Therapeutic strategies for relapsing-remitting multiple sclerosis: a special focus on reduction of grey matter damage as measured by brain atrophy. Expert Rev Neurother 2014; 14:1417-28. [PMID: 25391525 DOI: 10.1586/14737175.2014.979794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
In the past two decades, several pathological and radiological findings convincingly demonstrated that damage of the cortical and deep grey matter is a key issue in multiple sclerosis with a significant impact on physical and cognitive disability. Moreover, it has become increasingly evident that the effect of available therapies on the inflammatory white matter damage is not a guarantee of a meaningful effect on the neurodegenerative process mainly affecting the grey matter. Despite the efficacy of all approved disease-modifying drugs should be measured considering such a relevant aspect of the disease, data from clinical trials are few, scattered and heterogeneous. The aim of this review is to summarize the evidence so far acquired on the effect of reducing grey matter damage produced by current and emerging disease-modifying therapies for multiple sclerosis.
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Affiliation(s)
- Massimiliano Calabrese
- Neurology section, Department of Neurological and Movement Sciences, Policlinico di Borgo Roma, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Piazzale Ludovico Antonio Scuro, 37134, Verona, Italy
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Gajofatto A, Bianchi MR, Deotto L, Benedetti MD. Are natalizumab and fingolimod analogous second-line options for the treatment of relapsing-remitting multiple sclerosis? A clinical practice observational study. Eur Neurol 2014; 72:173-80. [PMID: 25226868 DOI: 10.1159/000361044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/26/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unclear whether natalizumab and fingolimod have analogous efficacy for relapsing-remitting multiple sclerosis (RRMS). OBJECTIVE To compare the outcome of RRMS patients treated with either therapy. METHODS RRMS patients treated with natalizumab or fingolimod at Verona Hospital, Italy, were included. The study design was retrospective, based on prospectively collected clinical and MRI data. As efficacy outcomes, time to relapse, relapse rate, expanded disability status scale (EDSS) score change, and new T2/gadolinium-enhancing lesions on brain MRI were compared over treatment period between the two groups. Multivariate Cox and logistic regression models were used to control for potential confounders. RESULTS Fifty-seven subjects receiving natalizumab and 30 receiving fingolimod for a median duration of 23 (1-63) and 22 (2-35) months, respectively (p = 0.22) were included. Patients treated with natalizumab had a more active pre-treatment disease course compared to those treated with fingolimod. In multivariate analysis, the relapse risk was reduced in patients on natalizumab (Hazard Ratio = 0.33; 95% CI = 0.11-1.03; p = 0.056) compared to those on fingolimod. There was no significant difference in EDSS and MRI outcomes. No relevant unexpected adverse events occurred. One patient discontinued natalizumab for progressive multifocal leukoencephalopathy. CONCLUSIONS RRMS patients receiving natalizumab had higher baseline disease activity and lower relapse risk over 20 months of treatment compared to those receiving fingolimod. Head-to-head randomized clinical trials are needed.
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Affiliation(s)
- Alberto Gajofatto
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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Mariotto S, Tamburin S, Salviati A, Ferrari S, Zoccarato M, Giometto B, Bertolasi L, Alessandrini F, Benedetti MD, Monaco S. Anti-N-methyl-d-aspartate receptor encephalitis causing a prolonged depressive disorder evolving to inflammatory brain disease. Case Rep Neurol 2014; 6:38-43. [PMID: 24707266 PMCID: PMC3975751 DOI: 10.1159/000358820] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a rapidly evolving condition that combines psychiatric and neurologic manifestations. Much remains unclear about its clinical onset and subsequent course. Although successful treatment depends on diagnosing the disorder early and therefore minimizing long-term complications, this is a difficult task owing to the atypical onset of this condition and the prolonged clinical course that has been observed in some patients. This report, illustrating a patient with slowly progressing psychiatric manifestations, unusual imaging and electrophysiological features, extends the information on varied clinical phenotypes. Case Report A 32-year-old woman suffered from an isolated depressive disorder for 4 months before undergoing psychiatric evaluation. During the following 5 months, she manifested hypersexuality, dysarthria, imbalance, dyskinesias and decreased word output. Brain magnetic resonance imaging (MRI) showed multifocal hyperintense T2/FLAIR lesions, a few contrast-enhanced, involving the corona radiata, the periventricular white matter, the deep gray nuclei, the optic nerves and the brainstem. MRI spectroscopy disclosed confluent bilateral demyelination and focal optic nerve involvement suggesting widespread encephalitis. Visual evoked potential studies indicated a demyelinating disorder. Serological screening and total body positron-emission tomography yielded negative findings for malignancies. Cerebrospinal fluid examination disclosed IgG oligoclonal bands and anti-NMDAR antibodies. Corticosteroids and intravenous immunoglobulin provided only slight improvement, whereas switching to cyclophosphamide markedly improved her neurological status. Conclusion In patients with a prolonged clinical course, including psychiatric and neurological symptoms, the differential diagnosis should be anti-NMDAR encephalitis. This report expands the known disease phenotypes in this emerging condition.
