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Storelli L, Pagani E, Rubin M, Margoni M, Filippi M, Rocca MA. A Fully Automatic Method to Segment Choroid Plexuses in Multiple Sclerosis Using Conventional MRI Sequences. J Magn Reson Imaging 2024; 59:1643-1652. [PMID: 37530734 DOI: 10.1002/jmri.28937] [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: 05/18/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Choroid plexus (CP) volume has been recently proposed as a proxy for brain neuroinflammation in multiple sclerosis (MS). PURPOSE To develop and validate a fast automatic method to segment CP using routinely acquired brain T1-weighted and FLAIR MRI. STUDY TYPE Retrospective. POPULATION Fifty-five MS patients (33 relapsing-remitting, 22 progressive; mean age = 46.8 ± 10.2 years; 31 women) and 60 healthy controls (HC; mean age = 36.1 ± 12.6 years, 33 women). FIELD STRENGTH/SEQUENCE 3D T2-weighted FLAIR and 3D T1-weighted gradient echo sequences at 3.0 T. ASSESSMENT Brain tissues were segmented on T1-weighted sequences and a Gaussian Mixture Model (GMM) was fitted to FLAIR image intensities obtained from the ventricle masks of the SIENAX. A second GMM was then applied on the thresholded and filtered ventricle mask. CP volumes were automatically determined and compared with those from manual segmentation by two raters (with 3 and 10 years' experience; reference standard). CP volumes from previously published automatic segmentation methods (freely available Freesurfer [FS] and FS-GMM) were also compared with reference standard. Expanded Disability Status Scale (EDSS) score was assessed within 3 days of MRI. Computational time was assessed for each automatic technique and manual segmentation. STATISTICAL TESTS Comparisons of CP volumes with reference standard were evaluated with Bland Altman analysis. Dice similarity coefficients (DSC) were computed to assess automatic CP segmentations. Volume differences between MS and HC for each method were assessed with t-tests and correlations of CP volumes with EDSS were assessed with Pearson's correlation coefficients (R). A P value <0.05 was considered statistically significant. RESULTS Compared to manual segmentation, the proposed method had the highest segmentation accuracy (mean DSC = 0.65 ± 0.06) compared to FS (mean DSC = 0.37 ± 0.08) and FS-GMM (0.58 ± 0.06). The percentage CP volume differences relative to manual segmentation were -0.1% ± 0.23, 4.6% ± 2.5, and -0.48% ± 2 for the proposed method, FS, and FS-GMM, respectively. The Pearson's correlations between automatically obtained CP volumes and the manually obtained volumes were 0.70, 0.54, and 0.56 for the proposed method, FS, and FS-GMM, respectively. A significant correlation between CP volume and EDSS was found for the proposed automatic pipeline (R = 0.2), for FS-GMM (R = 0.3) and for manual segmentation (R = 0.4). Computational time for the proposed method (32 ± 2 minutes) was similar to the manual segmentation (20 ± 5 minutes) but <25% of the FS (120 ± 15 minutes) and FS-GMM (125 ± 15 minutes) methods. DATA CONCLUSION This study developed an accurate and easily implementable method for automatic CP segmentation in MS using T1-weighted and FLAIR MRI. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Rubin
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Sharmin S, Roos I, Malpas CB, Iaffaldano P, Simone M, Filippi M, Kubala Havrdova E, Ozakbas S, Brescia Morra V, Alroughani R, Zaffaroni M, Patti F, Eichau S, Salemi G, Di Sapio A, Inglese M, Portaccio E, Trojano M, Amato MP, Kalincik T. Disease-modifying therapies in managing disability worsening in paediatric-onset multiple sclerosis: a longitudinal analysis of global and national registries. Lancet Child Adolesc Health 2024; 8:348-357. [PMID: 38547883 DOI: 10.1016/s2352-4642(24)00047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND High-efficacy disease-modifying therapies have been proven to slow disability accrual in adults with relapsing-remitting multiple sclerosis. However, their impact on disability worsening in paediatric-onset multiple sclerosis, particularly during the early phases, is not well understood. We evaluated how high-efficacy therapies influence transitions across five disability states, ranging from minimal disability to gait impairment and secondary progressive multiple sclerosis, in people with paediatric-onset multiple sclerosis. METHODS Longitudinal data were obtained from the international MSBase registry, containing data from people with multiple sclerosis from 151 centres across 41 countries, and the Italian Multiple Sclerosis and Related Disorders Register, containing data from people with multiple sclerosis from 178 Italian multiple sclerosis centres. People younger than 18 years at the onset of multiple sclerosis symptoms were included, provided they had a confirmed diagnosis of relapsing-remitting multiple sclerosis and at least four Expanded Disability Status Scale (EDSS) scores recorded within 12-month intervals. The primary outcome was the time to change in disability state: minimal disability (EDSS scores 0, 1·0, and 1·5), mild disability (EDSS scores 2·0 and 2·5), moderate disability (EDSS scores 3·0 and 3·5), gait impairment (EDSS scores ≥4·0), and clinician diagnosed secondary progressive multiple sclerosis. A multi-state model was constructed to simulate the natural course of multiple sclerosis, modelling the probabilities of both disability worsening and improvement simultaneously. The impact of high-efficacy disease-modifying therapies (alemtuzumab, cladribine, daclizumab, fingolimod, mitoxantrone, natalizumab, ocrelizumab, rituximab, or autologous haematopoietic stem cell transplantation) and low-efficacy disease-modifying therapies (dimethyl fumarate, glatiramer acetate, interferon beta, or teriflunomide), compared with no treatment, on the course of disability was assessed. Apart from recruitment, individuals with lived experience of multiple sclerosis were not involved in the design and conduct of this study. FINDINGS A total of 5224 people (3686 [70·6%] female and 1538 [29·4%] male) with mean age at onset of multiple sclerosis 15·24 years (SD 2·52) were included. High-efficacy therapies reduced the hazard of disability worsening across the disability states. The largest reduction (hazard ratio 0·41 [95% CI 0·31-0·53]) was observed in participants who were treated with high-efficacy therapies while in the minimal disability state, compared with those remained untreated. The benefit of high-efficacy therapies declined with increasing disability. Young people with minimal disability who received low-efficacy therapy also experienced a reduced hazard (hazard ratio 0·65 [95% CI 0·54-0·77]) of transitioning to mild disability, in contrast to those who remained untreated. INTERPRETATION Treatment of paediatric-onset relapsing-remitting multiple sclerosis with high-efficacy therapy substantially reduces the risk of reaching key disability milestones. This reduction in risk is most pronounced among young people with minimal or mild disability when treatment began. Children with relapsing-remitting multiple sclerosis should be treated early with high-efficacy therapy, before developing significant neurological impairments, to better preserve their neurological capacity. FUNDING National Health and Medical Research Council, Australia; MSBase Foundation Fellowship; MS Australia Postdoctoral Fellowship.
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Affiliation(s)
- Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Charles B Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Pietro Iaffaldano
- Centro SM Dipartimento di Scienze Mediche di Base, Neuroscienze ed Organi di Senso Universita' di Bari, Bari, Italy
| | - Marta Simone
- Pediatric MS Center, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Serkan Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
| | - Vincenzo Brescia Morra
- Unità Operativa Semplice Dipartimentale Sclerosi Multipla - AOU Policlinico Federico II, Naples, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Mauro Zaffaroni
- Centro Sclerosi Multipla, ASST Della Valle Olona, Ospedale Di Gallarate, Gallarate VA, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy; Multiple Sclerosis Centre, AOU Policlinico G Rodolico-San Marco, University of Catania, Catania, Italy
| | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Giuseppe Salemi
- Centro Per La Diagnosi E Cura Della SM E Delle Malattie Demielinizzanti - Dipt Radiologia Diagnostica, Interventistica e Stroke, AOUP P Giaccone di Palermo, Palermo, Italy
| | - Alessia Di Sapio
- SCDO Neurologia, Centro Di Riferimento Regionale Sclerosi Multipla (CReSM)-AOU San Luigi, Turin, Italy
| | - Matilde Inglese
- Centro Per Lo Studio E La Cura Della Sclerosi Multipla E Malattie Demielinizzanti - Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno, Infantili, Clinica Neurologica, Ospedale Policlinico San Martino (DiNOGMI), Genova, Italia
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Maria Trojano
- School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
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Fissolo N, Benkert P, Sastre-Garriga J, Mongay-Ochoa N, Vilaseca-Jolonch A, Llufriu S, Blanco Y, Hegen H, Berek K, Perez-Miralles F, Rejdak K, Villar LM, Monreal E, Alvarez-Lafuente R, Soylu OK, Abdelhak A, Bachhuber F, Tumani H, Martínez-Yélamos S, Sánchez-López AJ, García-Merino A, Gutiérrez L, Castillo-Trivino T, Lycke J, Rosenstein I, Furlan R, Filippi M, Téllez N, Ramió-Torrentà L, Lünemann JD, Wiendl H, Eichau S, Khalil M, Kuhle J, Montalban X, Comabella M. Serum biomarker levels predict disability progression in patients with primary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2024; 95:410-418. [PMID: 37940409 DOI: 10.1136/jnnp-2023-332251] [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: 07/18/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND We aimed to investigate the potential of serum biomarker levels to predict disability progression in a multicentric real-world cohort of patients with primary progressive multiple sclerosis (PPMS). METHODS A total of 141 patients with PPMS from 18 European MS centres were included. Disability progression was investigated using change in Expanded Disability Status Scale (EDSS) score over three time intervals: baseline to 2 years, 6 years and to the last follow-up. Serum levels of neurofilament light chain (sNfL), glial fibrillar acidic protein (sGFAP) and chitinase 3-like 1 (sCHI3L1) were measured using single-molecule array assays at baseline. Correlations between biomarker levels, and between biomarkers and age were quantified using Spearman's r. Univariable and multivariable linear models were performed to assess associations between biomarker levels and EDSS change over the different time periods. RESULTS Median (IQR) age of patients was 52.9 (46.4-58.5) years, and 58 (41.1%) were men. Median follow-up time was 9.1 (7.0-12.6) years. Only 8 (5.7%) patients received treatment during follow-up. sNfL and sGFAP levels were moderately correlated (r=0.43) and both weakly correlated with sCHI3L1 levels (r=0.19 and r=0.17, respectively). In multivariable analyses, levels of the three biomarkers were associated with EDSS changes across all time periods. However, when analysis was restricted to non-inflammatory patients according to clinical and radiological parameters (n=64), only sCHI3L1 levels remained associated with future EDSS change. CONCLUSIONS Levels of sNfL, sGFAP and sCHI3L1 are prognostic biomarkers associated with disability progression in patients with PPMS, being CHI3L1 findings less dependent on the inflammatory component associated with disease progression.
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Affiliation(s)
- Nicolás Fissolo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andreu Vilaseca-Jolonch
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Harald Hegen
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Luisa M Villar
- Departments of Neurology and Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal deInvestigacion Sanitaria (IRYCIS), Madrid, Spain
| | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, REEM, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Roberto Alvarez-Lafuente
- Environmental Factors in Degenerative Diseases Research Group, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico SanCarlos (IdISSC), Madrid, Spain
| | - Onder K Soylu
- Department of Neurology, Ulm University, Ulm, Germany
| | - Ahmed Abdelhak
- Department of Neurology, Ulm University, Ulm, Germany
- Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California San Francisco, San Francisco, California, USA
| | | | | | - Sergio Martínez-Yélamos
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari deBellvitge-IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Antonio J Sánchez-López
- Neuroimmunology Unit, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Antonio García-Merino
- Neuroimmunology Unit, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Lucía Gutiérrez
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Igal Rosenstein
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita Salute San Raffaele, Milano, Italy
| | - Nieves Téllez
- Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department,Hospital Universitari Dr. Josep Trueta and Hospital Santa Caterina.Neurodegeneration and Neuroinflammation research group (IDIBGI). Department of Medical Sciences, University of Girona, Girona, Spain
| | - Jan D Lünemann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Munster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Munster, Germany
| | - Sara Eichau
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
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Ghirelli A, Spinelli EG, Canu E, Basaia S, Castelnovo V, Cecchetti G, Sibilla E, Domi T, Magnani G, Caso F, Caroppo P, Prioni S, Villa C, Rossi G, Tremolizzo L, Appollonio I, Verde F, Ticozzi N, Silani V, Filippi M, Agosta F. Clinical and neuroanatomical characterization of the semantic behavioral variant of frontotemporal dementia in a multicenter Italian cohort. J Neurol 2024:10.1007/s00415-024-12338-9. [PMID: 38597943 DOI: 10.1007/s00415-024-12338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Semantic behavioral variant frontotemporal dementia (sbvFTD) is a neurodegenerative condition presenting with specific behavioral and semantic derangements and predominant atrophy of the right anterior temporal lobe (ATL). The objective was to evaluate clinical, neuropsychological, neuroimaging, and genetic features of an Italian sbvFTD cohort, defined according to recently proposed guidelines, compared to semantic variant primary progressive aphasia (svPPA) and behavioral variant FTD (bvFTD) patients. METHODS Fifteen sbvFTD, sixty-three bvFTD, and twenty-five svPPA patients and forty controls were enrolled. Patients underwent clinical, cognitive evaluations, and brain MRI. Symptoms of bvFTD patients between onset and first visit were retrospectively recorded and classified as early and late. Grey matter atrophy was investigated using voxel-based morphometry. RESULTS sbvFTD experienced early criteria-specific symptoms: world, object and person-specific semantic loss (67%), complex compulsions and rigid thought (60%). Sequentially, more behavioral symptoms emerged (apathy/inertia, loss of empathy) along with non-criteria-specific symptoms (anxiety, suspiciousness). sbvFTD showed sparing of attentive/executive functions, especially compared to bvFTD and better language functions compared to svPPA. All sbvFTD patients failed at the famous face recognition test and more than 80% failed in understanding written metaphors and humor. At MRI, sbvFTD had predominant right ATL atrophy, almost specular to svPPA. Three sbvFTD patients presented pathogenic genetic variants. CONCLUSION We replicated the application of sbvFTD diagnostic guidelines in an independent Italian cohort, demonstrating that the presence of person-specific semantic knowledge loss and mental rigidity, along with preserved executive functions and a predominant right ATL atrophy with sparing of frontal lobes, should prompt a diagnosis of sbvFTD.
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Affiliation(s)
- Alma Ghirelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edoardo Gioele Spinelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Veronica Castelnovo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giordano Cecchetti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Sibilla
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Teuta Domi
- Experimental Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Magnani
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Caso
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Caroppo
- Unit of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Prioni
- Unit of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cristina Villa
- Unit of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giacomina Rossi
- Unit of Neurology 5-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lucio Tremolizzo
- Neurology Unit, "San Gerardo" Hospital and University of Milano-Bicocca, Monza, Italy
| | - Ildebrando Appollonio
- Neurology Unit, "San Gerardo" Hospital and University of Milano-Bicocca, Monza, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- "Dino Ferrari" Center, Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- "Dino Ferrari" Center, Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- "Dino Ferrari" Center, Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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5
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Pozzi FE, Aprea V, Giovannelli G, Lattuada F, Crivellaro C, Bertola F, Castelnovo V, Canu E, Filippi M, Appollonio I, Ferrarese C, Agosta F, Tremolizzo L. Clinical and neuroimaging characterization of the first frontotemporal dementia family carrying the MAPT p.K298E mutation. Neurogenetics 2024:10.1007/s10048-024-00756-w. [PMID: 38592608 DOI: 10.1007/s10048-024-00756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
We present an in-depth clinical and neuroimaging analysis of a family carrying the MAPT K298E mutation associated with frontotemporal dementia (FTD). Initial identification of this mutation in a single clinical case led to a comprehensive investigation involving four affected siblings allowing to elucidate the mutation's phenotypic expression.A 60-year-old male presented with significant behavioral changes and progressed rapidly, exhibiting speech difficulties and cognitive decline. Neuroimaging via FDG-PET revealed asymmetrical frontotemporal hypometabolism. Three siblings subsequently showed varied but consistent clinical manifestations, including abnormal behavior, speech impairments, memory deficits, and motor symptoms correlating with asymmetric frontotemporal atrophy observed in MRI scans.Based on the genotype-phenotype correlation, we propose that the p.K298E mutation results in early-onset behavioral variant FTD, accompanied by a various constellation of speech and motor impairment.This detailed characterization expands the understanding of the p.K298E mutation's clinical and neuroimaging features, underlining its role in the pathogenesis of FTD. Further research is crucial to comprehensively delineate the clinical and epidemiological implications of the MAPT p.K298E mutation.
