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Nous A, Seynaeve L, Feys O, Wens V, De Tiège X, Van Mierlo P, Baroumand AG, Nieboer K, Allemeersch GJ, Mangelschots S, Michiels V, van der Zee J, Van Broeckhoven C, Ribbens A, Houbrechts R, De Witte S, Wittens MMJ, Bjerke M, Vanlersberghe C, Ceyssens S, Nagels G, Smolders I, Engelborghs S. Subclinical epileptiform activity in the Alzheimer continuum: association with disease, cognition and detection method. Alzheimers Res Ther 2024; 16:19. [PMID: 38263073 PMCID: PMC10804650 DOI: 10.1186/s13195-023-01373-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/17/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Epileptic seizures are an established comorbidity of Alzheimer's disease (AD). Subclinical epileptiform activity (SEA) as detected by 24-h electroencephalography (EEG) or magneto-encephalography (MEG) has been reported in temporal regions of clinically diagnosed AD patients. Although epileptic activity in AD probably arises in the mesial temporal lobe, electrical activity within this region might not propagate to EEG scalp electrodes and could remain undetected by standard EEG. However, SEA might lead to faster cognitive decline in AD. AIMS 1. To estimate the prevalence of SEA and interictal epileptic discharges (IEDs) in a well-defined cohort of participants belonging to the AD continuum, including preclinical AD subjects, as compared with cognitively healthy controls. 2. To evaluate whether long-term-EEG (LTM-EEG), high-density-EEG (hd-EEG) or MEG is superior to detect SEA in AD. 3. To characterise AD patients with SEA based on clinical, neuropsychological and neuroimaging parameters. METHODS Subjects (n = 49) belonging to the AD continuum were diagnosed according to the 2011 NIA-AA research criteria, with a high likelihood of underlying AD pathophysiology. Healthy volunteers (n = 24) scored normal on neuropsychological testing and were amyloid negative. None of the participants experienced a seizure before. Subjects underwent LTM-EEG and/or 50-min MEG and/or 50-min hd-EEG to detect IEDs. RESULTS We found an increased prevalence of SEA in AD subjects (31%) as compared to controls (8%) (p = 0.041; Fisher's exact test), with increasing prevalence over the disease course (50% in dementia, 27% in MCI and 25% in preclinical AD). Although MEG (25%) did not withhold a higher prevalence of SEA in AD as compared to LTM-EEG (19%) and hd-EEG (19%), MEG was significantly superior to detect spikes per 50 min (p = 0.002; Kruskall-Wallis test). AD patients with SEA scored worse on the RBANS visuospatial and attention subset (p = 0.009 and p = 0.05, respectively; Mann-Whitney U test) and had higher left frontal, (left) temporal and (left and right) entorhinal cortex volumes than those without. CONCLUSION We confirmed that SEA is increased in the AD continuum as compared to controls, with increasing prevalence with AD disease stage. In AD patients, SEA is associated with more severe visuospatial and attention deficits and with increased left frontal, (left) temporal and entorhinal cortex volumes. TRIAL REGISTRATION Clinicaltrials.gov, NCT04131491. 12/02/2020.