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Affiliation(s)
- Sara Mariotto
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Stefano Tamburin
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Alessandro Salviati
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Sergio Ferrari
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Marco Zoccarato
- Department of Neurology, Regional Hospital 'Ca' Foncello', Treviso, Italy
| | - Bruno Giometto
- Department of Neurology, Regional Hospital 'Ca' Foncello', Treviso, Italy
| | - Laura Bertolasi
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Franco Alessandrini
- Division of Neuroradiology, AOUI, Verona, Regional Hospital 'Ca' Foncello', Treviso, Italy
| | | | - Salvatore Monaco
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
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Giordano A, Lugaresi A, Confalonieri P, Granella F, Radice D, Trojano M, Martinelli V, Solari A, Giordano A, Martinelli V, Lugaresi A, Pucci E, Granella F, Trojano M, Solari A, Martinelli V, Pucci E, Messmer Uccelli M, Lugaresi A, Giordano A, Granella F, Solari A, Giordano A, Ferrari G, Martini F, Solari A, Radice D, D’Annunzio G, Lugaresi A, Farina D, Travaglini D, Pietrolongo E, Onofrj M, Torri Clerici V, Bonanno S, Brambilla L, Confalonieri P, Martinelli V, Radaelli M, Messina J, Comi G, Tortorella C, Luciannatelli E, Trojano M, Senesi C, Tsantes E, Granella F, Conti MZ, Rottoli MR, Bellantonio P, Fischetti M, Fantozzi R, Pala A, Traccis S, Di Battista G, Bianchi M, Benedetti MD, Gaetani L, Di Filippo M, Carolei A, Totaro R, Lanzillo R, Brescia Morra V, Coppola R, Cottone S, Chiavazza C, Cavalla P, Leonardi C, Aguglia U, Ziuliani C, Valla P, Sasanelli F, Valentino P, Quattrone A, Martino PG, Russo M, Vita G, Immovilli P. Implementation of the ‘Sapere Migliora’ information aid for newly diagnosed people with multiple sclerosis in routine clinical practice: a late-phase controlled trial. Mult Scler 2014; 20:1234-43. [DOI: 10.1177/1352458513519180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/11/2013] [Indexed: 11/16/2022]
Abstract
Background: The SIMS-Trial showed that the ‘Sapere Migliora’ information aid (IA) for newly diagnosed people with multiple sclerosis (PwMS) effectively improved patient knowledge and satisfaction with care. Objectives: The objectives of this paper are to assess the effectiveness of the IA in clinical practice and to compare the whole IA with the take-home booklet/website component alone. Methods: After updating the IA and replacing the CD with a website, a prospective, open-label non-randomised controlled trial compared the whole IA (group A, five SIMS-Trial centres) to take-home (group B, 16 centres). One month after the intervention, participants completed the MS Knowledge Questionnaire (MSKQ), care satisfaction questionnaire (COSM-R) (primary study outcomes), Hospital and Anxiety Depression Scale, and ad hoc questionnaire appraising the IA. Results: We enrolled 159 newly diagnosed PwMS (May 2012–March 2013). Drop-outs were four of 77 (5%, group A) and 11/82 (13%, group B). Primary endpoint (highest tertile both for MSKQ and COSM-R section 2 scores) was achieved by 38/77 (49%) group A and 33/82 (40%) group B ( p = 0.25). Attainment of secondary outcomes was also similar between groups. Conclusions: This study shows that the entire IA is not superior to the booklet/website alone, and that both are comparable in efficacy to the intervention arm of the SIMS-Trial. Trial registration number: ISRCTN78940214.