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Affiliation(s)
- Federico Emanuele Pozzi
- Neurology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Vittoria Aprea
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Francesca Lattuada
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Nuclear Medicine Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Cinzia Crivellaro
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Nuclear Medicine Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Francesca Bertola
- Medical Genetics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Veronica Castelnovo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carlo Ferrarese
- Neurology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucio Tremolizzo
- Neurology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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6
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Orlandi F, Carlos AF, Ali F, Clark HM, Duffy JR, Utianski RL, Botha H, Machulda MM, Stephens YC, Schwarz CG, Senjem ML, Jack CR, Agosta F, Filippi M, Dickson DW, Josephs KA, Whitwell JL. Histologic tau lesions and magnetic resonance imaging biomarkers differ across two progressive supranuclear palsy variants. Brain Commun 2024; 6:fcae113. [PMID: 38660629 PMCID: PMC11040515 DOI: 10.1093/braincomms/fcae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Progressive supranuclear palsy is a neurodegenerative disease characterized by the deposition of four-repeat tau in neuronal and glial lesions in the brainstem, cerebellar, subcortical and cortical brain regions. There are varying clinical presentations of progressive supranuclear palsy with different neuroimaging signatures, presumed to be due to different topographical distributions and burden of tau. The classic Richardson syndrome presentation is considered a subcortical variant, whilst progressive supranuclear palsy with predominant speech and language impairment is considered a cortical variant, although the pathological underpinnings of these variants are unclear. In this case-control study, we aimed to determine whether patterns of regional tau pathology differed between these variants and whether tau burden correlated with neuroimaging. Thirty-three neuropathologically confirmed progressive supranuclear palsy patients with either the Richardson syndrome (n = 17) or speech/language (n = 16) variant and ante-mortem magnetic resonance imaging were included. Tau lesion burden was semi-quantitatively graded in cerebellar, brainstem, subcortical and cortical regions and combined to form neuronal and glial tau scores. Regional magnetic resonance imaging volumes were converted to Z-scores using 33 age- and sex-matched controls. Diffusion tensor imaging metrics, including fractional anisotropy and mean diffusivity, were calculated. Tau burden and neuroimaging metrics were compared between groups and correlated using linear regression models. Neuronal and glial tau burden were higher in motor and superior frontal cortices in the speech/language variant. In the subcortical and brainstem regions, only the glial tau burden differed, with a higher burden in globus pallidus, subthalamic nucleus, substantia nigra and red nucleus in Richardson's syndrome. No differences were observed in the cerebellar dentate and striatum. Greater volume loss was observed in the motor cortex in the speech/language variant and in the subthalamic nucleus, red nucleus and midbrain in Richardson's syndrome. Fractional anisotropy was lower in the midbrain and superior cerebellar peduncle in Richardson's syndrome. Mean diffusivity was greater in the superior frontal cortex in the speech/language variant and midbrain in Richardson's syndrome. Neuronal tau burden showed associations with volume loss, lower fractional anisotropy and higher mean diffusivity in the superior frontal cortex, although these findings did not survive correction for multiple comparisons. Results suggest that a shift in the distribution of tau, particularly neuronal tau, within the progressive supranuclear palsy network of regions is driving different clinical presentations in progressive supranuclear palsy. The possibility of different disease epicentres in these clinical variants has potential implications for the use of imaging biomarkers in progressive supranuclear palsy.
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Affiliation(s)
- Francesca Orlandi
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Neurology and Neurophysiology, IRCCS San Raffaele University, Milan 20132, Italy
| | - Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Federica Agosta
- Department of Neurology and Neurophysiology, IRCCS San Raffaele University, Milan 20132, Italy
- Division of Neuroscience, Neuroimaging Research Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Massimo Filippi
- Department of Neurology and Neurophysiology, IRCCS San Raffaele University, Milan 20132, Italy
- Division of Neuroscience, Neuroimaging Research Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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7
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Lazzarotto A, Hamzaoui M, Tonietto M, Dubessy AL, Khalil M, Pirpamer L, Ropele S, Enzinger C, Battaglini M, Stromillo ML, De Stefano N, Filippi M, Rocca MA, Gallo P, Gasperini C, Stankoff B, Bodini B. Time is myelin: early cortical myelin repair prevents atrophy and clinical progression in multiple sclerosis. Brain 2024; 147:1331-1343. [PMID: 38267729 PMCID: PMC10994569 DOI: 10.1093/brain/awae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/15/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
Cortical myelin loss and repair in multiple sclerosis (MS) have been explored in neuropathological studies, but the impact of these processes on neurodegeneration and the irreversible clinical progression of the disease remains unknown. Here, we evaluated in vivo cortical demyelination and remyelination in a large cohort of people with all clinical phenotypes of MS followed up for 5 years using magnetization transfer imaging (MTI), a technique that has been shown to be sensitive to myelin content changes in the cortex. We investigated 140 people with MS (37 clinically isolated syndrome, 71 relapsing-MS, 32 progressive-MS), who were clinically assessed at baseline and after 5 years and, along with 84 healthy controls, underwent a 3 T-MRI protocol including MTI at baseline and after 1 year. Changes in cortical volume over the radiological follow-up were computed with a Jacobian integration method. Magnetization transfer ratio was employed to calculate for each patient an index of cortical demyelination at baseline and of dynamic cortical demyelination and remyelination over the follow-up period. The three indices of cortical myelin content change were heterogeneous across patients but did not significantly differ across clinical phenotypes or treatment groups. Cortical remyelination, which tended to fail in the regions closer to CSF (-11%, P < 0.001), was extensive in half of the cohort and occurred independently of age, disease duration and clinical phenotype. Higher indices of cortical dynamic demyelination (β = 0.23, P = 0.024) and lower indices of cortical remyelination (β = -0.18, P = 0.03) were significantly associated with greater cortical atrophy after 1 year, independently of age and MS phenotype. While the extent of cortical demyelination predicted a higher probability of clinical progression after 5 years in the entire cohort [odds ratio (OR) = 1.2; P = 0.043], the impact of cortical remyelination in reducing the risk of accumulating clinical disability after 5 years was significant only in the subgroup of patients with shorter disease duration and limited extent of demyelination in cortical regions (OR = 0.86, P = 0.015, area under the curve = 0.93). In this subgroup, a 30% increase in cortical remyelination nearly halved the risk of clinical progression at 5 years, independently of clinical relapses. Overall, our results highlight the critical role of cortical myelin dynamics in the cascade of events leading to neurodegeneration and to the subsequent accumulation of irreversible disability in MS. Our findings suggest that early-stage myelin repair compensating for cortical myelin loss has the potential to prevent neuro-axonal loss and its long-term irreversible clinical consequences in people with MS.
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Affiliation(s)
- Andrea Lazzarotto
- Department of Neuroscience, Sorbonne Université, Paris Brain Institute, CNRS, Inserm, 75013 Paris, France
- AP-HP, Hôpital Universitaire Pitié-Salpêtrière, 75013 Paris, France
- Padova Neuroscience Center, University of Padua, 35122 Padua, Italy
| | - Mariem Hamzaoui
- Department of Neuroscience, Sorbonne Université, Paris Brain Institute, CNRS, Inserm, 75013 Paris, France
| | - Matteo Tonietto
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, 91400 Orsay, France
- Roche Pharma Research & Early Development, F. Hoffmann-La Roche Ltd., CH-4070 Basel, Switzerland
| | | | - Michael Khalil
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, CH-4051 Basel, Switzerland
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria
| | | | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Maria Laura Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Paolo Gallo
- Padova Neuroscience Center, University of Padua, 35122 Padua, Italy
- Multiple Sclerosis Centre of Veneto Region, 35128 Padua, Italy
| | | | - Bruno Stankoff
- Department of Neuroscience, Sorbonne Université, Paris Brain Institute, CNRS, Inserm, 75013 Paris, France
- AP-HP, Hôpital Universitaire Pitié-Salpêtrière, 75013 Paris, France
| | - Benedetta Bodini
- Department of Neuroscience, Sorbonne Université, Paris Brain Institute, CNRS, Inserm, 75013 Paris, France
- AP-HP, Hôpital Universitaire Pitié-Salpêtrière, 75013 Paris, France
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8
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Filippi M, Ferrè L, Zanetta C, Rizzi C, Pessina G, Assogna F, Rocca MA. Prospective observational study to evaluate treatment satisfaction and effectiveness in patients with relapsing multiple sclerosis starting cladribine tablets (CLADREAL) in Italy. Front Neurol 2024; 15:1379712. [PMID: 38638312 PMCID: PMC11024245 DOI: 10.3389/fneur.2024.1379712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Disease-modifying therapies (DMTs) for multiple sclerosis (MS) reduce relapse frequency, magnetic resonance imaging (MRI) activity, and slow disability progression. Numerous DMTs are approved for relapsing forms of MS although real-world data on patient-reported outcomes (PROs) and quality of life (QoL) are needed to inform treatment choice. Immune reconstitution therapy with cladribine tablets is a highly effective treatment for relapsing MS (RMS). We present the protocol for an observational study to prospectively assess the effectiveness of cladribine tablets on clinical and MRI parameters as well as on PROs, including treatment satisfaction, QoL, sleep quality, self-perceived health, fatigue, and physical function. Enrolled patients at study sites in Italy will be adults with RMS (including relapsing-remitting and active secondary progressive MS) who are either treatment naïve or have received at least one first-line disease modifying DMT or no more than one second-line DMT. The primary objective will be change in global treatment satisfaction measured with the Treatment Satisfaction Questionnaire for Medication Version 1.4 approximately 24 months after initiating cladribine tablets in patients switching from previous DMTs. Secondary objectives will include global treatment satisfaction at earlier timepoints, will comprise treatment naïve patients, and will quantify treatment effectiveness and tolerability. We will also assess relapses, disability progression, MRI activity, and other PROs at approximately 12 and 24 months. The findings will provide insight from daily clinical practice into the patient's experience to complement data from controlled trials and inform treatment choice. EU PAS Registration Number EUPAS49334 filed 17/10/2022.
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Affiliation(s)
- Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Ferrè
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Zanetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Rizzi
- Merck Serono S.p.A., An Affiliate of Merck KGaA, Rome, Italy
| | | | | | - Maria A. Rocca
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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9
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Barbanti P, Aurilia C, Egeo G, Proietti S, D'Onofrio F, Torelli P, Aguggia M, Bertuzzo D, Finocchi C, Trimboli M, Cevoli S, Fiorentini G, Orlando B, Zucco M, Di Clemente L, Cetta I, Colombo B, di Poggio MLB, Favoni V, Grazzi L, Salerno A, Carnevale A, Robotti M, Frediani F, Altamura C, Filippi M, Vernieri F, Bonassi S. Correction to: Ultra-late response (> 24 weeks) to anti-CGRP monoclonal antibodies in migraine: a multicenter, prospective, observational study. J Neurol 2024:10.1007/s00415-024-12287-3. [PMID: 38564057 DOI: 10.1007/s00415-024-12287-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy.
- San Raffaele University, Rome, Italy.
| | - Cinzia Aurilia
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy.
| | - Gabriella Egeo
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Stefania Proietti
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Rome, Italy
| | - Florindo D'Onofrio
- Headache Center Neurology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Paola Torelli
- Unit of Neurology, Department of Medicine and Surgery, Headache Center, University of Parma, Parma, Italy
| | | | | | - Cinzia Finocchi
- Divisione di Neurologia, Ospedale San Paolo, ASL 2 Savonese, Savona, Italy
| | | | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Fiorentini
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Bianca Orlando
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Maurizio Zucco
- Headache Center, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Ilaria Cetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Valentina Favoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Licia Grazzi
- Neuroalgology Unit, Headache Center Fondazione, IRCCS Istituto Neurologico"Carlo Besta", Milan, Italy
| | - Antonio Salerno
- Headache Center San Giovanni Addolorata Hospital, Rome, Italy
| | | | | | | | - Claudia Altamura
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Stefano Bonassi
- San Raffaele University, Rome, Italy
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Rome, Italy
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10
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Guerrieri S, Rubin M, Gattuso I, Zanetta C, Genchi A, Preziosa P, Rocca MA, Filippi M, Moiola L. Can treatment adverse events be optimized by switching between different sphingosine 1-phosphate receptor modulators in multiple sclerosis? A case series. J Neurol 2024:10.1007/s00415-024-12342-z. [PMID: 38564055 DOI: 10.1007/s00415-024-12342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Simone Guerrieri
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Martina Rubin
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Irene Gattuso
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Zanetta
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Angela Genchi
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Lucia Moiola
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
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11
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Filippi M, Borriello G, Patti F, Inglese M, Trojano M, Marinelli F, Chisari C, Iaffaldano P, Zanetta C, Chesi P, Termini R, Marini MG. Perspectives on Neuromyelitis Optica Spectrum Disorders, the Narrative Medicine contribution to care. Neurol Sci 2024; 45:1589-1597. [PMID: 37919441 PMCID: PMC10942930 DOI: 10.1007/s10072-023-07146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND This research aimed to investigate the experience of Neuromyelitis Optica Spectrum Disorders (NMOSD) by integrating the perspectives of patients, caregivers and clinicians through narrative-based medicine to provide new insights to improve care relationships. METHODS The research was conducted in the second half of 2022 and involved six Italian centres treating NMOSD and targeted adult patients, their caregivers and healthcare providers to collect the three points of view of living with or caring for this rare disease, still difficult to treat despite the pharmacological options. Narratives followed a structured outline according to the time: yesterday-today-tomorrow, to capture all disease phases. RESULTS Twenty-five patients diagnosed with NMOSD, ten caregivers and 13 healthcare providers participated in the research. Patients reported symptoms limiting their daily activities and strongly impacting their social dimension. We noticed improvements across disease duration, whilst the persistence of limitations was recurrent in patients with longer diagnoses. Caregivers' narratives mainly share experiences of their daily life changes, the burden of the caregiving role and the solutions identified, if any. Healthcare providers defined their role as a guide. CONCLUSION Limitations in activities are prominent in the lives of people with NMOSD, along with fatigue. Family members are the weakest link in the chain and need information and support. Healthcare professionals are attentive to the helping dimension.
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Affiliation(s)
- Massimo Filippi
- IRCCS Ospedale San Raffaele, Unità di Neurologia e Neurofisiologia, Milan, Italy
| | - Giovanna Borriello
- Centro di riferimento Regionale per la Sclerosi Multipla, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Francesco Patti
- Dipartimento GF Ingrassia, Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Università di Catania, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico San Marco, Università di Catania, Catania, Italy
| | - Matilde Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Trojano
- Department of Translational Biomedicine and Neurosciences, DiBraiN, University of Bari Aldo Moro, Bari, Italy
| | - Fabiana Marinelli
- ASL Frosinone, Ospedale Fabrizio Spaziani UOC Neurologia, Centro Sclerosi multipla, Frosinone, Italy
| | - Clara Chisari
- Dipartimento GF Ingrassia, Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Università di Catania, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico San Marco, Università di Catania, Catania, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, DiBraiN, University of Bari Aldo Moro, Bari, Italy
| | - Chiara Zanetta
- IRCCS Ospedale San Raffaele, Unità di Neurologia e Neurofisiologia, Milan, Italy
| | - Paola Chesi
- Healthcare area, Fondazione ISTUD, Milano, Italy
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12
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Leocadi M, Canu E, Sarasso E, Gardoni A, Basaia S, Calderaro D, Castelnovo V, Volontè MA, Filippi M, Agosta F. Dual-task gait training improves cognition and resting-state functional connectivity in Parkinson's disease with postural instability and gait disorders. J Neurol 2024; 271:2031-2041. [PMID: 38189921 DOI: 10.1007/s00415-023-12151-w] [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: 09/13/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To assess whether dual-task gait/balance training with action observation training (AOT) and motor imagery (MI) ameliorates cognitive performance and resting-state (RS) brain functional connectivity (FC) in Parkinson's disease (PD) patients with postural instability and gait disorders (PIGD). METHODS 21 PD-PIGD patients were randomized into 2 groups: (1) DUAL-TASK + AOT-MI group performed a 6-week training consisting of AOT-MI combined with practicing observed-imagined gait and balance exercises; and (2) DUAL-TASK group performed the same exercises combined with landscape-videos observation. At baseline and after training, all patients underwent a computerized cognitive assessment, while 17 patients had also RS-fMRI scans. Cognitive and RS-FC changes (and their relationships) over time within and between groups were assessed. RESULTS After training, all PD-PIGD patients improved accuracy in a test assessing executive-attentive (mainly dual-task) skills. DUAL-TASK + AOT-MI patients showed increased RS-FC within the anterior salience network (aSAL), and reduced RS-FC within the anterior default mode network (aDMN), right executive control network and precuneus network. DUAL-TASK patients showed increased RS-FC within the visuospatial network, only. Group × Time interaction showed that, compared to DUAL-TASK group, DUAL-TASK + AOT-MI cases had reduced RS-FC within the aDMN, which correlated with higher accuracy in a dual-task executive-attentive test. CONCLUSIONS In PD-PIGD patients, both trainings promote cognitive improvement and brain functional reorganization. DUAL-TASK + AOT-MI training induced specific functional reorganization changes of extra-motor brain networks, which were related with improvement in dual-task performance.