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Affiliation(s)
- Amber Nous
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Neuroprotection and Neuromodulation (NEUR) Research Group, Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, Belgium
- Department of Biomedical Sciences, Universiteit Antwerpen, Antwerp, Belgium
- Laboratory of Pharmaceutical Chemistry, Drug Analysis and Drug Information (FASC), Research Group Experimental Pharmacology (EFAR), Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Laura Seynaeve
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Neuroprotection and Neuromodulation (NEUR) Research Group, Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, Belgium
| | - Odile Feys
- Department of Neurology, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Brussels, Belgium
- Laboratoire de Neuroimagerie Et Neuroanatomie Translationnelles (LN2T), Université Libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium
| | - Vincent Wens
- Laboratoire de Neuroimagerie Et Neuroanatomie Translationnelles (LN2T), Université Libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium
- Department of Translational Neuroimaging, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Brussels, Belgium
| | - Xavier De Tiège
- Laboratoire de Neuroimagerie Et Neuroanatomie Translationnelles (LN2T), Université Libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium
- Department of Translational Neuroimaging, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Brussels, Belgium
| | | | | | - Koenraad Nieboer
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gert-Jan Allemeersch
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Shana Mangelschots
- Neuroprotection and Neuromodulation (NEUR) Research Group, Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, Belgium
- Department of Biomedical Sciences, Universiteit Antwerpen, Antwerp, Belgium
| | - Veronique Michiels
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Julie van der Zee
- Department of Biomedical Sciences, Universiteit Antwerpen, Antwerp, Belgium
- Neurodegenerative Brain Diseases, VIB Center for Molecular Neurology, Antwerp, Belgium
| | - Christine Van Broeckhoven
- Department of Biomedical Sciences, Universiteit Antwerpen, Antwerp, Belgium
- Neurodegenerative Brain Diseases, VIB Center for Molecular Neurology, Antwerp, Belgium
| | | | | | - Sara De Witte
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Neuroprotection and Neuromodulation (NEUR) Research Group, Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, Belgium
| | - Mandy Melissa Jane Wittens
- Neuroprotection and Neuromodulation (NEUR) Research Group, Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, Belgium
- Department of Biomedical Sciences, Universiteit Antwerpen, Antwerp, Belgium
| | - Maria Bjerke
- Neuroprotection and Neuromodulation (NEUR) Research Group, Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, Belgium
- Department of Biomedical Sciences, Universiteit Antwerpen, Antwerp, Belgium
- Department of Clinical Biology, Laboratory of Clinical Neurochemistry, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Caroline Vanlersberghe
- Department of Anaesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Sarah Ceyssens
- Department of Nuclear Medicine, Universitair Ziekenhuis Antwerpen, University of Antwerp, Antwerpen, Belgium
| | - Guy Nagels
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Artificial Intelligence Supported Modelling in Clinical Sciences (AIMS) Research Group, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ilse Smolders
- Laboratory of Pharmaceutical Chemistry, Drug Analysis and Drug Information (FASC), Research Group Experimental Pharmacology (EFAR), Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
- Neuroprotection and Neuromodulation (NEUR) Research Group, Center for Neurosciences, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, Belgium.
- Department of Biomedical Sciences, Universiteit Antwerpen, Antwerp, Belgium.
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Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Mey J. Effects of left ventricular mass index on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0191] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In significant obstructive coronary artery disease (SOCAD), a mismatched assessment of the severity of coronary artery stenosis may occur between invasive coronary angiography and computed tomography (CT) derived fractional flow reserve (FFRCT). The exact mechanisms of unexpected underestimation of FFRCT remain unknown.
Purpose
The aims of this study are (1) to clarify the mechanisms of underestimation on FFRCT; and (2) to identify the predictive factors of FFRCT underestimation above the value of 0.80 in SOCAD vessels.
Methods
A total of 1160 outpatients who underwent CT angiography (CTA) with FFRCT analysis for suspected coronary artery disease (CAD) between January 2017 and June 2020 were evaluated. Among them, 141 consecutive patients who had both CTA coupled to FFRCT analysis and invasive angiogram showing >75% coronary stenosis were included for analysis. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT >0.80 (n=12) and FFRCT ≤0.80 (n=153). Vessel-related parameters, including vessel morphology (vessel length and lumen volume) and plaque components (non-calcified plaque volume and calcified plaque volume) and left ventricular (LV) myocardial-related parameters, including LV wall thickness at each site of the myocardium, and LV mass were evaluated semi-automatically.