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Affiliation(s)
- A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Italy
| | - A Lugaresi
- Department of Neuroscience and Imaging, University G. d’Annunzio of Chieti-Pescara, Italy
| | - P Confalonieri
- Department of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Italy
| | - F Granella
- Department of Neurosciences, Neurology Unit, University of Parma, Italy
| | - D Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Italy
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - V Martinelli
- Department of Neurology, Scientific Institute Hospital San Raffaele, Italy
| | - A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Italy
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Zanier ER, Zoerle T, Fiorini M, Longhi L, Cracco L, Bersano A, Branca V, Benedetti MD, De Simoni MG, Monaco S, Stocchetti N. Heart-fatty acid-binding and tau proteins relate to brain injury severity and long-term outcome in subarachnoid haemorrhage patients. Br J Anaesth 2013; 111:424-32. [PMID: 23650253 DOI: 10.1093/bja/aet149] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vasospasm and other secondary neurological insults may follow subarachnoid haemorrhage (SAH). Biomarkers have the potential to stratify patient risk and perhaps serve as an early warning sign of delayed ischaemic injury. METHODS Serial cerebrospinal fluid (CSF) samples were collected from 38 consecutive patients with aneurysmal SAH admitted to the neurosurgical intensive care unit. We measured heart-fatty acid-binding protein (H-FABP) and tau protein (τ) levels in the CSF to evaluate their association with brain damage, and their potential as predictors of the long-term outcome. H-FABP and τ were analysed in relation to acute clinical status, assessed by the World Federation of Neurological Surgeons (WFNS) scale, radiological findings, clinical vasospasm, and 6-month outcome. RESULTS H-FABP and τ increased after SAH. H-FABP and τ were higher in patients in poor clinical status on admission (WFNS 4-5) compared with milder patients (WFNS 1-3). Elevated H-FABP and τ levels were also observed in patients with early cerebral ischaemia, defined as a CT scan hypodense lesion visible within the first 3 days after SAH. After the acute phase, H-FABP, and τ showed a delayed increase with the occurrence of clinical vasospasm. Finally, patients with the unfavourable outcome (death, vegetative state, or severe disability) had higher peak levels of both proteins compared with patients with good recovery or moderate disability. CONCLUSIONS H-FABP and τ show promise as biomarkers of brain injury after SAH. They may help to identify the occurrence of vasospasm and predict the long-term outcome.
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Affiliation(s)
- E R Zanier
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Department of Neuroscience, Via G. La Masa 19, 20156 Milan, Italy.
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Galeotti F, Massari M, D'Alessandro R, Beghi E, Chiò A, Logroscino G, Filippini G, Benedetti MD, Pugliatti M, Santuccio C, Raschetti R. Risk of Guillain-Barré syndrome after 2010-2011 influenza vaccination. Eur J Epidemiol 2013; 28:433-44. [PMID: 23543123 PMCID: PMC3672511 DOI: 10.1007/s10654-013-9797-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 08/08/2012] [Accepted: 03/15/2013] [Indexed: 11/29/2022]
Abstract
Influenza vaccination has been implicated in Guillain Barré Syndrome (GBS) although the evidence for this link is controversial. A case–control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged ≥18 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case–control analysis and a self-controlled case series analysis (SCCS). Case–control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations.
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Affiliation(s)
- Francesca Galeotti
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
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D’Alessandro R, Vignatelli L, Lugaresi A, Baldin E, Granella F, Tola MR, Malagù S, Motti L, Neri W, Galeotti M, Santangelo M, Fiorani L, Montanari E, Scandellari C, Benedetti MD, Leone M. Risk of multiple sclerosis following clinically isolated syndrome: a 4-year prospective study. J Neurol 2013; 260:1583-93. [DOI: 10.1007/s00415-013-6838-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 12/01/2022]
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Turatti M, Gajofatto A, Bianchi MR, Ferrari S, Monaco S, Benedetti MD. Benign course of tumour-like multiple sclerosis. Report of five cases and literature review. J Neurol Sci 2012; 324:156-62. [PMID: 23151425 DOI: 10.1016/j.jns.2012.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/21/2012] [Accepted: 10/24/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) with initial neuroradiological features suggestive of brain tumour (tumour-like MS) may represent a challenging diagnosis. METHODS Among the patients seen at the MS centre of our Institution between 2000 and 2010, we identified cases presenting with a large (diameter>2 cm), well-defined lesion, suggestive of brain tumour on initial brain magnetic resonance imaging (MRI). Only patients with at least 10 years follow-up were included. RESULTS Five young women with MS who presented with a tumour-like lesion on initial brain MRI are described. All cases presented with sudden-onset neurological deficits due to a single large brain lesion compatible with neoplasm at MRI. Two cases underwent brain stereotactic biopsy, both misdiagnosed as astrocytoma. However, the subsequent clinical and MRI follow-up was consistent with MS in all cases. Unnecessary surgery and radiotherapy were responsible for disability in two cases. In three cases, the course of the disease remains benign after more than 13 years from symptoms onset. CONCLUSIONS Our report of clinical, radiological and pathological features of five tumour-like MS cases confirms that it is mandatory to consider a demyelinating process in the differential diagnosis of tumour-like brain lesions. Many tumour-like MS cases may have a favourable long term prognosis.