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Affiliation(s)
- Michela Leocadi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Davide Calderaro
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Veronica Castelnovo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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13
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Rocca MA, D’Amore G, Valsasina P, Tedone N, Meani A, Filippi M. 2.5-Year changes of connectivity dynamism are relevant for physical and cognitive deterioration in multiple sclerosis. Mult Scler 2024; 30:546-557. [PMID: 38372039 PMCID: PMC11010569 DOI: 10.1177/13524585241231155] [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: 11/20/2023] [Revised: 01/11/2024] [Accepted: 01/20/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND In MS, functional connectivity (FC) dynamism may influence disease evolution. OBJECTIVES The objective is to assess time-varying functional connectivity (TVFC) changes over time at 2.5-year follow-up in MS patients according to physical and cognitive worsening. METHODS We collected 3T magnetic resonance imaging (MRI) for TVFC assessment (performed using sliding-window analysis of centrality) and clinical evaluations at baseline and 2.5-year follow-up from 28 healthy controls and 129 MS patients. Of these, 79 underwent baseline and follow-up neuropsychological assessment. At 2.5 years, physical/cognitive worsening was defined according to disability/neuropsychological score changes. RESULTS At follow-up, 25/129 (19.3%) MS patients worsened physically and 14/79 (17.7%) worsened cognitively. At baseline, MS patients showed reduced TVFC versus controls. At 2.5-year follow-up, no TVFC changes were detected in controls. Conversely, TVFC decreased over time in parieto-temporal regions in stable MS patients and in default-mode network in worsened MS. In physically worsened MS, basal ganglia TVFC reductions were also found. Reduced TVFC over time in the putamen in physically worsened and reduced TVFC in the precuneus in cognitively worsened were significant versus stable MS. DISCUSSION At 2.5-year follow-up, default-mode network TVFC reductions were found in worsening MS. Moreover, reduced deep gray matter TVFC characterized physically worsened patients, whereas precuneus involvement characterized cognitively worsened MS patients.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia D’Amore
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
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14
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Tedone N, Vizzino C, Meani A, Gallo A, Altieri M, D'Ambrosio A, Pantano P, Piervincenzi C, Tommasin S, De Stefano N, Cortese R, Stromillo ML, Rocca MA, Filippi M. The brief repeatable battery of neuropsychological tests (BRB-N) version a: update of Italian normative data from the Italian Neuroimaging Network Initiative (INNI). J Neurol 2024; 271:1813-1823. [PMID: 38060030 DOI: 10.1007/s00415-023-12108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Cognitive impairment is a common clinical manifestation in people with multiple sclerosis (PwMS) and significantly impacts patients' quality life. Cognitive assessment is crucial for treatment decisions and understanding disease progression. Several neuropsychological batteries are used in MS, including the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), Minimal Assessment of Cognitive Function in MS (MACFIMS), and Brief International Cognitive Assessment for MS (BICAMS). However, normative data for BRB-N version A in Italy are outdated. OBJECTIVES To revise and update normative data for the BRB-N version A in the Italian population. METHODS From the Italian Neuroimaging Network Initiative (INNI) database, we retrospectively selected 342 healthy subjects (172 males and 170 females) evaluated at four Italian INNI-affiliated sites (Milan, Siena, Rome, Naples). The subjects underwent neuropsychological assessment using the BRB-N version A. Regression-based method relying on scaled scores was used to calculate demographic correction procedures. RESULTS No significant differences were found in age, education, and sex distribution among the four sites (p ≥ 0.055). Regression analysis provided normative data to calculate demographically adjusted z-scores for each BRB-N version A test. DISCUSSION This study provides updated normative data for the BRB-N version A in the Italian population. The use of a regression-based method and scaled scores ensures consistency with other neuropsychological batteries commonly used in Italy, namely MACFIMS and BICAMS. The availability of updated normative data increases reliability of neuropsychological assessment of cognitive function in Italian PwMS and other clinical populations using BRB-N version A, providing valuable insights for both clinical and research applications.
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Affiliation(s)
- Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Manuela Altieri
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro D'Ambrosio
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS NEUROMED, Pozzilli, Italy
| | - Claudia Piervincenzi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS NEUROMED, Pozzilli, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS NEUROMED, Pozzilli, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maria L Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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15
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Azzimonti M, Margoni M, Zanetta C, Genovese F, Martinelli V, Rocca MA, Baldoli C, Moiola L, Filippi M. Tumefactive demyelinating lesions: a challenging first manifestation of multiple sclerosis. J Neurol 2024; 271:1663-1667. [PMID: 38153549 DOI: 10.1007/s00415-023-12164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Matteo Azzimonti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Zanetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Genovese
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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16
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Tomić A, Sarasso E, Basaia S, Dragašević-Misković N, Svetel M, Kostić VS, Filippi M, Agosta F. Structural brain heterogeneity underlying symptomatic and asymptomatic genetic dystonia: a multimodal MRI study. J Neurol 2024; 271:1767-1775. [PMID: 38019294 DOI: 10.1007/s00415-023-12098-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Most of DYT genotypes follow an autosomal dominant inheritance pattern with reduced penetrance; the mechanisms underlying the disease development remain unclear. The objective of the study was to investigate cortical thickness, grey matter (GM) volumes and white matter (WM) alterations in asymptomatic (DYT-A) and symptomatic dystonia (DYT-S) mutation carriers. METHODS Eight DYT-A (four DYT-TOR1A and four DYT-THAP1), 14 DYT-S (seven DYT-TOR1A, and seven DYT-THAP1), and 37 matched healthy controls underwent 3D T1-weighted and diffusion tensor (DT) MRI to study cortical thickness, cerebellar and basal ganglia GM volumes and WM microstructural changes. RESULTS DYT-S showed thinning of the frontal and motor cortical regions related to sensorimotor and cognitive processing, together with putaminal atrophy and subcortical microstructural WM damage of both motor and extra-motor tracts such as cerebral peduncle, corona radiata, internal and external capsule, temporal and orbitofrontal WM, and corpus callosum. DYT-A had cortical thickening of middle frontal areas and WM damage of the corona radiata. CONCLUSIONS DYT genes phenotypic expression is associated with alterations of both motor and extra-motor WM and GM regions. Asymptomatic genetic status is characterized by a very subtle affection of the WM motor pathway, together with an increased cortical thickness of higher-order frontal regions that might interfere with phenotypic presentation and disease manifestation.
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Affiliation(s)
- Aleksandra Tomić
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Marina Svetel
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir S Kostić
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Lorefice L, Ferraro OE, Fenu G, Amato MP, Bresciamorra V, Conte A, De Luca G, Ferraro D, Filippi M, Gazzola P, Iaffaldano P, Inglese M, Lus G, Marfia GA, Patti F, Pesci I, Salemi G, Trojano M, Zaffaroni M, Monti MC, Cocco E. Late-onset multiple sclerosis: disability trajectories in relapsing-remitting patients of the Italian MS Registry. J Neurol 2024; 271:1630-1637. [PMID: 38172380 DOI: 10.1007/s00415-023-12152-9] [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: 09/25/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Generally infrequent, multiple sclerosis (MS) with late onset (LOMS) is characterized by an onset over the age of 50 and a mainly progressive course, while relapsing-remitting (RR) forms are less frequently observed and explored. This study aimed to characterize a large cohort of MS patients with RRMS at onset to assess the baseline factors related to the worst disability trajectories and explore the role of LOMS. METHODS The data were extracted from the Italian MS Register (IMSR). Disability trajectories, defined using at least two and up to twenty expanded disability status scale (EDSS) assessments annually performed, were implemented using group-based trajectory models (GBTMs) to identify different groups with the same trajectories over time. MS profiles were explored using multinomial logistic regression. RESULTS A total of 16,159 RR patients [1012 (6.26%) presented with LOMS] were analyzed. The GBTM identified four disability trajectories. The group with the most severe EDSS trend included 12.3% of the patients with a mean EDSS score > 4, which increased over time and exceeded 6 score. The group with medium severity EDSS trend comprised 21.9% of the patients and showed a change in EDSS > 3 scores over time. The largest group with 50.8% of patients reported a constant EDSS of 2 score. Finally, the benign group comprised 14.9% of the patients with a low and constant EDSS of 1 score over time. The probability of being in the worst groups increased if the patient was male; had LOMS or experienced brainstem, spinal, or supratentorial symptoms. CONCLUSIONS Four MS severity profiles among RRMS patients in the IMSR have been reported, with LOMS being associated with a rapid worsening of EDSS scores. These findings have important implications for recognizing and managing how older age, aging, and age-related factors interact with MS and its evolution.
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Affiliation(s)
- Lorena Lorefice
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy.
| | - Ottavia Elena Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Giuseppe Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Vincenzo Bresciamorra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, University of Naples "Federico II", Naples, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS. Annunziata Hospital University "G D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Diana Ferraro
- Department of Neurosciences, Civil Hospital of Baggiovara, AOU of Modena, Baggiovara, Italy
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Gazzola
- Neurology Unit, P.A. Micone Hospital, ASL3 Genovese, Genoa, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili (DINOGMI), Universita' Di Genova, Genoa, Liguria, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Science, University of Campania Luigi Vanvitelli, 80131, Naples, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Francesco Patti
- Department Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Unità Sanitaria Locale, Ospedale Di Vaio, Fidenza, Parma, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate - ASST Della Valle Olona, Gallarate, Italy
| | - Maria Cristina Monti
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy
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Mistri D, Valsasina P, Storelli L, Filippi M, Rocca MA. Monoaminergic network dysfunction and development of depression in multiple sclerosis: a longitudinal investigation. J Neurol 2024; 271:1618-1629. [PMID: 38112782 DOI: 10.1007/s00415-023-12138-7] [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: 11/02/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Monoaminergic network dysfunction is thought to underpin depression in multiple sclerosis (MS) patients. However, longitudinal studies are lacking. OBJECTIVES Here, we investigated the association between development of depressive symptoms in MS and changes of resting-state functional connectivity (RS FC) within monoaminergic networks. METHODS Forty-nine MS patients without depression [Montgomery-Asberg Depression Scale (MADRS) ≤ 9] and 27 healthy controls underwent clinical and 3.0 T RS FC assessment at baseline and after a median follow-up of 1.6 years (interquartile range 1.0-2.1 years). Monoamine-related RS FC was derived by independent component analysis, constrained to PET atlases for dopamine, noradrenaline and serotonin transporters. Longitudinal changes of RS FC within monoaminergic networks and their correlations with MADRS scores were assessed. RESULTS At baseline, MS patients showed decreased RS FC vs healthy controls in all PET-guided monoaminergic networks in frontal, cingulate and cerebellar cortices, and increased RS FC in parieto-occipital regions. Fourteen (29%) MS patients developed depressive symptoms (MADRS > 9) at follow-up (D-MS) and exhibited widespread RS FC decrease over time in the PET-guided dopamine network, mainly in orbitofrontal, occipital, anterior cingulate and precuneal cortices compared to patients who did not develop depressive symptoms. In D-MS, decreased RS FC over time was also observed in parahippocampal and occipital regions of the PET-guided noradrenaline network. Decreased RS FC over time in dopamine and noradrenaline PET-guided networks correlated with concomitant increased MADRS scores (r = range - 0.65/- 0.61, p < 0.001). CONCLUSIONS The development of depressive symptoms in MS patients was associated with specific RS FC changes within the dopamine and noradrenaline networks.
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Affiliation(s)
- Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Mistri D, Tedone N, Biondi D, Vizzino C, Pagani E, Rocca MA, Filippi M. Cognitive phenotypes in multiple sclerosis: mapping the spectrum of impairment. J Neurol 2024; 271:1571-1583. [PMID: 38007408 DOI: 10.1007/s00415-023-12102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Available criteria for cognitive phenotypes in multiple sclerosis (MS) do not consider the severity of impairment. OBJECTIVES To identify cognitive phenotypes with varying degrees of impairment in MS patients and describe their demographic, clinical and MRI characteristics. METHODS Two hundred and forty-three MS patients and 158 healthy controls underwent neuropsychological tests to assess memory, attention, and executive function. For each domain, mild impairment was defined as performing 1.5 standard deviations below the normative mean on two tests, while the threshold for significant impairment was 2 standard deviations. Patients were classified into cognitive phenotypes based on severity of the impairment (mild/significant) and number of domains affected (one/more). RESULTS Five cognitive phenotypes emerged: Preserved cognition (PC; 56%), Mild Single-Domain Impairment (MSD; 15%), Mild Multi-Domain Impairment (MMD; 9%), Significant Single-Domain Impairment (SSD; 12%), Significant Multi-Domain Impairment (SMD; 8%). Compared with PC, MSD patients were older, had longer disease duration (DD) and higher T2-hyperintense lesion volume (LV; all p ≤ 0.02); MMD patients were older, had longer DD, higher disability, higher T2 LV and lower thalamic volume (all p ≤ 0.01); SSD patients had longer DD and lower gray matter cortical volume, thalamic, caudate, putamen and accumbens volumes (all p ≤ 0.04); and SMD patients were older, had longer DD, higher disability and more extensive structural damage in all brain regions explored (all p ≤ 0.03), except white matter and amygdala volumes. CONCLUSIONS We identified five cognitive phenotypes with graded levels of impairment. These phenotypes were characterized by distinct demographic, clinical and MRI features, indicating potential variations in the neural substrates of dysfunction throughout disease stages.
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Affiliation(s)
- Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Diana Biondi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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20
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Romanò F, Valsasina P, Pagani E, De Simone A, Parolin E, Filippi M, Rocca MA. Structural and functional correlates of disability, motor and cognitive performances in multiple sclerosis: Focus on the globus pallidus. Mult Scler Relat Disord 2024; 86:105576. [PMID: 38579567 DOI: 10.1016/j.msard.2024.105576] [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: 12/18/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES To explore structural and functional alterations of external (GPe) and internal (GPi) globus pallidus in people with multiple sclerosis (pwMS) compared to healthy controls (HC) and analyze their relationship with measures of clinical disability, motor and cognitive impairment. METHODS Sixty pwMS and 30 HC comparable for age and sex underwent 3.0T MRI, including conventional, diffusion tensor MRI and resting state (RS) functional MRI. Expanded Disability Status Scale (EDSS) scores were rated and timed 25-foot walk (T25FW) test, nine-hole peg test (9HPT), and paced auditory serial addition test (PASAT) were administered. Two operators segmented the GP into GPe and GPi. Volumes, T1/T2 ratio, diffusivity indices and seed-based RS functional connectivity (FC) of the GP and its components were assessed. RESULTS PwMS had no atrophy or altered diffusivity measures of the GP. Compared to HC, pwMS had higher T1/T2 ratio in both GP regions, which correlated with EDSS score (r = 0.26-0.39, p = 0.01-0.05). RS FC analysis highlighted component-specific functional alterations in pwMS: the GPe had decreased RS FC with fronto-parietal cortices, whereas the GPi had decreased intra-GP RS FC and increased RS FC with the thalamus. Worse EDSS, 9HPT, T25FW and PASAT scores were associated with GP RS FC modifications (r=-0.51‒0.51, p < 0.001). CONCLUSIONS Structural GP involvement in MS was homogeneous across its portions. Increased T1/T2 ratio values, possibly representing iron accumulation, were related to more severe disability. RS FC alterations of the GPe and GPi were consistent with their roles within the basal ganglia network and correlated with worse functional status, suggesting less efficient communication between structures.