Results
Vessel morphology and plaque components did not differ between FFRCT >0.80 and ≤0.80, whereas LV wall thickness (average; 10.7±2.7 vs. 8.4±1.6 mm, and maximal; 13.5±3.0 vs. 10.6±1.8 mm, all p value <0.001), LV mass (136.4±38.4 vs. 98.8±26.8 g, p<0.001), and LV mass index (73.8±22.6 vs. 51.8±12.2 g/m2, p<0.001) were significantly higher in FFRCT >0.80. Next, we investigated the parameters that correlated with FFRCT. Of all, vessel morphology and plaque components were not related to FFRCT, whereas maximal LV wall thickness, r=0.24, p=0.01; LV mass, r=0.19. p=0.04; and LV mass index, r=0.30, p=0.001) correlated with FFRCT. In the vessels showing FFRCT >0.80, only LV mass (r=0.84, p=0.005) and LV mass index (r=0.67, p=0.047) correlated with FFRCT. (Figure 1). LV mass index was the strongest predictor of a distal FFRCT of >0.80 with the area under curve (AUC) 0.81, 95% CI 0.62 – 1.00, P<0.0001 and an optimal cut-off value of 66.5 g/m2 sensitivity 77.8%, specificity 89.6% (Figure 2).
Conclusions
FFRCT is affected not by vessel-related parameters but LV myocardial-related parameters in SOCAD. The presence of an excessive LV mass is a major predictor of underestimation of FFRCT in SOCAD vessels. LV myocardial-related parameters should be considered when interpreting numerical values of FFRCT to avoid the possibility of overlooked SOCAD.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- T Tsugu
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - K Tanaka
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - D Belsack
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - H Devos
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - Y Nagatomo
- National Defense Medical College Hospital, Department of Cardiology, Tokorozawa, Japan
| | - V Michiels
- Universitair Ziekenhuis Brussel, Cardiology, Centrum voor Hart- en Vaatziekten, Brussels, Belgium
| | - J F Argacha
- Universitair Ziekenhuis Brussel, Cardiology, Centrum voor Hart- en Vaatziekten, Brussels, Belgium
| | - B Cosyns
- Universitair Ziekenhuis Brussel, Cardiology, Centrum voor Hart- en Vaatziekten, Brussels, Belgium
| | - N Buls
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - J De Mey
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
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Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Mey J. Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0190] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
FFRCT gradually decreases from the proximal to the distal part of a vessel and reach the pathological threshold for significant ischemia even in the absence of obstructive coronary artery disease (CAD). The exact mechanisms of such gradual FFRCT decline remain unknown.
Purpose
The aims of this study are (1) to clarify the mechanisms of the gradual decline of computed tomography (CT) derived fractional flow reserve (FFRCT); and (2) to identify the predictive factors of an FFRCT decline below the pathological value of 0.80 in no apparent CAD vessels.
Methods
A total of 1058 outpatients with suspected CAD and who underwent CT angiography (CTA) with FFRCT analysis between January 2017 and December 2019 were evaluated. Among them, 150 consecutive patients who had both a CTA coupled to an FFRCT analysis and an invasive angiogram showing <25% coronary stenosis were included for analysis. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT >0.80 (n=317) and FFRCT ≤0.80 (n=114). ΔFFRCT was defined as the magnitude of the change in FFRCT from the proximal to the distal vessel. Plaque characterization and vessel morphology measurements were performed semi-automatically. Vessel constituents were characterized based on Hounsfield units (HU) into lumen volume (<−50 HU), non-calcified plaque (NCP) (−50–150 HU), and calcified plaque (>150 HU).