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Affiliation(s)
- Marco Turatti
- The Section of Clinical Neurology, Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Italy
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Brigo F, Storti M, Benedetti MD, Rossini F, Nardone R, Tezzon F, Fiaschi A, Bongiovanni LG, Manganotti P. Resting motor threshold in idiopathic generalized epilepsies: a systematic review with meta-analysis. Epilepsy Res 2012; 101:3-13. [PMID: 22542570 DOI: 10.1016/j.eplepsyres.2012.03.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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: 01/30/2012] [Revised: 03/13/2012] [Accepted: 03/28/2012] [Indexed: 12/24/2022]
Abstract
Resting motor threshold (rMT) assessed by means of Transcranial Magnetic Stimulation (TMS) is thought to reflect trans-synaptic excitability of cortico-spinal neurons. TMS studies reporting rMT in idiopathic generalized epilepsies (IGEs) yielded discrepant results, so that it is difficult to draw a definitive conclusion on cortico-spinal excitability in IGEs by simple summation of previous results regarding this measure. Our purpose was to carry out a systematic review and a meta-analysis of studies evaluating rMT values obtained during single-pulse TMS in patients with IGEs. Controlled studies measuring rMT by single-pulse TMS in drug-naive patients older than 12 years affected by IGEs were systematically reviewed. rMT values were assessed calculating mean difference and odds ratio with 95% confidence intervals (CI). Fourteen trials (265 epileptic patients and 424 controls) were included. Patients with juvenile myoclonic epilepsy (JME) have a statistically significant lower rMT compared with controls (mean difference: -6.78; 95% CI -10.55 to -3.00); when considering all subtypes of IGEs and IGEs other than JME no statistically significant differences were found. Overall considered, the results are indicative of a cortico-spinal hyper-excitability in JME, providing not enough evidence for motor hyper-excitability in other subtypes of IGE. The considerable variability across studies probably reflects the presence of relevant clinical and methodological heterogeneity, and higher temporal variability among rMT measurements over time, related to unstable cortical excitability in these patients.
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Affiliation(s)
- Francesco Brigo
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy.
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Paraboschi EM, Soldà G, Gemmati D, Orioli E, Zeri G, Benedetti MD, Salviati A, Barizzone N, Leone M, Duga S, Asselta R. Genetic association and altered gene expression of mir-155 in multiple sclerosis patients. Int J Mol Sci 2011; 12:8695-712. [PMID: 22272099 PMCID: PMC3257096 DOI: 10.3390/ijms12128695] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [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: 09/19/2011] [Revised: 10/31/2011] [Accepted: 11/22/2011] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis (MS) is a complex autoimmune disease of the central nervous system characterized by chronic inflammation, demyelination, and axonal damage. As microRNA (miRNA)-dependent alterations in gene expression in hematopoietic cells are critical for mounting an appropriate immune response, miRNA deregulation may result in defects in immune tolerance. In this frame, we sought to explore the possible involvement of miRNAs in MS pathogenesis by monitoring the differential expression of 22 immunity-related miRNAs in peripheral blood mononuclear cells of MS patients and healthy controls, by using a microbead-based technology. Three miRNAs resulted >2 folds up-regulated in MS vs controls, whereas none resulted down-regulated. Interestingly, the most up-regulated miRNA (mir-155; fold change = 3.30; P = 0.013) was previously reported to be up-regulated also in MS brain lesions. Mir-155 up-regulation was confirmed by qPCR experiments. The role of mir-155 in MS susceptibility was also investigated by genotyping four single nucleotide polymorphisms (SNPs) mapping in the mir-155 genomic region. A haplotype of three SNPs, corresponding to a 12-kb region encompassing the last exon of BIC (the B-cell Integration Cluster non-coding RNA, from which mir-155 is processed), resulted associated with the disease status (P = 0.035; OR = 1.36, 95% CI = 1.05–1.77), suggesting that this locus strongly deserves further investigations.