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Affiliation(s)
- Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alice De Simone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emma Parolin
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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21
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Margoni M, Valsasina P, Bacchetti A, Mistri D, Preziosa P, Rocca MA, Filippi M. Resting state functional connectivity modifications in monoaminergic circuits underpin fatigue development in patients with multiple sclerosis. Mol Psychiatry 2024:10.1038/s41380-024-02532-6. [PMID: 38528072 DOI: 10.1038/s41380-024-02532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
Dysregulation of monoaminergic networks might have a role in the pathogenesis of fatigue in multiple sclerosis (MS). We investigated longitudinal changes of resting state (RS) functional connectivity (FC) in monoaminergic networks and their association with the development of fatigue in MS. Eighty-nine MS patients and 49 age- and sex-matched healthy controls (HC) underwent neurological, fatigue, and RS functional MRI assessment at baseline and after a median follow-up of 1.3 years (interquartile range = 1.01-2.01 years). Monoaminergic-related RS FC was estimated with an independent component analysis constrained to PET atlases for dopamine (DA), noradrenaline (NA), and serotonin (5-HT) transporters. At baseline, 24 (27%) MS patients were fatigued (F) and 65 were not fatigued (NF). Of these, 22 (34%) developed fatigue (DEV-FAT) at follow-up and 43 remained not fatigued (NO-FAT). At baseline, F-MS patients showed increased monoaminergic-related RS FC in the caudate nucleus vs NF-MS and in the hippocampal, postcentral, temporal, and occipital cortices vs NF-MS and HC. Moreover, F-MS patients exhibited decreased RS FC in the frontal cortex vs NF-MS and HC, and in the thalamus vs NF-MS. During the follow-up, no RS FC changes were observed in HC. NO-FAT patients showed limited DA-related RS FC modifications, whereas DEV-FAT MS patients showed increased DA-related RS FC in the left hippocampus, significant at time-by-group interaction analysis. In the NA-related network, NO-FAT patients showed decreased RS FC over time in the left superior frontal gyrus. This region showed increased RS FC in both DEV-FAT and F-MS patients; this divergent behavior was significant at time-by-group interaction analysis. Finally, DEV-FAT MS patients presented increased 5-HT-related RS FC in the angular and middle occipital gyri, while this latter region showed decreased 5-HT-related RS FC during the follow-up in F-MS patients. In MS patients, distinct patterns of alterations were observed in monoaminergic networks based on their fatigue status. Fatigue was closely linked to specific changes in the basal ganglia and hippocampal, superior frontal, and middle occipital cortices.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Bacchetti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Albergoni M, Pagani E, Preziosa P, Meani A, Margoni M, Rocca MA, Filippi M. Thalamic nuclei volume partially mediates the effects of aerobic capacity on fatigue in people with multiple sclerosis. J Neurol 2024:10.1007/s00415-024-12277-5. [PMID: 38507073 DOI: 10.1007/s00415-024-12277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Fatigue is frequent in people with multiple sclerosis (pwMS) impacting physical and cognitive functions. Lower aerobic capacity and regional thalamic volume may be involved in the pathophysiology of fatigue in pwMS. OBJECTIVES To identify associations between thalamic nuclei volumes, aerobic capacity and fatigue and to investigate whether the influence of aerobic capacity on fatigue in pwMS is mediated by thalamic integrity. METHODS Eighty-three pwMS underwent a clinical evaluation with assessment of fatigue (Modified Fatigue Impact Scale [MFIS]), including physical (pMFIS) and cognitive (cMFIS) components, and peak of oxygen uptake (VO2peak). PwMS and 63 sex- and age-matched healthy controls (HC) underwent a 3 T brain MRI to quantify volume of the whole thalamus and its nuclei. RESULTS Compared to HC, pwMS showed higher global MFIS, pMFIS and cMFIS scores, and lower VO2peak and thalamic volumes (p < 0.001). In pwMS, higher VO2peak was significantly associated with lower MFIS and pMFIS scores (r value = - 0.326 and - 0.356; pFDR ≤ 0.046) and higher laterodorsal thalamic nucleus (Dor) cluster volume (r value = 0.300; pFDR = 0.047). Moreover, lower Dor thalamic cluster volume was significantly associated with higher MFIS, pMFIS and cMFIS scores (r value range = - 0.305; - 0.293; pFDR ≤ 0.049). The volume of Dor thalamic cluster partially mediated the positive effects of VO2peak on both MFIS and cMFIS, with relative indirect effects of 21% and 32% respectively. No mediation was found for pMFIS. CONCLUSIONS Higher VO2peak is associated with lower fatigue in pwMS, likely acting on Dor thalamic cluster volume integrity. Such an effect might be different according to the type of fatigue (cognitive or physical).
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Affiliation(s)
- Matteo Albergoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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23
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Preziosa P, Rocca MA, Filippi M. Radiologically isolated syndromes: to treat or not to treat? J Neurol 2024:10.1007/s00415-024-12294-4. [PMID: 38502339 DOI: 10.1007/s00415-024-12294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to increased detection of individuals exhibiting asymptomatic brain and spinal cord lesions suggestive of multiple sclerosis (MS), defined as "radiologically isolated syndrome" (RIS). Specific criteria have been proposed and updated over time to identify individuals with RIS. Moreover, a younger age, the presence of infratentorial, spinal cord or gadolinium-enhancing lesions, as well as of cerebrospinal fluid-specific oligoclonal bands have been recognized as relevant risk factors for the occurrence of a first clinical event. Recent randomized controlled trials conducted in individuals with RIS have shown that dimethyl fumarate and teriflunomide significantly reduce the occurrence of clinical events in this population. These findings support the notion that early treatment initiation may positively influence the prognosis of these patients. However, several aspects should be taken into account before treating individuals with RIS in the real-world clinical setting, including an accurate identification of individuals with RIS to avoid misdiagnosis, a precise stratification of their risk of experiencing a first clinical event and further data supporting favorable balance between benefits and risks, even in the long term. This commentary provides an overview of the latest updates in RIS diagnosis, prognosis, and emerging treatment evidence.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Montini F, Nozzolillo A, Tedone N, Mistri D, Rancoita PM, Zanetta C, Mandelli A, Furlan R, Moiola L, Martinelli V, Rocca MA, Filippi M. COVID-19 has no impact on disease activity, progression and cognitive performance in people with multiple sclerosis: a 2-year study. J Neurol Neurosurg Psychiatry 2024; 95:342-347. [PMID: 37857497 DOI: 10.1136/jnnp-2023-332073] [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: 06/22/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Sequelae of COVID-19 in people with multiple sclerosis (PwMS) have not been characterised. We explored whether COVID-19 is associated with an increased risk of disease activity, disability worsening, neuropsychological distress and cognitive dysfunction during the 18-24 months following SARS-COV-2 infection. METHODS We enrolled 174 PwMS with history of COVID-19 (MS-COVID) between March 2020 and March 2021 and compared them to an age, sex, disease duration, Expanded Disability Status Scale (EDSS), and a line of treatment-matched group of 348 PwMS with no history of COVID-19 in the same period (MS-NCOVID). We collected clinical, MRI data and SARS-CoV2 immune response in the 18-24 months following COVID-19 or baseline evaluation. At follow-up, PwMS also underwent a complete neuropsychological assessment with brief repeatable battery of neuropsychological tests and optimised scales for fatigue, anxiety, depression and post-traumatic stress symptoms. RESULTS 136 MS-COVID and 186 MS-NCOVID accepted the complete longitudinal evaluation. The two groups had similar rate of EDSS worsening (15% vs 11%, p=1.00), number of relapses (6% vs 5%, p=1.00), disease-modifying therapy change (7% vs 4%, p=0.81), patients with new T2-lesions (9% vs 11%, p=1.00) and gadolinium-enhancing lesions (7% vs 4%, p=1.00) on brain MRI. 22% of MS-COVID and 23% MS-NCOVID were cognitively impaired at 18-24 months evaluation, with similar prevalence of cognitive impairment (p=1.00). The z-scores of global and domain-specific cognitive functions and the prevalence of neuropsychiatric manifestations were also similar. No difference was detected in terms of SARS-CoV2 cellular immune response. CONCLUSIONS In PwMS, COVID-19 has no impact on disease activity, course and cognitive performance 18-24 months after infection.
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Affiliation(s)
| | | | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Paola Mv Rancoita
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milano, Italy
| | - Chiara Zanetta
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alessandra Mandelli
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - Maria A Rocca
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
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Nigri A, Stanziano M, Fedeli D, Manera U, Ferraro S, Medina Carrion JP, Palermo S, Lequio L, Denegri F, Agosta F, Spinelli EG, Filippi M, Grisoli M, Valentini MC, De Mattei F, Canosa A, Calvo A, Chiò A, Bruzzone MG, Moglia C. Distinct neural signatures of pulvinar in C9orf72 amyotrophic lateral sclerosis mutation carriers and noncarriers. Eur J Neurol 2024:e16266. [PMID: 38469975 DOI: 10.1111/ene.16266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/30/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND AND PURPOSE Thalamic alterations have been reported as a major feature in presymptomatic and symptomatic patients carrying the C9orf72 mutation across the frontotemporal dementia-amyotrophic lateral sclerosis (ALS) spectrum. Specifically, the pulvinar, a high-order thalamic nucleus and timekeeper for large-scale cortical networks, has been hypothesized to be involved in C9orf72-related neurodegenerative diseases. We investigated whether pulvinar volume can be useful for differential diagnosis in ALS C9orf72 mutation carriers and noncarriers and how underlying functional connectivity changes affect this region. METHODS We studied 19 ALS C9orf72 mutation carriers (ALSC9+) accurately matched with wild-type ALS (ALSC9-) and ALS mimic (ALSmimic) patients using structural and resting-state functional magnetic resonance imaging data. Pulvinar volume was computed using automatic segmentation. Seed-to-voxel functional connectivity analyses were performed using seeds from a pulvinar functional parcellation. RESULTS Pulvinar structural integrity had high discriminative values for ALSC9+ patients compared to ALSmimic (area under the curve [AUC] = 0.86) and ALSC9- (AUC = 0.77) patients, yielding a volume cutpoint of approximately 0.23%. Compared to ALSmimic, ALSC9- showed increased anterior, inferior, and lateral pulvinar connections with bilateral occipital-temporal-parietal regions, whereas ALSC9+ showed no differences. ALSC9+ patients when compared to ALSC9- patients showed reduced pulvinar-occipital connectivity for anterior and inferior pulvinar seeds. CONCLUSIONS Pulvinar volume could be a differential biomarker closely related to the C9orf72 mutation. A pulvinar-cortical circuit dysfunction might play a critical role in disease progression and development, in both the genetic phenotype and ALS wild-type patients.
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Affiliation(s)
- Anna Nigri
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Davide Fedeli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Umberto Manera
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Stefania Ferraro
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- School of Life Science and Technology, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Sara Palermo
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Lequio
- Neuroradiology Unit, CTO Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federica Denegri
- Neuroradiology Unit, CTO Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Edoardo Gioele Spinelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Grisoli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Consuelo Valentini
- Neuroradiology Unit, CTO Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Filippo De Mattei
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Antonio Canosa
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Andrea Calvo
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Adriano Chiò
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
- Institute of Cognitive Sciences and Technologies, National Council of Research, Rome, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cristina Moglia
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
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26
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Barbanti P, Egeo G, Proietti S, d'Onofrio F, Aurilia C, Finocchi C, Di Clemente L, Zucco M, Doretti A, Messina S, Autunno M, Ranieri A, Carnevale A, Colombo B, Filippi M, Tasillo M, Rinalduzzi S, Querzani P, Sette G, Forino L, Zoroddu F, Robotti M, Valenza A, Camarda C, Borrello L, Aguggia M, Viticchi G, Tomino C, Fiorentini G, Orlando B, Bonassi S, Torelli P. Assessing the Long-Term (48-Week) Effectiveness, Safety, and Tolerability of Fremanezumab in Migraine in Real Life: Insights from the Multicenter, Prospective, FRIEND3 Study. Neurol Ther 2024:10.1007/s40120-024-00591-z. [PMID: 38451463 DOI: 10.1007/s40120-024-00591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/14/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Long-term (1-year) fremanezumab treatment proved to be effective, safe, and well tolerated in individuals with migraine and < 2 medication clusters in a randomized controlled trial (RCT). We aimed to assess real-world evidence (RWE), long-term effectiveness, tolerability, and safety of fremanezumab in people with high-frequency episodic migraine (HFEM) or chronic migraine (CM) with > 3 treatment failures and various comorbidities. METHODS A 48-week, prospective, multicenter (n = 26), cohort study assessed fremanezumab's effectiveness, safety, and tolerability in consecutive adults with HFEM or CM with > 3 treatment failures. Primary endpoint was variation from baseline in monthly migraine days (MMD) in HFEM and monthly headache days (MHD) in CM at weeks 45-48. Secondary endpoints were changes in monthly analgesic medications, Numerical Rating Scale (NRS), Headache Impact Test (HIT-6), and the Migraine Disability Assessment Scale (MIDAS) scores and ≥ 50%, ≥ 75%, and 100% responder rates. RESULTS Of 533 participants who had received ≥ 1 fremanezumab dose, 130 were treated for ≥ 48 weeks and considered for effectiveness analysis. No participant missed any treatment dosage every other consecutive month during the 12-month period. PRIMARY ENDPOINT fremanezumab significantly (p < 0.001) reduced both MMD (- 6.4) in HFEM and MHD (- 14.5) in CM. Secondary endpoints: a significant reduction (p < 0.001) was observed in monthly analgesic medications (HFEM - 6.0; CM -16.5), NRS (HFEM - 3.4; CM - 3.4), HIT-6 (HFEM - 16.9; CM - 17.9) and MIDAS score (HFEM - 50.4; CM - 76.6). The ≥ 50%, ≥ 75%, and 100% response rates to fremanezumab were 75.5%, 36.7%, and 2% in HFEM and 71.6%, 44.4%, and 3.7% in CM. Corresponding response rates were 60.5%, 37.2%, and 2.3% in individuals with psychiatric comorbidities, 74.2%, 50%, and 4.8% in CM with medication overuse, and 60.9%, 39.1%, and 4.3% in CM with medication overuse and psychiatric comorbidities. Mild and transient treatment-emergent adverse events occurred in 7.8% of the participants. No subject discontinued the treatment for any reason. CONCLUSION This RWE study documents that long-term fremanezumab treatment is highly effective and remarkably well tolerated in subjects with HFEM or CM with multiple (> 3) therapeutic failures, even in the presence of concomitant medication overuse, psychiatric comorbidities, or both. The effectiveness-to-tolerability ratio appears to be better in RWE than in RCTs.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy.
- San Raffaele University, Rome, Italy.
| | - Gabriella Egeo
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy
| | - Stefania Proietti
- Clinical and Molecular Epidemiology, IRCCS San Raffaele, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
| | | | - Cinzia Aurilia
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy
| | | | - Laura Di Clemente
- Headache Center, Neurology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Maurizio Zucco
- Headache Center, Neurology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alberto Doretti
- Laboratory of Neuroscience, Department of Neurology-Stroke Unit, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Stefano Messina
- Laboratory of Neuroscience, Department of Neurology-Stroke Unit, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Massimo Autunno
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Angelo Ranieri
- Neurology Unit and Stroke-Unit, AORN A. Cardarelli, Naples, Italy
| | - Antonio Carnevale
- Headache Center, Neurology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Bruno Colombo
- Department of Neurology, Headache Unit, Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Massimo Filippi
- Department of Neurology, Headache Unit, Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Miriam Tasillo
- Stroke Unit, S. Camillo de Lellis Hospital, Rieti, Italy
| | | | - Pietro Querzani
- Neurology Unit, S. Maria Delle Croci Hospital-AUSL Romagna, Ravenna, Italy
| | - Giuliano Sette
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Lorenzo Forino
- Neurology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesco Zoroddu
- Neurology Unit, Pediatric Headache Center, University of Sassari, Sassari, Italy
| | | | | | - Cecilia Camarda
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | | | - Marco Aguggia
- Neurology and Stroke Unit, Cardinal Massaia Hospital, Asti, Italy
| | | | - Carlo Tomino
- Scientific Direction IRCCS San Raffaele, Rome, Italy
| | | | - Bianca Orlando
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy
| | - Stefano Bonassi
- Clinical and Molecular Epidemiology, IRCCS San Raffaele, Roma, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
| | - Paola Torelli
- Department of Medicine and Surgery, Headache Center, Neurology Unit, University of Parma, Parma, Italy
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Teggi R, Colombo B, Cugnata F, Albera R, Libonati GA, Balzanelli C, Casani AP, Cangiano I, Familiari M, Lucisano S, Mandalà M, Neri G, Pecci R, Bussi M, Filippi M. Phenotypes and clinical subgroups in vestibular migraine: a cross-sectional study with cluster analysis. Neurol Sci 2024; 45:1209-1216. [PMID: 37845481 DOI: 10.1007/s10072-023-07116-w] [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: 08/04/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The aim of this multicentric cross-sectional study was to collect phenotypes and clinical variability on a large sample of 244 patients enrolled in different university centers in Italy, trying to differentiate subtypes of VM. BACKGROUND VM is one of the most frequent episodic vertigo characterized by a great clinical variability for duration of attacks and accompanying symptoms. Diagnosis is based only on clinical history of episodic vertigo in 50% of cases associated with migrainous headache or photo/phonophobia. METHODS We enrolled in different university centers 244 patients affected by definite VM according to the criteria of the Barany Society between January 2022 and December 2022. An audiometric examination and a CNS MRI were performed before inclusion. Patients with low-frequency sensorineural hearing loss were not included, as well as patients with an MRI positive otherwise that for microischemic lesions. Patients were asked to characterize vestibular symptoms choosing among (multiple answers were allowed): internal vertigo, dizziness, visuo-vestibular symptoms/external vertigo; onset of vertigo and duration, neurovegetative, and cochlear accompanying symptoms (hearing loss, tinnitus, and fullness during attacks) were collected as well as migrainous headache and/or photo/phonophobia during vertigo; autoimmune disorders were also analyzed. A bedside examination was performed including study of spontaneous-positional nystagmus with infrared video goggles, post head shaking ny, skull vibration test, and video head impulse test. RESULTS We included 244 subjects, 181 were females (74.2%). The age of onset of the first vertigo was 36.6 ± 14.5 while of the first headache was 23.2 ± 10.1. A positive correlation has been found between the first headache and the first vertigo. The mean duration of vertigo attacks was 11 ± 16 h. We carried on a cluster analysis to identify subgroups of patients with common clinical features. Four variables allowed to aggregate clusters: age of onset of vertigo, duration of vertigo attacks, presence of migrainous headache during vertigo, and presence of cochlear symptoms during vertigo. We identified 5 clusters: cluster 1/group 1 (23 subjects, 9.4%) characterized by longer duration of vertigo attacks; cluster 2/group 2 (52 subjects, 21.3%) characterized by absence of migrainous headache and cochlear symptoms during vertigo; cluster 3/group 3 (44 subjects, 18%) characterized by presence of cochlear symptoms during vertigo but not headache; cluster 4/group 4 (57 subjects, 23.4%) by the presence of both cochlear symptoms and migrainous headache during vertigo; cluster 5/group 5 (68 subjects, 27.9%) characterized by migrainous headache but no cochlear symptoms during vertigo. CONCLUSION VM is with any evidence a heterogeneous disorder and clinical presentations exhibit a great variability. In VM, both symptoms orienting toward a peripheral mechanism (cochlear symptoms) and central ones (long lasting positional non-paroxysmal vertigo) may coexist. Our study is the first published trying to characterize subgroups of VM subjects, thus orienting toward different pathophysiological mechanisms.