Results
FFRCT decreased continuously from the proximal to distal across the three major vessels in both FFRCT>0.80 and FFRCT ≤0.80 groups (Figure 1). Compared to FFRCT>0.80 group, NCP volume was significantly higher in all three major vessels in FFRCT ≤0.80 group (210.2±83.6 mm3 vs. 140.9±139.3 mm3 for the RCA, p=0.01; 177.5±150.2 mm3 vs. 133.2±112.2 mm3 for the LAD, p=0.04; 127.6±91.5 mm3 vs. 58.7±57.7 mm3 for the LCX, p<0.01). Next, we investigated the vessel parameters that correlated with ΔFFRCT. ΔFFRCT was correlated with lumen volume in FFRCT>0.80 group (r=−0.24, p<0.0001), whereas ΔFFRCT was correlated with NCP volume in FFRCT ≤0.80 group (r=0.42, p<0.001) (Figure 2). An NCP volume above 44.8 mm3 was the strongest predictor of distal FFRCT of ≤0.80 (area under the curve 0.69, p<0.0001, sensitivity 95%, specificity 39%).
Conclusions
FFRCT is affected by vascular morphology and plaque characteristics even in the early stage of coronary artery disease. Our study highlights that subclinical coronary artery disease strongly influences FFRCT by effects unrelated to coronary stenosis. The presence of NCP is a major predictor of the gradual decrease of FFRCT toward pathological values. Anatomical findings as vessel morphology and plaque characteristics should be taken into consideration when interpreting numerical values of FFRCT to avoid unnecessary referrals for invasive coronary angiography or percutaneous coronary intervention.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- T Tsugu
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - K Tanaka
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - D Belsack
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - H Devos
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - Y Nagatomo
- National Defense Medical College Hospital, Department of Cardiology, Tokorozawa, Japan
| | - V Michiels
- Universitair Ziekenhuis Brussel, Cardiology, Centrum voor Hart- en Vaatziekten, Brussels, Belgium
| | - J F Argacha
- Universitair Ziekenhuis Brussel, Cardiology, Centrum voor Hart- en Vaatziekten, Brussels, Belgium
| | - B Cosyns
- Universitair Ziekenhuis Brussel, Cardiology, Centrum voor Hart- en Vaatziekten, Brussels, Belgium
| | - N Buls
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - J De Mey
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
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Argacha JF, Vandeloo B, Mizukami T, Tanaka K, Belsack D, Lochy S, Schoors D, Azzano A, Roosens B, Michiels V, Thorrez Y, Sieira J, Magne J, Demey J, Cosyns B. P2721FFRct analysis for screening of obstructive coronary artery disease: a propensity score adjusted study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1038] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines recommend functional assessment in stable coronary artery disease (CAD) to guide further treatment. Computed tomography fractional flow reserve (FFRCT) has been proposed for non-invasive assessment of stable CAD. A cutoff value of FFRCT ≥0.8 has been shown cost-effective, and allowing to avoid inappropriate invasive coronary angiography (ICA). However, no results from real-life hospital registries have been reported yet.
Purpose
We aimed to compare the impact of FFRCT with conventional coronary CT angiography (CTA) for detecting obstructive CAD in the daily practice of a tertiary referral hospital.
Methods
Patients referred to CTA for suspected CAD between 2013 and 2017 were included. FFRCT analysis was introduced in 2015 and performed at the discretion of the radiologist by Heartflow Inc. FFRCT was considered abnormal if FFR was <0.8 in at least one of 3 main vessels. Obstructive CAD was defined on both CTA and ICA by the presence of a stenosis ≥50% in at least one of 3 main vessels, or an invasive FFR<0.8. Propension to perform a FFRCT was modeled, based on gender, cardiovascular risk factors, completion of stress test and echocardiography and presence of a lesion of more than 50% stenosis on CTA. A logistic regression adjusted for the propensity score was then performed on the use of ICA, the presence of significant CAD on ICA and revascularization rate either by PCI or CABG.