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Affiliation(s)
- Elvezia Maria Paraboschi
- Dipartimento di Biologia e Genetica per le Scienze Mediche, Università degli Studi di Milano, Milano, Italia/Via Viotti 3/5, Milan 20133, Italy; E-Mails: (E.M.P.); (S.D.); (R.A.)
| | - Giulia Soldà
- Dipartimento di Biologia e Genetica per le Scienze Mediche, Università degli Studi di Milano, Milano, Italia/Via Viotti 3/5, Milan 20133, Italy; E-Mails: (E.M.P.); (S.D.); (R.A.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-02-5031-5852; Fax: +39-02-5031-5864
| | - Donato Gemmati
- Hemostasis & Thrombosis Center, Hematology Section and Department Biomedical Sciences & Advanced Therapies, University of Ferrara, Ferrara, Italy/Corso Giovecca 203, Ferrara 44121, Italy; E-Mails: (D.G.); (E.O.); (G.Z.)
| | - Elisa Orioli
- Hemostasis & Thrombosis Center, Hematology Section and Department Biomedical Sciences & Advanced Therapies, University of Ferrara, Ferrara, Italy/Corso Giovecca 203, Ferrara 44121, Italy; E-Mails: (D.G.); (E.O.); (G.Z.)
| | - Giulia Zeri
- Hemostasis & Thrombosis Center, Hematology Section and Department Biomedical Sciences & Advanced Therapies, University of Ferrara, Ferrara, Italy/Corso Giovecca 203, Ferrara 44121, Italy; E-Mails: (D.G.); (E.O.); (G.Z.)
| | - Maria Donata Benedetti
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Policlinico G. Rossi, University of Verona, Verona, Italy/Piazzale L.A. Scuro 10, Verona 37134, Italy; E-Mails: (M.D.B.); (A.S.)
| | - Alessandro Salviati
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Policlinico G. Rossi, University of Verona, Verona, Italy/Piazzale L.A. Scuro 10, Verona 37134, Italy; E-Mails: (M.D.B.); (A.S.)
| | - Nadia Barizzone
- Department of Medical Sciences, University of Eastern Piedmont, Novara, Italy/Via Solaroli, 17, Novara 28100, Italy; E-Mail:
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Eastern Piedmont, Novara, Italy/Via Solaroli, 17, Novara 28100, Italy; E-Mail: (M.L.)
| | - Maurizio Leone
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Eastern Piedmont, Novara, Italy/Via Solaroli, 17, Novara 28100, Italy; E-Mail: (M.L.)
- Department of Neurology, A.O.U. Maggiore della Carità, Novara, Italy/Corso Mazzini 18, Novara 28100, Italy
| | - Stefano Duga
- Dipartimento di Biologia e Genetica per le Scienze Mediche, Università degli Studi di Milano, Milano, Italia/Via Viotti 3/5, Milan 20133, Italy; E-Mails: (E.M.P.); (S.D.); (R.A.)
| | - Rosanna Asselta
- Dipartimento di Biologia e Genetica per le Scienze Mediche, Università degli Studi di Milano, Milano, Italia/Via Viotti 3/5, Milan 20133, Italy; E-Mails: (E.M.P.); (S.D.); (R.A.)
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Corrado L, Bergamaschi L, Barizzone N, Fasano ME, Guerini FR, Salvetti M, Galimberti D, Benedetti MD, Leone M, D'Alfonso S. Association of the CBLB gene with multiple sclerosis: new evidence from a replication study in an Italian population. J Med Genet 2010; 48:210-1. [PMID: 21037273 DOI: 10.1136/jmg.2010.081380] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The T allele of rs9657904 within the CBLB gene was recently found to be significantly associated with multiple sclerosis (MS) in a genome-wide association study in Sardinia. OBJECTIVE To replicate this association in an independent population with a different genetic background. METHODS The rs9657904 variant was typed in a sample of 1435 cases and 1466 controls from the Italian mainland. RESULTS It was found that in this sample also, the common allele T of rs9657904 is significantly positively associated (one-tailed p=7.35 × 10(-5)) and with a comparable effect size with MS (OR=1.31, 95% CI 1.14 to 1.52). CONCLUSION These data provide further evidence of the association of MS disease with variation within CBLB.