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Affiliation(s)
- Roberto Teggi
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy.
| | - Bruno Colombo
- Div. of Neurology, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Federica Cugnata
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Albera
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | | | - Cristiano Balzanelli
- Department of Otolaryngology, University of Brescia, Spedali Civili, Brescia, Italy
| | - Augusto Pietro Casani
- Department of Otorhinolaryngology, Pisa University Medical School Otorhinolaryngology, Pisa University Medical School, Pisa, Italy
| | - Iacopo Cangiano
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Marco Familiari
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Sergio Lucisano
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Marco Mandalà
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Rudi Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Mario Bussi
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Massimo Filippi
- Div. of Neurology, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
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28
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Sarasso E, Emedoli D, Gardoni A, Zenere L, Canu E, Basaia S, Doretti A, Ticozzi N, Iannaccone S, Amadio S, Del Carro U, Filippi M, Agosta F. Cervical motion alterations and brain functional connectivity in cervical dystonia. Parkinsonism Relat Disord 2024; 120:106015. [PMID: 38325256 DOI: 10.1016/j.parkreldis.2024.106015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Evaluating the neural correlates of sensorimotor control deficits in cervical dystonia (CD) is fundamental to plan the best treatment. This study aims to assess kinematic and resting-state functional connectivity (RS-FC) characteristics in CD patients relative to healthy controls. METHODS Seventeen CD patients and 14 age-/sex-matched healthy controls were recruited. Electromagnetic sensors were used to evaluate dystonic pattern, mean/maximal cervical movement amplitude and joint position error with eyes open and closed, and movement quality during target reaching with the head. RS-fMRI was acquired to compare the FC of brain sensorimotor regions between patients and controls. In patients, correlations between motion analysis and FC data were assessed. RESULTS CD patients relative to controls showed reduced mean and maximal cervical range of motion (RoM) in rotation both towards and against dystonia pattern and reduced total RoM in rotation both with eyes open and closed. They had less severe dystonia pattern with eyes open vs eyes closed. CD patients showed an altered movement quality and sensorimotor control during target reaching and a higher joint position error. Compared to controls, CD patients showed reduced FC between supplementary motor area (SMA), occipital and cerebellar areas, which correlated with lower cervical RoM in rotation both with eyes open and closed and with worse movement quality during target reaching. CONCLUSIONS FC alterations between SMA and occipital and cerebellar areas may represent the neural basis of cervical sensorimotor control deficits in CD patients. Electromagnetic sensors and RS-fMRI might be promising tools to monitor CD and assess the efficacy of rehabilitative interventions.
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Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Daniele Emedoli
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Zenere
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Doretti
- Department of Neurology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Amadio
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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29
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Iaffaldano P, Lucisano G, Guerra T, Patti F, Cocco E, De Luca G, Brescia Morra V, Pozzilli C, Zaffaroni M, Ferraro D, Gasperini C, Salemi G, Bergamaschi R, Lus G, Inglese M, Romano S, Bellantonio P, Di Monte E, Maniscalco GT, Conte A, Lugaresi A, Vianello M, Torri Clerici VLA, Di Sapio A, Pesci I, Granella F, Totaro R, Marfia GA, Danni MC, Cavalla P, Valentino P, Aguglia U, Montepietra S, Ferraro E, Protti A, Spitaleri D, Avolio C, De Riz M, Maimone D, Cavaletti G, Gazzola P, Tedeschi G, Sessa M, Rovaris M, Di Palma F, Gatto M, Cargnelutti D, De Robertis F, Logullo FO, Rini A, Meucci G, Ardito B, Banfi P, Nasuelli D, Paolicelli D, Rocca MA, Portaccio E, Chisari CG, Fenu G, Onofrj M, Carotenuto A, Ruggieri S, Tortorella C, Ragonese P, Nica M, Amato MP, Filippi M, Trojano M. Evaluation of drivers of treatment switch in relapsing multiple sclerosis: a study from the Italian MS Registry. J Neurol 2024; 271:1150-1159. [PMID: 38135850 DOI: 10.1007/s00415-023-12137-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Active relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) are currently defined as "relapsing MS" (RMS). The aim of this cross-sectional study was to assess drivers of treatment switches due to clinical relapses in a population of RMS patients collected in the Italian MS and Related Disorders Register (I-MS&RD). METHODS RRMS and SPMS patients with at least one relapse in a time window of 2 years before of data extraction were defined as RMS. Factors associated with disease-modifying therapy (DMT) switching due to clinical activity were assessed through multivariable logistic regression models in which treatment exposure was included as the last recorded DMT and the last DMT's class [moderate-efficacy (ME), high-efficacy (HE) DMTs and anti-CD20 drugs]. RESULTS A cohort of 4739 RMS patients (4161 RRMS, 578 SPMS) was extracted from the I-MS&RD. A total of 2694 patients switching DMTs due to relapses were identified. Switchers were significantly (p < 0.0001) younger, less disabled, more frequently affected by an RR disease course in comparison to non-switcher patients. The multivariable logistic regression models showed that Alemtuzumab (OR 0.08, 95% CI 0.02-0.37), Natalizumab (0.48, 0.30-0.76), Ocrelizumab (0.1, 0.02-0.45) and Rituximab (0.23, 0.06-0.82) exposure was a protective factor against treatment switch due to relapses. Moreover, the use of HE DMTs (0.43, 0.31-0.59), especially anti-CD20 drugs (0.14, 0.05-0.37), resulted to be a protective factor against treatment switch due to relapses in comparison with ME DMTs. CONCLUSIONS More than 50% of RMS switched therapy due to disease activity. HE DMTs, especially anti-CD20 drugs, significantly reduce the risk of treatment switch.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Tommaso Guerra
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Giovanna De Luca
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit and Multiple Sclerosis Center, ASST Della Valle Olona, Hospital of Gallarate, Via Pastori 4, 21013, Gallarate, VA, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di BaggiovaraAzienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | | | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matilde Inglese
- Dipartimento di NeuroscienzeRiabilitazioneOftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), Universita' di Genova, Genova, Italy
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Italy
| | | | - Elisabetta Di Monte
- Center for Multiple Sclerosis, Hospital ASL 4 "Madonna delle Grazie", 75100, Matera, Italy
| | | | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- Neurophysiopatology Unit, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Marika Vianello
- MS Unit, OU Neurology "Ca' Foncello" Hospital, Treviso, Italy
| | | | - Alessia Di Sapio
- Department of Neurology, Regional Referral Multiple Sclerosis Center, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Ilaria Pesci
- Neurology Unit, Ospedale Vaio-Fidenza, Parma, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rocco Totaro
- Centro Malattie Demielinizzanti-Clinica Neurologica, Ospedale San Salvatore, L'Aquila, Coppito, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Maura Chiara Danni
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Paola Cavalla
- Centro Sclerosi Multipla e Neurologia 1 D.U, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Valentino
- Istituto di neurologia, Università Magna Graecia Catanzaro, Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sara Montepietra
- MS Centre, SMN Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | | | | | | | - Carlo Avolio
- MS Center, University of Neurology, Foggia, Italy
| | - Milena De Riz
- Centro Sclerosi Multipla-Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, ARNAS Garibaldi, Catania, Italy
| | | | - Paola Gazzola
- SC Neurologia, Ospedale P. Antero Micone-ASL 3 Genovese, Genoa, Italy
| | - Gioacchino Tedeschi
- I Division of Neurology, Universita della Campania "L. Vanvitelli", Naples, Italy
| | - Maria Sessa
- Centro Provinciale Sclerosi Multipla, ASST papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rovaris
- MS Center, Scientific Institute Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Franco Di Palma
- SM Center Neurology Department, ASST Lariana S. Anna Hospital, Como, Italy
| | - Maurizia Gatto
- Centro Malattie Demielinizzanti, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | | | | | | | - Augusto Rini
- Centro Sclerosi Multipla, Ospedale A. Perrino, Brindisi, Italy
| | - Giuseppe Meucci
- Ambulatorio Sclerosi MultiplaUnita' Operativa di Neurologia e Neurofisiopatologia, Spedali Riuniti di Livorno, Livorno, Italy
| | - Bonaventura Ardito
- Centro Sclerosi Mutipla UOC di Neurologia, Ospedale Della Murgia Fabio Perinei, Altamura, Italy
| | - Paola Banfi
- Dipartimento di Neurologia, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Davide Nasuelli
- ASST Della Valle Olona Presidio Ospedaliero di Saronno Ambulatorio Sclerosi Multipla, Saronno, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Maria Assunta Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - Clara Grazia Chisari
- Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy
| | - Giuseppe Fenu
- Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Marco Onofrj
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | | | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Massimo Filippi
- Neurology and Neurorehabilitation Units, Neurophysiology Service, Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- School of Medicine, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, Bari, Italy.
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Filippi M, Rocca MA. Autoimmune Encephalitis and Blood-Brain Barrier Permeability at Dynamic Contrast-enhanced MRI. Radiology 2024; 310:e240458. [PMID: 38501950 DOI: 10.1148/radiol.240458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience (M.F., M.A.R.), Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.F., M.A.R.)
| | - Maria A Rocca
- From the Neuroimaging Research Unit, Division of Neuroscience (M.F., M.A.R.), Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.F., M.A.R.)
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Domi T, Schito P, Sferruzza G, Russo T, Pozzi L, Agosta F, Carrera P, Riva N, Filippi M, Quattrini A, Falzone YM. Unveiling the SOD1-mediated ALS phenotype: insights from a comprehensive meta-analysis. J Neurol 2024; 271:1342-1354. [PMID: 37930481 DOI: 10.1007/s00415-023-12074-6] [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: 09/14/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis associated with mutations in SOD1 (SOD1-ALS) might be susceptible to specific treatment. The aim of the study is to outline the clinical features of SOD1-ALS patients by comparing them to patients without ALS major gene variants and patients with variants in other major ALS genes. Defining SOD1-ALS phenotype may assist clinicians in identifying patients who should be prioritized for genetic testing. METHODS We performed an extensive literature research including original studies which reported the clinical features of SOD1-ALS and at least one of the following patient groups: C9ORF72 hexanucleotide repeat expansion (C9-ALS), TARDBP (TARDBP-ALS), FUS (FUS-ALS) or patients without a positive test for a major-ALS gene (N-ALS). A random effects meta-analytic model was applied to clinical data extracted encompassing sex, site and age of onset. To reconstruct individual patient survival data, the published Kaplan-Meier curves were digitized. Data were measured as odds ratio (OR) or standardized mean difference (SMD) as appropriate. Median survival was compared between groups. RESULTS Twenty studies met the inclusion criteria. We identified 721 SOD1-ALS, 470 C9-ALS, 183 TARDBP-ALS, 113 FUS-ALS and 2824 N-ALS. SOD1-ALS showed a higher rate of spinal onset compared with N-ALS and C9-ALS (OR = 4.85, 95% CI = 3.04-7.76; OR = 10.47, 95% CI = 4.32-27.87) and an earlier onset compared with N-ALS (SMD = - 0.45, 95% CI = - 0.72 to - 0.18). SOD1-ALS had a similar survival compared with N-ALS (p = 0.14), a longer survival compared with C9-ALS (p < 0.01) and FUS-ALS (p = 0.019) and a shorter survival compared with TARDBP-ALS (p < 0.01). DISCUSSION This study indicates the presence of a specific SOD1-ALS phenotype. Insights in SOD1-ALS clinical features are important in genetic counseling, disease prognosis and support patients' stratification in clinical trials.
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Affiliation(s)
- Teuta Domi
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paride Schito
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Giacomo Sferruzza
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Tommaso Russo
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Laura Pozzi
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Carrera
- Unit of Genomics for Human Disease Diagnosis, Division of Genetics and Cell Biology, Laboratory of Clinical Molecular Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- 3rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neuroimaging Research Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Yuri Matteo Falzone
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
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Ramari C, D'hooge M, Dalgas U, Feinstein A, Amato MP, Brichetto G, Chataway J, Chiaravalloti ND, Cutter GR, DeLuca J, Farrell R, Filippi M, Freeman J, Inglese M, Meza C, Motl RW, Rocca MA, Sandroff BM, Salter A, Kos D, Feys P. Prevalence and Associated Clinical Characteristics of Walking-Related Motor, Cognitive, and Fatigability in Progressive Multiple Sclerosis: Baseline Results From the CogEx Study. Neurorehabil Neural Repair 2024:15459683241236161. [PMID: 38426484 DOI: 10.1177/15459683241236161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND People with progressive multiple sclerosis (PMS) present motor (eg, walking) and cognitive impairments, and report fatigue. Fatigue encompasses fatigability which is objectively measured by the capacity to sustain a motor or cognitive task. OBJECTIVE To investigate the prevalence of walking and cognitive fatigability (CF) and the associated clinical characteristics in a large sample of PMS patients. METHODS PMS patients (25-65 years old) were included from 11 sites (Europe and North America), having cognitive impairment (1.28 standard deviation below normative data for the symbol digit modality test [SDMT]). Walking fatigability (WF) was assessed using the distance walk index (DWI) and CF using the SDMT (scores from the last 30 seconds compared to the first 30 seconds). Additional measures were: cognitive assessment-Brief International Cognitive Assessment for multiple sclerosis (MS), cardiorespiratory fitness, 6-minute walk, physical activity, depressive symptoms, perceived fatigue-Modified Fatigue Impact Scale (MFIS), MS impact-MSIS-29, and walking ability. RESULTS Of 298 participants, 153 (51%) presented WF (DWI = -28.9 ± 22.1%) and 196 (66%) presented CF (-29.7 ± 15%). Clinical characteristics (EDSS, disease duration, and use of assistive device) were worse in patients with versus without WF. They also presented worse scores on MSIS-29 physical, MFIS total and physical and reduced physical capacity. CF patients scored better in the MSIS-29 physical and MFIS psychosocial, compared to non-CF group. Magnitude of CF and WF were not related. CONCLUSIONS Half of the cognitively-impaired PMS population presented WF which was associated with higher disability, physical functions, and fatigue. There was a high prevalence of CF but without strong associations with clinical, cognitive, and physical functions. TRIAL REGISTRATION NUMBER The "CogEx-study," www.clinicaltrial.gov identifier number: NCT03679468.