Results
2906 patients (50% of male, 56±12) were included in this registry. Diabetes, hypertension, dyslipidemia and smoking were present in respectively 12.3, 30.5, 27.5 and 9% of patients. A stress ECG and a transthoracic echo were obtained in respectively 37.1 and 49% of patients. FFRCT was performed in 757 (26%) and was abnormal in 323 (42.7%) of the patients. An ICA was performed in 622 (21.4%) patients and was abnormal in 292 (46.9%). After propensity score weighting, FFRCT was associated with an increase in ICA (OR=1.58, 95% CI: 1.23–2.02, p<0.01). There were no significant changes regarding ICA showing obstructive CAD with FFRCT (OR=1.13, 95% CI: 0.78–1.66, p=0.5) but a trend towards an increase of revascularization (OR=1.48, 95% CI: 0.98–2.24, p=0.06). In patient undergoing an ICA, a FFRCT ≥0.8 was decreasing the presence of significant CAD (OR=0.27, 95% CI: 0.16–0.48, p<0.001), whereas a FFRCT <0.8 increased the rate of revascularization (OR=24.7, 95% CI: 12.3–49.7, p<0.001).
Conclusion
These real life data showed that, adding FFRCT to conventional CTA, and interpreting only the numerical values of FFRCT, would increase the use of ICA in patients suspected of CAD. A trend towards an increase in revascularization was also observed. Therefore, another index than the minimal FFRCT should be used to improve discrimination regarding the presence of obstructive CAD. However, normal values of FFRCT were strong predictors of the absence of significant CAD, and abnormal values of FFRCT for the need of a revascularization.
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Affiliation(s)
- J.-F Argacha
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - B Vandeloo
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - T Mizukami
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - K Tanaka
- University Hospital (UZ) Brussels, Radiology department, Brussels, Belgium
| | - D Belsack
- University Hospital (UZ) Brussels, Radiology department, Brussels, Belgium
| | - S Lochy
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - D Schoors
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - A Azzano
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - B Roosens
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - V Michiels
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - Y Thorrez
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - J Sieira
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - J Magne
- University Hospital of Limoges, Limoges, France
| | - J Demey
- University Hospital (UZ) Brussels, Radiology department, Brussels, Belgium
| | - B Cosyns
- University Hospital (UZ) Brussels, Brussels, Belgium
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Cambron M, Mostert J, D’Hooghe M, Nagels G, Willekens B, Debruyne J, Algoed L, Verhagen W, Hupperts R, Heersema D, De Keyser J, De Groot L, De Bruyne J, Foselle E, Guillaume D, Merckx H, Vanopdenbosch L, Vokaer M, Klippel ND, Nuytten D, Van Remoortel A, Symons A, D’haeseleer M, Bissay V, Van Merhaegen-Wieleman A, Van Lint M, Michiels V, Haentjens P, Van Wijmeersch B, Tillemans B, Van Hecke W, Hengstman G. Fluoxetine in progressive multiple sclerosis: The FLUOX-PMS trial. Mult Scler 2019; 25:1728-1735. [DOI: 10.1177/1352458519843051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Preclinical studies suggest that fluoxetine has neuroprotective properties that might reduce axonal degeneration in multiple sclerosis (MS). Objective: To determine whether fluoxetine slows accumulation of disability in progressive MS. Methods: In a double-blind multicenter phase 2 trial, patients with primary or secondary progressive MS were randomized to fluoxetine 40 mg/day or placebo for a period of 108 weeks. Clinical assessments were performed every 12 weeks by trained study nurses who visited the patients at their home. The primary outcome was the time to a 12-week confirmed 20% increase in the Timed 25 Foot Walk or 9-Hole Peg test. Secondary outcomes included the Hauser ambulation index, cognitive tests, fatigue, and brain magnetic resonance imaging (MRI). Results: In the efficacy analysis, 69 patients received fluoxetine and 68 patients received placebo. Using the log-rank test ( p = 0.258) and Cox regression analysis ( p = 0.253), we found no significant difference in the primary outcome between the two groups. Due to an unexpected slow rate of progression in the placebo group, there was insufficient statistical power to detect a potential benefit of fluoxetine. We found no differences between the two groups for secondary outcomes. Conclusion: The trial failed to demonstrate a neuroprotective effect of fluoxetine in patients with progressive MS.