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Affiliation(s)
- Lucia Corrado
- Department of Medical Sciences and Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Eastern Piedmont, Novara, Italy
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Gajofatto A, Monaco S, Fiorini M, Zanusso G, Vedovello M, Rossi F, Turatti M, Benedetti MD. Assessment of Outcome Predictors in First-Episode Acute Myelitis. ACTA ACUST UNITED AC 2010; 67:724-30. [DOI: 10.1001/archneurol.2010.107] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Invernizzi P, Bonometti MA, Turri E, Benedetti MD, Salviati A. A case of Fabry disease with central nervous system (CNS) demyelinating lesions: a double trouble? Mult Scler 2008; 14:1003-6. [PMID: 18632784 DOI: 10.1177/1352458508092355] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present the case of a 36-year-old woman affected with Fabry disease (FD), with neuroradiologic and laboratory tests suggestive of a coexistent inflammatory demyelinating disease. Since the age of 23, she presented recurrent neurologic deficits, such as right limb paresthesias, diplopia, and right leg weakness. Magnetic resonance imaging revealed multiple demyelinating lesions in periventricular areas, corpus callosum, and spinal cord. Cerebrospinal fluid analysis showed the presence of oligoclonal bands, while visual-evoked potentials were delayed with preserved morphology. FD is usually considered as a differential diagnosis of multiple sclerosis, but we think that the best explanation of all pathological features in this case is the coexistence of the two diseases.
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Affiliation(s)
- P Invernizzi
- Department of Neurological Sciences and Vision, Section of Clinical Neurology, University of Verona, Verona, Italy.
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Fiorini M, Zanusso G, Benedetti MD, Righetti PG, Monaco S. Cerebrospinal fluid biomarkers in clinically isolated syndromes and multiple sclerosis. Proteomics Clin Appl 2007; 1:963-71. [PMID: 21136750 DOI: 10.1002/prca.200700091] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Indexed: 02/01/2023]
Abstract
A panel of three cerebrospinal fluid (CSF) markers for clinically isolated syndromes (CIS) and multiple sclerosis (MS), based on SDS-PAGE, 2-D maps, and immunoblot results, is here proposed. No individual marker has any specificity, though, since they appear in a number of other neurological diseases. However the set of three, with the respective modulation sign (up-regulated or maintained at constant level), appears to be unique for MS. These proteins are: tau protein (levels remaining constant and undistinguishable from controls, contrary to up- and downregulation in other neurological disorders); 14-3-3 protein (strong upregulation of distinct isoforms) and cystatin C (changing in accordance to disease stage and progression). As an additional evidence, one can rely in the pattern of isoforms of 14-3-3, as obtained by 2-D maps and Western blot analysis: this pattern further distinguishes the variation of this protein from other neurological syndromes, notably sporadic Creutzfeldt-Jakob disease (sCJD), motor neuron diseases and other dementias. In contrast, a similar qualitative and quantitative upregulation of 14-3-3 is observed in Guillain-Barré syndrome (GBS), a demyelinating condition affecting the peripheral nervous system. To the best of our knowledge, this is the first time in which such a panel of biomarkers is reported in MS.
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Affiliation(s)
- Michele Fiorini
- Section of Clinical Neurology, Department of Neurological and Visual Sciences, University of Verona, Verona, Italy
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Mazzola S, Lira MG, Benedetti MD, Salviati A, Ottaviani S, Malerba G, Ortombina M, Pignatti PF. COX-2 promoter region polymorphisms in multiple sclerosis: lack of association of ?765G>C with disease risk. Int J Immunogenet 2007; 34:71-4. [PMID: 17373929 DOI: 10.1111/j.1744-313x.2007.00675.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/30/2022]
Abstract
Cyclooxygenase-2 (COX-2) is extensively expressed in multiple sclerosis lesions suggesting that regulatory variants of the COX-2 gene could be implicated in multiple sclerosis (MS). Screening of the proximal 5' regulatory region and genotyping of -765G>C and -62C>G showed that polymorphisms in this COX-2 region are unlikely to be involved in MS susceptibility.
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Affiliation(s)
- S Mazzola
- Department of Mother and Child, Biology and Genetics, Section Biology and Genetics, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy.