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Affiliation(s)
- Cintia Ramari
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- UMSC University MS Center Hasselt Pelt, Hasselt Pelt, Belgium
| | - Mieke D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- National MS Center, Melsbroek, Belgium
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Brian M Sandroff
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- UMSC University MS Center Hasselt Pelt, Hasselt Pelt, Belgium
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Preziosa P, Pagani E, Meani A, Storelli L, Margoni M, Yudin Y, Tedone N, Biondi D, Rubin M, Rocca MA, Filippi M. Chronic Active Lesions and Larger Choroid Plexus Explain Cognition and Fatigue in Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200205. [PMID: 38350048 DOI: 10.1212/nxi.0000000000200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Chronic inflammation may contribute to cognitive dysfunction and fatigue in patients with multiple sclerosis (MS). Paramagnetic rim lesions (PRLs) and choroid plexus (CP) enlargement have been proposed as markers of chronic inflammation in MS being associated with a more severe disease course. However, their relation with cognitive impairment and fatigue has not been fully explored yet. Here, we investigated the contribution of PRL number and volume and CP enlargement to cognitive impairment and fatigue in patients with MS. METHODS Brain 3T MRI, neurologic evaluation, and neuropsychological assessment, including the Brief Repeatable Battery of Neuropsychological Tests and Modified Fatigue Impact Scale, were obtained from 129 patients with MS and 73 age-matched and sex-matched healthy controls (HC). PRLs were identified on phase images of susceptibility-weighted imaging, whereas CP volume was quantified using a fully automatic method on brain three-dimensional T1-weighted and fluid-attenuated inversion recovery MRI sequences. Predictors of cognitive impairment and fatigue were identified using random forest. RESULTS Thirty-six (27.9%) patients with MS were cognitively impaired, and 31/113 (27.4%) patients had fatigue. Fifty-nine (45.7%) patients with MS had ≥1 PRLs (median = 0, interquartile range = 0;2). Compared with HC, patients with MS showed significantly higher T2-hyperintense white matter lesion (WM) volume; lower normalized brain, thalamic, hippocampal, caudate, cortical, and WM volumes; and higher normalized CP volume (p from <0.001 to 0.040). The predictors of cognitive impairment (relative importance) (out-of-bag area under the curve [OOB-AUC] = 0.707) were normalized brain volume (100%), normalized caudate volume (89.1%), normalized CP volume (80.3%), normalized cortical volume (70.3%), number (67.3%) and volume (66.7%) of PRLs, and T2-hyperintense WM lesion volume (64.0%). Normalized CP volume was the only predictor of the presence of fatigue (OOB-AUC = 0.563). DISCUSSION Chronic inflammation, with higher number and volume of PRLs and enlarged CP, may contribute to cognitive impairment in MS in addition to gray matter atrophy. The contribution of enlarged CP in explaining fatigue supports the relevance of immune-related processes in determining this manifestation independently of disease severity. PRLs and CP enlargement may contribute to the pathophysiology of cognitive impairment and fatigue in MS, and they may represent clinically relevant therapeutic targets to limit the impact of these clinical manifestations in MS.
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Affiliation(s)
- Paolo Preziosa
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Loredana Storelli
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Margoni
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Yury Yudin
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Tedone
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diana Biondi
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Rubin
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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34
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Stanziano M, Fedeli D, Manera U, Ferraro S, Medina Carrion JP, Palermo S, Sciortino P, Cogoni M, Agosta F, Basaia S, Filippi M, Grisoli M, Valentini MC, De Mattei F, Canosa A, Calvo A, Bruzzone MG, Chiò A, Nigri A, Moglia C. Resting-state fMRI functional connectome of C9orf72 mutation status. Ann Clin Transl Neurol 2024; 11:686-697. [PMID: 38234062 DOI: 10.1002/acn3.51989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/15/2023] [Accepted: 12/16/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE The resting-state functional connectome has not been extensively investigated in amyotrophic lateral sclerosis (ALS) spectrum disease, in particular in relationship with patients' genetic status. METHODS Here we studied the network-to-network connectivity of 19 ALS patients carrying the C9orf72 hexanucleotide repeat expansion (C9orf72+), 19 ALS patients not affected by C9orf72 mutation (C9orf72-), and 19 ALS-mimic patients (ALSm) well-matched for demographic and clinical variables. RESULTS When compared with ALSm, we observed greater connectivity of the default mode and frontoparietal networks with the visual network for C9orf72+ patients (P = 0.001). Moreover, the whole-connectome showed greater node degree (P < 0.001), while sensorimotor cortices resulted isolated in C9orf72+. INTERPRETATION Our results suggest a crucial involvement of extra-motor functions in ALS spectrum disease. In particular, alterations of the visual cortex may have a pathogenic role in C9orf72-related ALS. The prominent feature of these patients would be increased visual system connectivity with the networks responsible of the functional balance between internal and external attention.
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Affiliation(s)
- Mario Stanziano
- Neuroradiology Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Davide Fedeli
- Neuroradiology Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Umberto Manera
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Stefania Ferraro
- Neuroradiology Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
- MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Jean P Medina Carrion
- Neuroradiology Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Sara Palermo
- Neuroradiology Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Paola Sciortino
- Neuroradiology Unit, CTO Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maurizio Cogoni
- Neuroradiology Unit, CTO Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Grisoli
- Neuroradiology Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Maria C Valentini
- Neuroradiology Unit, CTO Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Filippo De Mattei
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Antonio Canosa
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Andrea Calvo
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Maria G Bruzzone
- Neuroradiology Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Adriano Chiò
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
- Institute of Cognitive Sciences and Technologies, National Council of Research, Rome, Italy
| | - Anna Nigri
- Neuroradiology Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Cristina Moglia
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
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Cutillo G, Rubin M, d'Amore G, Malcangi M, Vezzulli PQ, Ferrè L, Martinelli V, Esposito F, Filippi M. Infratentorial posterior reversible encephalopathy syndrome in INFβ1a-treated multiple sclerosis patient. J Neurol 2024:10.1007/s00415-024-12226-2. [PMID: 38386046 DOI: 10.1007/s00415-024-12226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Gianni Cutillo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Martina Rubin
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia d'Amore
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Malcangi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Q Vezzulli
- Neuroradiology Unit and High Field MRI Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Ferrè
- Laboratory of Human Genetics of Neurological Disorders, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Martinelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Federica Esposito
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Laboratory of Human Genetics of Neurological Disorders, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Canu E, Rugarli G, Coraglia F, Basaia S, Cecchetti G, Calloni SF, Vezzulli PQ, Spinelli EG, Santangelo R, Caso F, Falini A, Magnani G, Filippi M, Agosta F. Real-word application of the AT(N) classification and disease-modifying treatment eligibility in a hospital-based cohort. J Neurol 2024:10.1007/s00415-024-12221-7. [PMID: 38381175 DOI: 10.1007/s00415-024-12221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND AND OBJECTIVES The AT(N) classification system stratifies patients based on biomarker profiles, including amyloid-beta deposition (A), tau pathology (T), and neurodegeneration (N). This study aims to apply the AT(N) classification to a hospital-based cohort of patients with cognitive decline and/or dementia, within and outside the Alzheimer's disease (AD) continuum, to enhance our understanding of the multidimensional aspects of AD and related disorders. Furthermore, we wish to investigate how many cases from our cohort would be eligible for the available disease modifying treatments, such as aducanemab and lecanemab. METHODS We conducted a retrospective evaluation of 429 patients referred to the Memory Center of IRCCS San Raffaele Hospital in Milan. Patients underwent clinical/neuropsychological assessments, lumbar puncture, structural brain imaging, and positron emission tomography (FDG-PET). Patients were stratified according to AT(N) classification, group comparisons were performed and the number of eligible cases for anti-β amyloid monoclonal antibodies was calculated. RESULTS Sociodemographic and clinical features were similar across groups. The most represented group was A + T + N + accounting for 38% of cases, followed by A + T - N + (21%) and A - T - N + (20%). Although the clinical presentation was similar, the A + T + N + group showed more severe cognitive impairment in memory, language, attention, executive, and visuospatial functions compared to other AT(N) groups. Notably, T + patients demonstrated greater memory complaints compared to T - cases. FDG-PET outperformed MRI and CT in distinguishing A + from A - patients. Although 61% of the observed cases were A + , only 17% of them were eligible for amyloid-targeting treatments. DISCUSSION The AT(N) classification is applicable in a real-world clinical setting. The classification system provided insights into clinical management and treatment strategies. Low cognitive performance and specific regional FDG-PET hypometabolism at diagnosis are highly suggestive for A + T + or A - T + profiles. This work provides also a realistic picture of the proportion of AD patients eligible for disease modifying treatments emphasizing the need for early detection.
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Affiliation(s)
- Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Rugarli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Coraglia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giordano Cecchetti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sonia Francesca Calloni
- Neuroradiology Unit and High Field MRI Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Edoardo Gioele Spinelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Santangelo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Caso
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Falini
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroradiology Unit and High Field MRI Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Magnani
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Zanetta C, Faustino P, Guerrieri S, Nozzolillo A, Genchi A, Bucca C, Rocca MA, Moiola L, Filippi M. Fast but not furious: Rapid ocrelizumab infusion as a strategy to optimize multiple sclerosis patients' management. J Neurol Sci 2024; 457:122897. [PMID: 38278095 DOI: 10.1016/j.jns.2024.122897] [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: 11/15/2023] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVES Multiple sclerosis clinicians are continuously challenged to be innovative in delivering therapies and there is ongoing pressure to maximize day-hospital vacancies. We describe our single-center experience with ocrelizumab (OCR) rapid infusion (OCR-RI) in patients with MS (pwMS). METHODS For pwMS with prior exposure to OCR standard infusion (OCR-SI) for at least one year/two cycles, infusion time was reduced from 3.5 to 2.0 h. A comparative analysis between OCR-RI vs OCR-SI patients was conducted. RESULTS 283 (76.7%) out of 369 OCR-treated pwMS performed OCR-RI; 86 subjects did not start OCR-RI due to infusion-related reactions (IRR) occurring with OCR-SI (n = 13) or OCR-treatment duration shorter than one year (n = 73). Disease duration was longer in OCR-RI (p < 0.001). Median numbers of overall-OCR and OCR-RI cycles were 7 (IQR = 5-8) and 4 (IQR = 2-5) (p < 0.001). Overall, 38 (10.3%) IRR were reported, 25 (8.8%) in OCR-RI and 13 (15.1%) in OCR-SI group. IRR frequency did not differ between the two groups (p = 0.106). IRR included throat irritation, rash, hypotension, fever and gastrointestinal symptoms. IRR severity was mild (81.6%) or moderate (18.4%), all resolved and did not differ in distribution between the two groups. When IRR occurred, infusions were temporarily stopped, hydration and/or symptomatic medications were given and infusions were subsequently resumed at standard velocity. OCR-RI was not a risk factor for IRR (OR 0.55, 95% CI: 0.27-1.13, p = 0.096). CONCLUSIONS In our cohort, IRR frequency, severity and management were comparable to literature. No severe IRR were observed. RI protocols represent a strategy to optimize patients' management in the clinic.
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Affiliation(s)
- Chiara Zanetta
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patricia Faustino
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Department and Multiple Sclerosis Centre of Integrated Responsibility, Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
| | - Simone Guerrieri
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Agostino Nozzolillo
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angela Genchi
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bucca
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Moiola
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Cecchetti G, Basaia S, Canu E, Cividini C, Cursi M, Caso F, Santangelo R, Fanelli GF, Magnani G, Agosta F, Filippi M. EEG Correlates in the 3 Variants of Primary Progressive Aphasia. Neurology 2024; 102:e207993. [PMID: 38165298 DOI: 10.1212/wnl.0000000000207993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The 3 clinical presentations of primary progressive aphasia (PPA) reflect heterogenous neuropathology, which is difficult to be recognized in vivo. Resting-state (RS) EEG is promising for the investigation of brain electrical substrates in neurodegenerative conditions. In this study, we aim to explore EEG cortical sources in the characterization of the 3 variants of PPA. METHODS This is a cross-sectional, single-center, memory center-based cohort study. Patients with PPA and healthy controls were consecutively recruited at the Neurology Unit, IRCCS San Raffaele Scientific Institute (Milan, Italy). Each participant underwent an RS 19-channel EEG. Using standardized low-resolution brain electromagnetic tomography, EEG current source densities were estimated at voxel level and compared among study groups. Using an RS functional MRI-driven model of source reconstruction, linear lagged connectivity (LLC) values within language and extra-language brain networks were obtained and analyzed among groups. RESULTS Eighteen patients with logopenic PPA variant (lvPPA; mean age = 72.7 ± 6.6; % female = 52.4), 21 patients with nonfluent/agrammatic PPA variant (nfvPPA; mean age = 71.7 ± 8.1; % female = 66.6), and 9 patients with semantic PPA variant (svPPA; mean age = 65.0 ± 6.9; % female = 44.4) were enrolled in the study, together with 21 matched healthy controls (mean age = 69.2 ± 6.5; % female = 57.1). Patients with lvPPA showed a higher delta density than healthy controls (p < 0.01) and patients with nfvPPA (p < 0.05) and svPPA (p < 0.05). Patients with lvPPA also displayed a greater theta density over the left posterior hemisphere (p < 0.01) and lower alpha2 values (p < 0.05) over the left frontotemporal regions than controls. Patients with nfvPPA showed a diffuse greater theta density than controls (p < 0.05). LLC was altered in all patients relative to controls (p < 0.05); the alteration was greater at slow frequency bands and within language networks than extra-language networks. Patients with lvPPA also showed greater LLC values at theta band than patients with nfvPPA (p < 0.05). DISCUSSION EEG findings in patients with PPA suggest that lvPPA-related pathology is associated with a characteristic disruption of the cortical electrical activity, which might help in the differential diagnosis from svPPA and nfvPPA. EEG connectivity was disrupted in all PPA variants, with distinct findings in disease-specific PPA groups. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that EEG analysis can distinguish PPA due to probable Alzheimer disease from PPA due to probable FTD from normal aging.
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Affiliation(s)
- Giordano Cecchetti
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Basaia
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Cividini
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Cursi
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Caso
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Santangelo
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna F Fanelli
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Magnani
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neurology Unit (G.C., F.C., R.S., G.M., F.A., M.F.), Neurophysiology Service (G.C., M.C., R.S., G.F.F., M.F.), and Neuroimaging Research Unit (G.C., S.B., E.C., C.C., F.A., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (G.C., F.A., M.F.); and Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Rocca MA, Preziosa P, Filippi M. Juxtacortical Paramagnetic Rim: A New MRI Marker to Characterize Focal Cortical Pathology in Multiple Sclerosis? Neurology 2024; 102:e208085. [PMID: 38165304 DOI: 10.1212/wnl.0000000000208085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024] Open
Abstract
The accumulation of focal white matter and cortical inflammatory demyelinating lesions represents the pathologic hallmark of multiple sclerosis (MS).1 Typically, acute white matter lesions are characterized by an increased blood-brain barrier (BBB) permeability, an inflammatory infiltrate, and ongoing demyelination and axonal transection.2 In the chronic phase, a substantial proportion of white matter lesions, known as chronic active lesions, exhibit a hypocellular core with a rim of iron-laden activated microglia/macrophages, with no abnormal BBB permeability.2 Some of these lesions can be identified on susceptibility-based MRI as exhibiting a paramagnetic rim, and they are, therefore, referred to as "paramagnetic rim lesions" (PRLs).3.
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Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Barbanti P, Aurilia C, Egeo G, Proietti S, Torelli P, d'Onofrio F, Carnevale A, Tavani S, Orlando B, Fiorentini G, Colombo B, Filippi M, Bonassi S, Cevoli S. Impact of multiple treatment cycles with anti-CGRP monoclonal antibodies on migraine course: focus on discontinuation periods. Insights from the multicenter, prospective, I-GRAINE study. J Neurol 2024:10.1007/s00415-024-12192-9. [PMID: 38342785 DOI: 10.1007/s00415-024-12192-9] [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: 12/27/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES While a single 12-month treatment cycle (TrC) with anti-CGRP mAbs is not disease-modifying for most patients, there is limited understanding of the effects of multiple TrCs on migraine course. We evaluated whether a second TrC might modify the migraine course by comparing the occurrence of migraine relapse after discontinuation of the second TrC to that following the cessation of the first TrC. METHODS In a real-life, multicenter, prospective study we considered all consecutive patients diagnosed with high-frequency episodic migraine (HFEM) or chronic migraine (CM) with > 3 treatment failures and treated with any anti-CGRP mAbs for ≥ 2 consecutive 12-month TrCs who were responders at week 12. The primary endpoint was the change in monthly migraine days (MMD) for HFEM or monthly headache days (MHD) for CM at the first month of treatment discontinuation after the second TrC (D2) compared to the first TrC (D1). Secondary endpoints included variations in monthly analgesic medications (MAM), Numeric Rating Scale (NRS), and Headache Impact Test (HIT-6) scores, ≥ 50%, ≥ 75%, and 100% response rates, and relapse from episodic migraine to CM and from no-medication overuse (MO) to MO at D2 vs. D1. RESULTS One-hundred-seventy-eight patients completed two 12-month TrCs with anti-CGRP mAbs. At D2, patients experienced a significant reduction in MMD (- 0.6, p = 0.028), MHD (- 2.6, p < 0.001), monthly analgesic medications (- 2.0, p < 0.001), and HIT-6 score (- 2.2, p < 0.001) compared to D1, indicating improved effectiveness. The ≥ 50% response rate at weeks 45-48 during the first TrC was 95.5%, while at weeks 45-48 of the second TrC was 99.4%. Corresponding rates at D1 was 20.2% whereas at D2 was 51.6% (p < 0.0001). No statistical difference emerged in ≥ 75% and 100% responders. The relapse rate from episodic migraine to CM at D2 was lower than at D1 (12.3% vs 30.4%; p = 0.0002) Fewer patients experienced relapse from no-MO to MO at D2 compared to D1 (29.5% vs 68.7%; p = 0.00001). DISCUSSION A second TrC with anti-CGRP mAbs demonstrated clinical improvements compared to the first one, as indicated by a milder migraine relapse at D2 compared to D1. Multiple TrCs with anti-CGRP mAbs could progressively modify migraine evolution by reducing CGRP-dependent neuroinflammatory nociceptive inputs to the brain.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy.