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Affiliation(s)
- Melissa Cambron
- Department of Neurology, UZ Brussel, Brussel, Belgium/Center for Neurosciences (C4N) Vrije Universiteit Brussel (VUB), Brussels, Belgium/ Department of Neurology, AZ Sint-Jan, Bruges, Belgium
| | - Jop Mostert
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marie D’Hooghe
- Department of Neurology, UZ Brussel, Brussel, Belgium/Center for Neurosciences (C4N) Vrije Universiteit Brussel (VUB), Brussels, Belgium/Nationaal MS Centrum Melsbroek, Steenokkerzeel, Belgium
| | - Guy Nagels
- Department of Neurology, UZ Brussel, Brussel, Belgium/Center for Neurosciences (C4N) Vrije Universiteit Brussel (VUB), Brussels, Belgium/Nationaal MS Centrum Melsbroek, Steenokkerzeel, Belgium
| | - Barbara Willekens
- Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Jan Debruyne
- Department of Neurology, University Hospital Gent, Gent, Belgium
| | - Luc Algoed
- Department of Neurology, AZ Maria Middelares, Gent, Belgium
| | - Wim Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Raymond Hupperts
- Department of Neurology, Zuyderland Medisch Centrum, Sittard-Geleen, The Netherlands
| | - Dorothea Heersema
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jacques De Keyser
- Department of Neurology, UZ Brussel, Brussel, Belgium/Center for Neurosciences (C4N) Vrije Universiteit Brussel (VUB), Brussels, Belgium/ Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Hostenbach S, Pauwels A, Michiels V, Raeymaekers H, Van Binst AM, Van Merhaeghen-Wieleman A, Van Schuerbeek P, De Keyser J, D'Haeseleer M. Role of cerebral hypoperfusion in multiple sclerosis (ROCHIMS): study protocol for a proof-of-concept randomized controlled trial with bosentan. Trials 2019; 20:164. [PMID: 30871594 PMCID: PMC6416892 DOI: 10.1186/s13063-019-3252-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
Background Axonal degeneration is related to long-term disability in patients with multiple sclerosis (MS). The underlying mechanism remains ill understood but appears to involve axonal energetic dysfunction. A globally impaired cerebral blood flow (CBF) has been observed in the normal-appearing white matter (NAWM) of patients with MS, which is probably related to astrocytic overexpression of endothelin-1 (ET-1). Cerebral hypoperfusion has been associated with reduced mitochondrial activity and disabling symptoms (e.g. fatigue and cognitive decline) of MS. Countering this process could therefore be beneficial in the disease course. Short-term CBF restoration with a single 62.5-mg dose of the ET-1 receptor antagonist bosentan has already been demonstrated in patients with MS. Methods The ROCHIMS study is a proof-of-concept double-blind randomized clinical trial in which patients with relapsing-remitting MS will receive either 62.5 mg bosentan or matching placebo twice daily during 28 ± 2 days. Clinical evaluation and brain magnetic resonance imaging (MRI) will be performed at baseline and treatment termination. Based on previous work, we expect a global increase of CBF in the individuals treated with bosentan. The primary outcome measure is the change of N-acetyl aspartate in centrum semiovale NAWM, which is a marker of regional axonal mitochondrial activity. Other parameters of interest include changes in fatigue, cognition, motor function, depression, and brain volume. Discussion We hypothesize that restoring cerebral hypoperfusion in MS patients improves axonal metabolism. Early positive effects on fatigue and cognitive dysfunction related to MS might additionally be detected. There is a medical need for drugs that can slow down the progressive axonal degeneration in MS, making this an important topic of interest. Trial registration Clinical Trials Register, EudraCT 2017-001253-13. Registered on 15 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3252-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stéphanie Hostenbach
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium. .,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Ayla Pauwels
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Veronique Michiels
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology and Medical Physics, UZ Brussel, Brussels, Belgium
| | | | | | | | - Jacques De Keyser