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45
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Zanusso G, Fiorini M, Farinazzo A, Gelati M, Benedetti MD, Ferrari S, Dalla Libera A, Capaldi S, Monaco HL, Rizzuto N, Monaco S. Phosphorylated 14-3-3zeta protein in the CSF of neuroleptic-treated patients. Neurology 2006; 64:1618-20. [PMID: 15883327 DOI: 10.1212/01.wnl.0000160397.81314.84] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/15/2022] Open
Abstract
The authors describe 12 neuroleptic-treated patients with dementia of various etiologies who showed CSF elevation of phosphorylated 14-3-3zeta and normal tau protein levels. This contrasted with elevated amounts of 14-3-3 gamma, epsilon, and unphosphorylated zeta coupled to high tau protein levels in Creutzfeldt-Jakob disease and negative 14-3-3 assay in drug-free patients with dementia. Characterization of CSF 14-3-3 isoforms and determination of tau protein level can help to distinguish different etiologies of dementia.
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Affiliation(s)
- G Zanusso
- Department of Neurological and Visual Sciences, University of Verona, Verona, Italy
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46
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Gomez-Lira M, Moretto G, Bonamini D, Benedetti MD, Pignatti PF, Rizzuto N, Salviati A. Myelin oligodendrocyte glycoprotein polymorphisms and multiple sclerosis. J Neuroimmunol 2002; 133:241-3. [PMID: 12446029 DOI: 10.1016/s0165-5728(02)00361-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Abstract
A detailed analysis of the coding sequences of myelin oligodendrocyte glycoprotei (MOG) gene was performed in multiple sclerosis (MS) patients and in control individuals and three new polymorphisms are described: T636C, nt 571+77C-->T (IVS 4), and nt 710-44A-->G (IVS 6). Screening studies demonstrated that T636C was present in three MS patients and in no control individual and that polymorphisms nt 571+77C-->T (IVS 4), and nt 710-44A-->G (IVS 6), were present with no significant frequency differences in MS patients and control individuals. No mutations were found after sequencing the coding sequences of the extracellular domain of MOG gene in 20 MS patients and 20 control individuals. Screening studies were also performed for known polymorphisms: G15A, Val142Leu, nt 571+68A-->G (IVS 4), and 571+92C-->G (IVS 4). Polymorphism Val 142 Leu, which is linked to nt 571+68A-->G (IVS 4), resulted under-represented in MS patients.
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Affiliation(s)
- M Gomez-Lira
- Department of Mother and Child, Biology and Genetics, Section Biology and Genetics, Università di Verona, Strada Le Grazie 8, 37134, Verona, Italy.
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Benedetti MD, Salviati A, Filipponi S, Manfredi M, De Togni L, Gomez Lira M, Stenta G, Fincati E, Pampanin M, Rizzuto N, Danti G. Prevalence of dementia and apolipoprotein e genotype distribution in the elderly of buttapietra, verona province, Italy. Neuroepidemiology 2002; 21:74-80. [PMID: 11901276 DOI: 10.1159/000048620] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [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: 11/19/2022] Open
Abstract
We investigated the prevalence of dementia and the apolipoprotein E (APOE) genotype distribution in the elderly of Buttapietra, a village near Verona, Italy. All residents over the age of 74 (n = 238), including those who were institutionalized, were studied using a direct-contact, single-phase design. The overall prevalence of dementia, clinically defined by DSM-III-R criteria, was 15.8 cases per 100 population, with age-specific figures increasing steeply with advancing age in both sexes. Alzheimer's disease (AD) was the most frequent dementing disorder (43%). APOE genotyping was determined after DNA amplification by restriction isotyping. We found that the epsilon4 allele and the epsilon3/epsilon4 genotype were associated with all types of dementia, although only the association of epsilon3/epsilon4 with AD reached statistical significance (odds ratio 4.5, 95% confidence interval 1.3-16.1). However, as reported in other Mediterranean countries, the frequency of the epsilon4 allele in our population was low (8.9%), suggesting that the population-attributable risk for AD, at least for elderly individuals (> or =75 years), could be small.
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Affiliation(s)
- M D Benedetti
- Dipartimento di Scienze Neurologiche e della Visione, Sezione Neurologia Clinica, Università di Verona, Italia.