- San Raffaele University, Rome, Italy.
| | - Cinzia Aurilia
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy
| | - Gabriella Egeo
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy
| | - Stefania Proietti
- Clinical and Molecular Epidemiology, IRCCS San Raffaele, Rome, Italy
| | - Paola Torelli
- Unit of Neurology, Department of Medicine and Surgery, Headache Center, University of Parma, Parma, Italy
| | - Florindo d'Onofrio
- Headache Center Neurology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | | | - Sofia Tavani
- Catholic University of Sacred Heart Rome, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Bianca Orlando
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy
| | - Giulia Fiorentini
- Headache and Pain Unit, IRCCS San Raffaele, Via Della Pisana 235, 00163, Rome, Italy
- San Raffaele University, Rome, Italy
| | - Bruno Colombo
- Headache Unit, Department of Neurology, Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Massimo Filippi
- Headache Unit, Department of Neurology, Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Stefano Bonassi
- San Raffaele University, Rome, Italy
- Clinical and Molecular Epidemiology, IRCCS San Raffaele, Rome, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Preziosa P, Storelli L, Tedone N, Margoni M, Mistri D, Azzimonti M, Filippi M, Rocca MA. Spatial correspondence among regional gene expressions and gray matter volume loss in multiple sclerosis. Mol Psychiatry 2024:10.1038/s41380-024-02452-5. [PMID: 38326561 DOI: 10.1038/s41380-024-02452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
In multiple sclerosis (MS), a non-random and clinically relevant pattern of gray matter (GM) volume loss has been described. Whether differences in regional gene expression might underlay distinctive pathological processes contributing to this regional variability has not been explored yet. Two hundred eighty-six MS patients and 172 healthy controls (HC) underwent a brain 3T MRI, a complete neurological evaluation and a neuropsychological assessment. Using Allen Human Brain Atlas, voxel-based morphometry and MENGA platform, we integrated brain transcriptome and neuroimaging data to explore the spatial cross-correlations between regional GM volume loss and expressions of 2710 genes involved in MS (p < 0.05, family-wise error-corrected). Enrichment analyses were performed to evaluate overrepresented molecular functions, biological processes and cellular components involving genes significantly associated with voxel-based morphometry-derived GM maps (p < 0.05, Bonferroni-corrected). A diffuse GM volume loss was found in MS patients compared to HC and it was spatially correlated with 74 genes involved in GABA neurotransmission and mitochondrial oxidoreductase activity mainly expressed in neurons and astrocytes. A more severe GM volume loss was spatially associated, in more disabled MS patients, with 44 genes involved in mitochondrial integrity of all resident cells of the central nervous system (CNS) and, in cognitively impaired MS patients, with 64 genes involved in mitochondrial protein heterodimerization and oxidoreductase activities expressed also in microglia and endothelial cells. Specific differences in the expressions of genes involved in synaptic GABA receptor activities and mitochondrial functions in resident CNS cells may influence regional susceptibility to MS-related excitatory/inhibitory imbalance and oxidative stress, and subsequently, to GM volume loss.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Azzimonti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Gentile F, Maranzano A, Verde F, Bettoni V, Colombo E, Doretti A, Olivero M, Scheveger F, Colombrita C, Bulgarelli I, Spinelli EG, Torresani E, Messina S, Maderna L, Agosta F, Morelli C, Filippi M, Silani V, Ticozzi N. The value of routine blood work-up in clinical stratification and prognosis of patients with amyotrophic lateral sclerosis. J Neurol 2024; 271:794-803. [PMID: 37801095 PMCID: PMC10827966 DOI: 10.1007/s00415-023-12015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND There is an unmet need in amyotrophic lateral sclerosis (ALS) to provide specific biomarkers for the disease. Due to their easy availability, we aimed to investigate whether routine blood parameters provide useful clues for phenotypic classification and disease prognosis. METHODS We analyzed a large inpatient cohort of 836 ALS patients who underwent deep phenotyping with evaluation of the clinical and neurophysiological burden of upper (UMN) and lower (LMN) motor neuron signs. Disability and progression rate were measured through the revised ALS Functional Rating Scale (ALSFRS-R) and its changes during time. Cox regression analysis was performed to assess survival associations. RESULTS Creatinine significantly correlated with LMN damage (r = 0.38), active (r = 0.18) and chronic (r = 0.24) denervation and baseline ALSFRS-R (r = 0.33). Creatine kinase (CK), alanine (ALT) and aspartate (AST) transaminases correlated with active (r = 0.35, r = 0.27, r = 0.24) and chronic (r = 0.37, r = 0.20, r = 0.19) denervation, while albumin and C-reactive protein significantly correlated with LMN score (r = 0.20 and r = 0.17). Disease progression rate showed correlations with chloride (r = -0.19) and potassium levels (r = -0.16). After adjustment for known prognostic factors, total protein [HR 0.70 (95% CI 0.57-0.86)], creatinine [HR 0.86 (95% CI 0.81-0.92)], chloride [HR 0.95 (95% CI 0.92-0.99)], lactate dehydrogenase [HR 0.99 (95% CI 0.99-0.99)], and AST [HR 1.02 (95% CI 1.01-1.02)] were independently associated with survival. CONCLUSIONS Creatinine is a reliable biomarker for ALS, associated with clinical features, disability and survival. Markers of nutrition/inflammation may offer additional prognostic information and partially correlate with clinical features. AST and chloride could further assist in predicting progression rate and survival.
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Affiliation(s)
- Francesco Gentile
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Federico Verde
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Veronica Bettoni
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, Università degli Studi di Pavia, Pavia, Italy
| | - Eleonora Colombo
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Alberto Doretti
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Marco Olivero
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | | | - Claudia Colombrita
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ilaria Bulgarelli
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Edoardo Gioele Spinelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Erminio Torresani
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Messina
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Luca Maderna
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Federica Agosta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Claudia Morelli
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy.
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy.
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Chapleau M, La Joie R, Yong K, Agosta F, Allen IE, Apostolova L, Best J, Boon BDC, Crutch S, Filippi M, Fumagalli GG, Galimberti D, Graff-Radford J, Grinberg LT, Irwin DJ, Josephs KA, Mendez MF, Mendez PC, Migliaccio R, Miller ZA, Montembeault M, Murray ME, Nemes S, Pelak V, Perani D, Phillips J, Pijnenburg Y, Rogalski E, Schott JM, Seeley W, Sullivan AC, Spina S, Tanner J, Walker J, Whitwell JL, Wolk DA, Ossenkoppele R, Rabinovici GD. Demographic, clinical, biomarker, and neuropathological correlates of posterior cortical atrophy: an international cohort study and individual participant data meta-analysis. Lancet Neurol 2024; 23:168-177. [PMID: 38267189 DOI: 10.1016/s1474-4422(23)00414-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Posterior cortical atrophy is a rare syndrome characterised by early, prominent, and progressive impairment in visuoperceptual and visuospatial processing. The disorder has been associated with underlying neuropathological features of Alzheimer's disease, but large-scale biomarker and neuropathological studies are scarce. We aimed to describe demographic, clinical, biomarker, and neuropathological correlates of posterior cortical atrophy in a large international cohort. METHODS We searched PubMed between database inception and Aug 1, 2021, for all published research studies on posterior cortical atrophy and related terms. We identified research centres from these studies and requested deidentified, individual participant data (published and unpublished) that had been obtained at the first diagnostic visit from the corresponding authors of the studies or heads of the research centres. Inclusion criteria were a clinical diagnosis of posterior cortical atrophy as defined by the local centre and availability of Alzheimer's disease biomarkers (PET or CSF), or a diagnosis made at autopsy. Not all individuals with posterior cortical atrophy fulfilled consensus criteria, being diagnosed using centre-specific procedures or before development of consensus criteria. We obtained demographic, clinical, biofluid, neuroimaging, and neuropathological data. Mean values for continuous variables were combined using the inverse variance meta-analysis method; only research centres with more than one participant for a variable were included. Pooled proportions were calculated for binary variables using a restricted maximum likelihood model. Heterogeneity was quantified using I2. FINDINGS We identified 55 research centres from 1353 papers, with 29 centres responding to our request. An additional seven centres were recruited by advertising via the Alzheimer's Association. We obtained data for 1092 individuals who were evaluated at 36 research centres in 16 countries, the other sites having not responded to our initial invitation to participate to the study. Mean age at symptom onset was 59·4 years (95% CI 58·9-59·8; I2=77%), 60% (56-64; I2=35%) were women, and 80% (72-89; I2=98%) presented with posterior cortical atrophy pure syndrome. Amyloid β in CSF (536 participants from 28 centres) was positive in 81% (95% CI 75-87; I2=78%), whereas phosphorylated tau in CSF (503 participants from 29 centres) was positive in 65% (56-75; I2=87%). Amyloid-PET (299 participants from 24 centres) was positive in 94% (95% CI 90-97; I2=15%), whereas tau-PET (170 participants from 13 centres) was positive in 97% (93-100; I2=12%). At autopsy (145 participants from 13 centres), the most frequent neuropathological diagnosis was Alzheimer's disease (94%, 95% CI 90-97; I2=0%), with common co-pathologies of cerebral amyloid angiopathy (71%, 54-88; I2=89%), Lewy body disease (44%, 25-62; I2=77%), and cerebrovascular injury (42%, 24-60; I2=88%). INTERPRETATION These data indicate that posterior cortical atrophy typically presents as a pure, young-onset dementia syndrome that is highly specific for underlying Alzheimer's disease pathology. Further work is needed to understand what drives cognitive vulnerability and progression rates by investigating the contribution of sex, genetics, premorbid cognitive strengths and weaknesses, and brain network integrity. FUNDING None.
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Affiliation(s)
- Marianne Chapleau
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Keir Yong
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, UK
| | - Federica Agosta
- Vita-Salute, San Raffaele University, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Insitute, Milan, Italy
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - John Best
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Baayla D C Boon
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Sebastian Crutch
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, UK
| | - Massimo Filippi
- Vita-Salute, San Raffaele University, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Insitute, Milan, Italy
| | | | - Daniela Galimberti
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - David J Irwin
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mario F Mendez
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Patricio Chrem Mendez
- Memory Center, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires Argentina
| | - Raffaella Migliaccio
- Paris Brain Institute (ICM), FrontLab, Institut de la mémoire et de la maladie d'Alzheimer (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Maxime Montembeault
- Douglas Research Centre, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Sára Nemes
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victoria Pelak
- Departments of Neurology and Ophthalmology, Divisions of Neuro-Ophthalmology and Behavioral Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniela Perani
- Vita-Salute, San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele, San Raffaele University, Milan, Italy
| | - Jeffrey Phillips
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology & Alzheimer's Disease, Northwestern University, Evanston, IL, USA
| | - Jonathan M Schott
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, London, UK; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - William Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - A Campbell Sullivan
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jeremy Tanner
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Jamie Walker
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | | | - David A Wolk
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands; Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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Bisecco A, Matrone F, Capobianco M, De Luca G, Filippi M, Granella F, Lus G, Marfia GA, Mirabella M, Patti F, Trojano M, Mascolo A, Copetti M, Tedeschi G, Gallo A. COVID-19 outbreak in Italy: an opportunity to evaluate extended interval dosing of ocrelizumab in MS patients. J Neurol 2024; 271:699-710. [PMID: 37982852 PMCID: PMC10827970 DOI: 10.1007/s00415-023-12084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic, ocrelizumab (OCR) infusions for MS patients were often re-scheduled because of MS center's disruption and concerns regarding immunosuppression. The aim of the present study was to assess changes in OCR schedule during the first wave of pandemic in Italy and to evaluate the effect of delayed infusion on clinical/radiological endpoints. METHODS Data were extracted from the Italian MS Register database. Standard interval dosing was defined as an infusion interval ≤ 30 weeks, while extended interval dosing was defined as an infusion interval > 30 weeks at the time of the observation period. Clinico-demographics variables were tested as potential predictors for treatment delay. Time to first relapse and time to first MRI event were evaluated. Cumulative hazard curves were reported along their 95% confidence intervals. A final sample of one-thousand two patients with MS from 65 centers was included in the analysis: 599 pwMS were selected to evaluate the modification of OCR infusion intervals, while 717 pwRMS were selected to analyze the effect of infusion delay on clinical/MRI activity. RESULTS Mean interval between two OCR infusions was 28.1 weeks before pandemic compared to 30.8 weeks during the observation period, with a mean delay of 2.74 weeks (p < 0.001). No clinico-demographic factors emerged as predictors of infusion postponement, except for location of MS centers in the North of Italy. Clinical relapses (4 in SID, 0 in EID) and 17 MRI activity reports (4 in SID, 13 in EID) were recorded during follow-up period. DISCUSSION Despite the significant extension of OCR infusion interval during the first wave of pandemic in Italy, a very small incidence of clinical/radiological events was observed, thus suggesting durable efficacy of OCR, as well as the absence of rebound after its short-term suspension.
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Affiliation(s)
- Alvino Bisecco
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy.
| | - Federica Matrone
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Marco Capobianco
- SCDO Neurology and Regional Reference Multiple Sclerosis Center, A.O.U. San Luigi, Orbassano, Italy
- Department of Neurology, AO S. Croce e Carle, Cuneo, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Massimo Filippi
- MS Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Multiple Sclerosis Centre, Unit of Neurology, Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Giacomo Lus
- MS Center - II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Centro Di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia, University of Catania, Catania, Italy
| | | | - Agnese Mascolo
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Gioacchino Tedeschi
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Antonio Gallo
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
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Cagol A, Cortese R, Barakovic M, Schaedelin S, Ruberte E, Absinta M, Barkhof F, Calabrese M, Castellaro M, Ciccarelli O, Cocozza S, De Stefano N, Enzinger C, Filippi M, Jurynczyk M, Maggi P, Mahmoudi N, Messina S, Montalban X, Palace J, Pontillo G, Pröbstel AK, Rocca MA, Ropele S, Rovira À, Schoonheim MM, Sowa P, Strijbis E, Wattjes MP, Sormani MP, Kappos L, Granziera C. Diagnostic Performance of Cortical Lesions and the Central Vein Sign in Multiple Sclerosis. JAMA Neurol 2024; 81:143-153. [PMID: 38079177 PMCID: PMC10714285 DOI: 10.1001/jamaneurol.2023.4737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/06/2023] [Indexed: 02/13/2024]
Abstract
Importance Multiple sclerosis (MS) misdiagnosis remains an important issue in clinical practice. Objective To quantify the performance of cortical lesions (CLs) and central vein sign (CVS) in distinguishing MS from other conditions showing brain lesions on magnetic resonance imaging (MRI). Design, Setting, and Participants This was a retrospective, cross-sectional multicenter study, with clinical and MRI data acquired between January 2010 and May 2020. Centralized MRI analysis was conducted between July 2020 and December 2022 by 2 raters blinded to participants' diagnosis. Participants were recruited from 14 European centers and from a multicenter pan-European cohort. Eligible participants had a diagnosis of MS, clinically isolated syndrome (CIS), or non-MS conditions; availability of a brain 3-T MRI scan with at least 1 sequence suitable for CL and CVS assessment; presence of T2-hyperintense white matter lesions (WMLs). A total of 1051 individuals were included with either MS/CIS (n = 599; 386 [64.4%] female; mean [SD] age, 41.5 [12.3] years) or non-MS conditions (including other neuroinflammatory disorders, cerebrovascular disease, migraine, and incidental WMLs in healthy control individuals; n = 452; 302 [66.8%] female; mean [SD] age, 49.2 [14.5] years). Five individuals were excluded due to missing clinical or demographic information (n = 3) or unclear diagnosis (n = 2). Exposures MS/CIS vs non-MS conditions. Main Outcomes and Measures Area under the receiver operating characteristic curves (AUCs) were used to explore the diagnostic performance of CLs and the CVS in isolation and in combination; sensitivity, specificity, and accuracy were calculated for various cutoffs. The diagnostic importance of CLs and CVS compared to conventional MRI features (ie, presence of infratentorial, periventricular, and juxtacortical WMLs) was ranked with a random forest model. Results The presence of CLs and the previously proposed 40% CVS rule had a sensitivity, specificity, and accuracy for MS of 59.0% (95% CI, 55.1-62.8), 93.6% (95% CI, 91.4-95.6), and 73.9% (95% CI, 71.6-76.3) and 78.7% (95% CI, 75.5-82.0), 86.0% (95% CI, 82.1-89.5), and 81.5% (95% CI, 78.9-83.7), respectively. The diagnostic performance of the CVS (AUC, 0.89 [95% CI, 0.86-0.91]) was superior to that of CLs (AUC, 0.77 [95% CI, 0.75-0.80]; P < .001), and was increased when combining the 2 imaging markers (AUC, 0.92 [95% CI, 0.90-0.94]; P = .04); in the random forest model, both CVS and CLs outperformed the presence of infratentorial, periventricular, and juxtacortical WMLs in supporting MS differential diagnosis. Conclusions and Relevance The findings in this study suggest that CVS and CLs may be valuable tools to increase the accuracy of MS diagnosis.