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Fenzi F, Benedetti MD, Moretto G, Rizzuto N. Glial cell and macrophage reactions in rat spinal ganglion after peripheral nerve lesions: an immunocytochemical and morphometric study. Arch Ital Biol 2001; 139:357-65. [PMID: 11603078] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Following peripheral nerve injury perineuronal satellite cell reaction in the corresponding spinal ganglion is observed. The mechanisms underlying the glial responses to axon injury remain unknown. In an immunocytochemical and morphometric study we investigated satellite cell and macrophage responses in the rat L4 and L5 dorsal root ganglia (DRG) during the seven days immediately after unilateral sciatic nerve crush or transection. Nerve lesion induced a significant increase of glial fibrillary acidic protein-immunoreactive (GFAP-IR) cells in the ipsilateral L4-L5 DRGs. The number of ED1-positive macrophages significantly increased as well. We found no significant differences between the increases provoked by the two types of nerve lesion, but the macrophage activation was detected earlier after nerve transection than after crush. No correlation was detected between satellite cells and macrophages reactions over the 7 day period we examined. These findings support the idea that intercellular neuron-glial diffusible signals play a major role in DRG glial cell response to peripheral nerve lesion.
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Affiliation(s)
- F Fenzi
- Section of Clinical Neurology, Department of Neurological Sciences and Visual Sciences, University of Verona, Policlinico Borgo Roma, 37134 Verona, Italy
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Benedetti MD, Maraganore DM, Bower JH, McDonnell SK, Peterson BJ, Ahlskog JE, Schaid DJ, Rocca WA. Hysterectomy, menopause, and estrogen use preceding Parkinson's disease: an exploratory case-control study. Mov Disord 2001; 16:830-7. [PMID: 11746612 DOI: 10.1002/mds.1170] [Citation(s) in RCA: 162] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We studied the association of Parkinson's disease (PD) with type of menopause (natural or surgical), age at menopause, and postmenopausal estrogen replacement therapy using a case-control design. We used the medical records-linkage system of the Rochester Epidemiology Project to identify 72 women who developed PD in Olmsted County, MN, during the twenty years 1976-1995. Each incident case was matched by age (+/- 1 year) to a general population control subject. We collected exposure data through review of the complete medical records of cases and control subjects in the system. PD cases had undergone hysterectomy (with or without unilateral oophorectomy) significantly more often than control subjects (odds ratio [OR] = 3.36; 95% confidence interval [CI] = 1.05-10.77). In addition, PD cases had experienced early menopause (< or = 46 years) more commonly than control subjects (OR = 2.18; 95% CI = 0.88-5.39). Finally, PD cases had used estrogens orally or parenterally for at least 6 months after menopause less frequently (8%) than control subjects (14%; OR = 0.47; 95% CI = 0.12-1.85). However, the findings for early menopause and estrogen replacement therapy were not statistically significant. Despite the limited sample size of this exploratory study, we hypothesize that there is an increased risk of PD in conditions causing an early reduction in endogenous estrogen. This hypothesis needs to be confirmed in a larger study.
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Affiliation(s)
- M D Benedetti
- Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Benedetti MD, Bower JH, Maraganore DM, McDonnell SK, Peterson BJ, Ahlskog JE, Schaid DJ, Rocca WA. Smoking, alcohol, and coffee consumption preceding Parkinson's disease: a case-control study. Neurology 2000; 55:1350-8. [PMID: 11087780 DOI: 10.1212/wnl.55.9.1350] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.2] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the association of PD with preceding smoking, alcohol, and coffee consumption using a case-control design. METHODS The authors used the medical records linkage system of the Rochester Epidemiology Project to identify 196 subjects who developed PD in Olmsted County, MN, during the years 1976 to 1995. Each incident case was matched by age (+/-1 year) and sex to a general population control subject. The authors reviewed the complete medical records of cases and control subjects to abstract exposure information. RESULTS For coffee consumption, the authors found an OR of 0.35 (95% CI = 0.16 to 0.78, p = 0.01), a dose-effect trend (p = 0.003), and a later age at PD onset in cases who drank coffee compared with those who never did (median 72 versus 64 years; p = 0.0002). The inverse association with coffee remained significant after adjustment for education, smoking, and alcohol drinking and was restricted to PD cases with onset at age <72 years and to men. The OR for cigarette smoking was 0.69 (95% CI = 0.45 to 1.08, p = 0.1). The authors found no association between PD and alcohol consumption. Extreme or unusual behaviors such as tobacco chewing or snuff use and a diagnosis of alcoholism were significantly more common in control subjects than cases. CONCLUSIONS These findings suggest an inverse association between coffee drinking and PD; however, this association does not imply that coffee has a direct protective effect against PD. Alternative explanations for the association should be considered.
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Affiliation(s)
- M D Benedetti
- Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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