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Affiliation(s)
- Alessandro Cagol
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Muhamed Barakovic
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center, Basel, Switzerland
| | - Martina Absinta
- Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | - Frederik Barkhof
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, United Kingdom
- Multiple Sclerosis Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical College VUMC, Amsterdam, the Netherlands
| | - Massimiliano Calabrese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Castellaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- National Institute for Health and Care Research (NIHR) University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Sirio Cocozza
- Departments of Advanced Biomedical Sciences and Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maciej Jurynczyk
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Pietro Maggi
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Neuroinflammation Imaging Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Nima Mahmoudi
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Silvia Messina
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Division of Neurology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Palace
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Pontillo
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- Multiple Sclerosis Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical College VUMC, Amsterdam, the Netherlands
- Departments of Advanced Biomedical Sciences and Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Anne-Katrin Pröbstel
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, Basel, Switzerland
| | - Maria A. Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Menno M. Schoonheim
- Multiple Sclerosis Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical College VUMC, Amsterdam, the Netherlands
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Eva Strijbis
- Multiple Sclerosis Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical College VUMC, Amsterdam, the Netherlands
| | - Mike P. Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, Genova, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy
| | - Ludwig Kappos
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
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Cacciaguerra L, Curatoli C, Vizzino C, Valsasina P, Filippi M, Rocca MA. Functional correlates of cognitive abilities vary with age in pediatric multiple sclerosis. Mult Scler Relat Disord 2024; 82:105404. [PMID: 38159365 DOI: 10.1016/j.msard.2023.105404] [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: 09/13/2023] [Revised: 11/08/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Pediatric multiple sclerosis (PedMS) can hamper brain maturation. Aim of this study was to assess the neuropsychological profile of PedMS patients and their resting-state functional connectivity (RS FC). METHODS We assessed intelligence quotient (IQ), executive speed, and language in 76 PedMS patients. On a 3.0T scanner RS FC of brain networks was estimated with a seed-based analysis (subset of 58 right-handed PedMS patients and 22 matched healthy controls). Comparisons were run between controls and PedMS (whole cohort and by age). RESULTS Ninety-five% of patients had normal IQ. The highest rate of failure was observed in executive speed. PedMS showed reduced RS FC in all networks than controls, especially in the basal ganglia. In younger patients (<16-year-old, n = 32) reduced RS FC in the basal ganglia, language, and sensorimotor networks associated with poorer cognitive performance (p < 0.05; r range: 0.39; 0.56). Older patients (≥16-year-old, n = 26) showed increased RS FC in the basal ganglia, default-mode, sensorimotor, executive, and language networks, associated with poorer performance in executive speed and language abilities (p < 0.05; r range: -0.40; -0.59). In both groups, lower RS FC of the caudate nucleus associated with poorer executive speed. CONCLUSIONS The effect of PedMS on RS FC is clinically relevant and differs according to patients' age.
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Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Curatoli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Spinelli EG, Ghirelli A, Basaia S, Canu E, Castelnovo V, Cividini C, Russo T, Schito P, Falzone YM, Riva N, Filippi M, Agosta F. Structural and Functional Brain Network Connectivity at Different King's Stages in Patients With Amyotrophic Lateral Sclerosis. Neurology 2024; 102:e207946. [PMID: 38165325 PMCID: PMC10962907 DOI: 10.1212/wnl.0000000000207946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There is currently no validated disease-stage biomarker for amyotrophic lateral sclerosis (ALS). The identification of quantitative and reproducible markers of disease stratification in ALS is fundamental for study design definition and inclusion of homogenous patient cohorts into clinical trials. Our aim was to assess the rearrangements of structural and functional brain connectivity underlying the clinical stages of ALS, to suggest objective, reproducible measures provided by MRI connectomics mirroring disease staging. METHODS In this observational study, patients with ALS and healthy controls (HCs) underwent clinical evaluation and brain MRI on a 3T scanner. Patients were classified into 4 groups, according to the King's staging system. Structural and functional brain connectivity matrices were obtained using diffusion tensor and resting-state fMRI data, respectively. Whole-brain network-based statistics (NBS) analysis and comparisons of intraregional and inter-regional connectivity values using analysis of covariance models were performed between groups. Correlations between MRI and clinical/cognitive measures were tested using Pearson coefficient. RESULTS One hundred four patients with ALS and 61 age-matched and sex-matched HCs were included. NBS and regional connectivity analyses demonstrated a progressive decrease of intranetwork and internetwork structural connectivity of sensorimotor regions at increasing ALS stages in our cohort, compared with HCs. By contrast, functional connectivity showed divergent patterns between King's stages 3 (increase in basal ganglia and temporal circuits [p = 0.04 and p = 0.05, respectively]) and 4 (frontotemporal decrease [p = 0.03]), suggesting a complex interplay between opposite phenomena in late stages of the disease. Intraregional sensorimotor structural connectivity was correlated with ALS Functional Rating Scale-revised (ALSFRS-r) score (r = 0.31, p < 0.001) and upper motor neuron burden (r = -0.25, p = 0.01). Inter-regional frontal-sensorimotor structural connectivity was also correlated with ALSFRS-r (r = 0.24, p = 0.02). No correlations with cognitive measures were found. DISCUSSION MRI of the brain allows to demonstrate and quantify increasing disruption of structural connectivity involving the sensorimotor networks in ALS, mirroring disease stages. Frontotemporal functional disconnection seems to characterize only advanced disease phases. Our findings support the utility of MRI connectomics to stratify patients and stage brain pathology in ALS in a reproducible way, which may mirror clinical progression.
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Affiliation(s)
- Edoardo G Spinelli
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alma Ghirelli
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Basaia
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Castelnovo
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Cividini
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tommaso Russo
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paride Schito
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Yuri M Falzone
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- From the Neuroimaging Research Unit (E.G.S., A.G., S.B., E.C., V.C., C.C., M.F., F.A.), Division of Neuroscience, and Neurology Unit (E.G.S., A.G., T.R., P.S., Y.M.F., M.F., F.A.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (E.G.S., A.G., T.R., M.F., F.A.); Neurorehabilitation Unit (N.R., M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Barbanti P, Aurilia C, Egeo G, Proietti S, D'Onofrio F, Torelli P, Aguggia M, Bertuzzo D, Finocchi C, Trimboli M, Cevoli S, Fiorentini G, Orlando B, Zucco M, Di Clemente L, Cetta I, Colombo B, di Poggio MLB, Favoni V, Grazzi L, Salerno A, Carnevale A, Robotti M, Frediani F, Altamura C, Filippi M, Vernieri F, Bonassi S. Ultra-late response (> 24 weeks) to anti-CGRP monoclonal antibodies in migraine: a multicenter, prospective, observational study. J Neurol 2024:10.1007/s00415-023-12103-4. [PMID: 38231271 DOI: 10.1007/s00415-023-12103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Nearly 60% of migraine patients treated with monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway experience a ≥ 50% reduction in monthly migraine days (MMD) at 12 weeks compared to baseline (responders). However, approximately half of the patients not responding to anti-CGRP mAbs ≤ 12 weeks do respond ≤ 24 weeks (late responders). We assessed frequency and characteristics of patients responding to anti-CGRP mAbs only > 24 weeks (ultra-late responders). METHODS In this multicenter (n = 16), prospective, observational, real-life study, we enrolled all consecutive adults affected by high-frequency episodic migraine (HFEM: ≥ 8 days/month) or chronic migraine (CM), with ≥ 3 prior therapeutic failures, treated with any anti-CGRP mAbs for ≥ 48 weeks. We defined responders patients with a ≥ 50% response rate ≤ 12 weeks, late responders those with a ≥ 50% response rate ≤ 24 weeks, and ultra-late responders those achieving a ≥ 50% response only > 24 weeks. RESULTS A total of 572 migraine patients completed ≥ 48 weeks of anti-CGRP mAbs treatment. Responders accounted for 60.5% (346/572), late responders for 15% (86/572), and ultra-late responders for 15.7% (90/572). Among ultra-late responders, 7.3% (42/572) maintained the ≥ 50% response rate across all subsequent time intervals (weeks 28, 32, 36, 40, 44, and 48) and were considered persistent ultra-late responders, while 8.4% (48/572) missed the ≥ 50% response rate at ≥ 1 subsequent time interval and were classified as fluctuating ultra-late responders. Fifty patients (8.7%) did not respond at any time interval ≤ 48 weeks. Ultra-late responders differed from responders for higher BMI (p = 0.033), longer duration of medication overuse (p < 0.001), lower NRS (p = 0.017) and HIT-6 scores (p = 0.002), higher frequency of dopaminergic symptoms (p = 0.002), less common unilateral pain-either alone (p = 0.010) or in combination with UAS (p = 0.023), allodynia (p = 0.043), or UAS and allodynia (p = 0.012)-a higher number of comorbidities (p = 0.012), psychiatric comorbidities (p = 0.010) and a higher proportion of patients with ≥ 1 comorbidity (p = 0.020). CONCLUSION Two-thirds of patients not responding to anti-CGRP mAbs ≤ 24 weeks do respond later, while non-responders ≤ 48 weeks are quite rare (8.7%). These findings suggest to rethink the duration of migraine prophylaxis and the definition of resistant and refractory migraine, currently based on the response after 2-3 months of treatment.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy.
- San Raffaele University, Rome, Italy.
| | - Cinzia Aurilia
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy.
| | - Gabriella Egeo
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Stefania Proietti
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Rome, Italy
| | - Florindo D'Onofrio
- Headache Center Neurology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Paola Torelli
- Unit of Neurology, Department of Medicine and Surgery, Headache Center, University of Parma, Parma, Italy
| | | | | | - Cinzia Finocchi
- Divisione di Neurologia, Ospedale San Paolo, ASL 2 Savonese, Savona, Italy
| | | | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Fiorentini
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Bianca Orlando
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Maurizio Zucco
- Headache Center, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Ilaria Cetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Valentina Favoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Licia Grazzi
- Neuroalgology Unit, Headache Center Fondazione, IRCCS Istituto Neurologico"Carlo Besta", Milan, Italy
| | - Antonio Salerno
- Headache Center San Giovanni Addolorata Hospital, Rome, Italy
| | | | | | | | - Claudia Altamura
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Stefano Bonassi
- San Raffaele University, Rome, Italy
- Headache Center Neurology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
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49
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Ulutekin C, Galli E, Schreiner B, Khademi M, Callegari I, Piehl F, Sanderson N, Kirschenbaum D, Mundt S, Filippi M, Furlan R, Olsson T, Derfuss T, Ingelfinger F, Becher B. B cell depletion attenuates CD27 signaling of T helper cells in multiple sclerosis. Cell Rep Med 2024; 5:101351. [PMID: 38134930 PMCID: PMC10829729 DOI: 10.1016/j.xcrm.2023.101351] [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: 07/14/2023] [Revised: 10/12/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
Multiple sclerosis is a chronic inflammatory disease of the central nervous system. Whereas T cells are likely the main drivers of disease development, the striking efficacy of B cell-depleting therapies (BCDTs) underscore B cells' involvement in disease progression. How B cells contribute to multiple sclerosis (MS) pathogenesis-and consequently the precise mechanism of action of BCDTs-remains elusive. Here, we analyze the impact of BCDTs on the immune landscape in patients with MS using high-dimensional single-cell immunophenotyping. Algorithm-guided analysis reveals a decrease in circulating T follicular helper-like (Tfh-like) cells alongside increases in CD27 expression in memory T helper cells and Tfh-like cells. Elevated CD27 indicates disrupted CD27/CD70 signaling, as sustained CD27 activation in T cells leads to its cleavage. Immunohistological analysis shows CD70-expressing B cells at MS lesion sites. These results suggest that the efficacy of BCDTs may partly hinge upon the disruption of Th cell and B cell interactions.
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Affiliation(s)
- Can Ulutekin
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Edoardo Galli
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Multiple Sclerosis Center, Neurologic Clinic and Policlinic, Department of Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Bettina Schreiner
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Mohsen Khademi
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18A, 171 76 Stockholm, Sweden
| | - Ilaria Callegari
- Multiple Sclerosis Center, Neurologic Clinic and Policlinic, Department of Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Fredrik Piehl
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18A, 171 76 Stockholm, Sweden
| | - Nicholas Sanderson
- Multiple Sclerosis Center, Neurologic Clinic and Policlinic, Department of Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Daniel Kirschenbaum
- Institute of Neuropathology, University Hospital Zurich, University of Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Sarah Mundt
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Via Olgettina n. 60 - 20132, Italy; Vita-Salute San Raffaele University, Milan, Via Olgettina n. 60 - 20132, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina n. 60 - 20132, Milan, Italy
| | - Tomas Olsson
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Visionsgatan 18A, 171 76 Stockholm, Sweden
| | - Tobias Derfuss
- Multiple Sclerosis Center, Neurologic Clinic and Policlinic, Department of Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Florian Ingelfinger
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
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50
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Ruggieri S, Prosperini L, Al-Araji S, Annovazzi PO, Bisecco A, Ciccarelli O, De Stefano N, Filippi M, Fleischer V, Evangelou N, Enzinger C, Gallo A, Garjani A, Groppa S, Haggiag S, Khalil M, Lucchini M, Mirabella M, Montalban X, Pozzilli C, Preziosa P, Río J, Rocca MA, Rovira A, Stromillo ML, Zaffaroni M, Tortorella C, Gasperini C. Assessing treatment response to oral drugs for multiple sclerosis in real-world setting: a MAGNIMS Study. J Neurol Neurosurg Psychiatry 2024; 95:142-150. [PMID: 37775266 DOI: 10.1136/jnnp-2023-331920] [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: 05/26/2023] [Accepted: 08/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The assessment of treatment response is a crucial step for patients with relapsing-remitting multiple sclerosis on disease-modifying therapies (DMTs). We explored whether a scoring system developed within the MAGNIMS (MRI in Multiple Sclerosis) network to evaluate treatment response to injectable drugs can be adopted also to oral DMTs. METHODS A multicentre dataset of 1200 patients who started three oral DMTs (fingolimod, teriflunomide and dimethyl fumarate) was collected within the MAGNIMS network. Disease activity after the first year was classified by the 'MAGNIMS' score based on the combination of relapses (0-≥2) and/or new T2 lesions (<3 or ≥3) on brain MRI. We explored the association of this score with the following 3-year outcomes: (1) confirmed disability worsening (CDW); (2) treatment failure (TFL); (3) relapse count between years 1 and 3. The additional value of contrast-enhancing lesions (CELs) and lesion location was explored. RESULTS At 3 years, 160 patients experienced CDW: 12% of them scored '0' (reference), 18% scored '1' (HR=1.82, 95% CI 1.20 to 2.76, p=0.005) and 37% scored '2' (HR=2.74, 95% CI 1.41 to 5.36, p=0.003) at 1 year. The analysis of other outcomes provided similar findings. Considering the location of new T2 lesions (supratentorial vs infratentorial/spinal cord) and the presence of CELs improved the prediction of CDW and TFL, respectively, in patients with minimal MRI activity alone (one or two new T2 lesions). CONCLUSIONS Early relapses and substantial MRI activity in the first year of treatment are associated with worse short-term outcomes in patients treated with some of the oral DMTs.
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Affiliation(s)
- Serena Ruggieri
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Sarmad Al-Araji
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Pietro Osvaldo Annovazzi
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimo Filippi
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Vinzenz Fleischer
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nikos Evangelou
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology (Division of Neuroradiology, Vascular and Interventional Radiology), Medical University of Graz, Graz, Austria
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Afagh Garjani
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sergiu Groppa
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Shalom Haggiag
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Matteo Lucchini
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Xavier Montalban
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Preziosa
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jordi Río
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Maria A Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria L Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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