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Neurology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Miguel D'Haeseleer
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,National Multiple Sclerosis Centrum, Melsbroek, Belgium
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7
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Abstract
Aims Since the introduction of transcatheter aortic valve implantation (TAVI), newer generation and novel devices such as the retrievable JenaValve™ have been developed. We evaluated the procedural and 6-month results of our first experience with implantation of the JenaValve™. Methods and results From June 2012 to December 2013, 24 consecutive patients (mean age 80 ± 7 years, 42 % male) underwent an elective transapical TAVI with the JenaValve™. Device success was 88 %. The mortality rate was 4 % at 30 days and 31 % at 6 months. TAVI reduced the mean transvalvular gradient (44.2 ± 11.1 mmHg vs. 12.3 ± 4.3 mmHg, p < 0.001) and increased the mean aortic valve area (0.8 3 ± 0.23 to 1.70 ± 0.44 cm2). A mild paravalvular leakage (PVL) occurred in 4 patients (18 %) and a moderate PVL in 1 patient (4 %). Mean New York Heart Association Functional Class improved from 2.9 ± 0.5 to 2.0 ± 0.8 at 30 days. Conclusion TAVI using the JenaValve™ prosthesis seems adequate and safe in this first experience cohort.
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Affiliation(s)
- V J Nijenhuis
- Department of Cardiology, St. Antonius Hospital Koekoekslaan 1, 3435, Nieuwegein, the Netherlands,
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9
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Cambron M, Mostert J, Haentjens P, D'Hooghe M, Nagels G, Willekens B, Heersema D, Debruyne J, Van Hecke W, Algoed L, De Klippel N, Fosselle E, Laureys G, Merckx H, Van Wijmeersch B, Vanopdenbosch L, Verhagen W, Hupperts R, Hengstman G, Michiels V, Van Merhaegen-Wieleman A, De Keyser J. Fluoxetine in progressive multiple sclerosis (FLUOX-PMS): study protocol for a randomized controlled trial. Trials 2014; 15:37. [PMID: 24460863 PMCID: PMC3931920 DOI: 10.1186/1745-6215-15-37] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/14/2014] [Indexed: 11/30/2022] Open
Abstract
Background Currently available disease-modifying treatments acting by modifying the immune response are ineffective in progressive multiple sclerosis (MS), which is caused by a widespread axonal degeneration. Mechanisms suspected to be involved in this widespread axonal degeneration are reduced axonal energy metabolism, axonal glutamate toxicity, and reduced cerebral blood flow. Fluoxetine might theoretically reduce axonal degeneration in MS because it stimulates energy metabolism through enhancing glycogenolysis, stimulates the production of brain-derived neurotrophic factor, and dilates cerebral arterioles. The current document presents the protocol of a clinical trial to test the hypothesis that fluoxetine slows down the progressive phase of MS. Methods/Design The FLUOX-PMS trial is a multi-center, randomized, controlled and double-blind clinical study. A total of 120 patients with the diagnosis of either secondary or primary progressive MS will be treated either by fluoxetine (40 mg daily) or placebo for a total period of 108 weeks. The primary endpoint is the time to confirmed disease progression defined as either at least a 20% increase in the timed 25-Foot Walk or at least a 20% increase in the 9-Hole Peg Test. Secondary endpoints include the Hauser ambulation index, cognitive changes, fatigue, magnetic resonance imaging of the brain, and in a small subgroup optical coherence tomography. Discussion The FLUOX-PMS trial will gives us information as to whether fluoxetine has neuroprotective effects in patients with progressive MS. Trial Registration Eudra-CT: 2011-003775-11
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Affiliation(s)
- Melissa Cambron
- Department of Neurology, University Hospital Brussel, Center for Neurosciences Vrije Universiteit Brussel (VUB) UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
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10
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Abstract
OBJECTIVE In this paper we review critically the current status of neurocognitive studies in patients with chronic fatigue syndrome (CFS). METHOD CFS literature was monitored as part of a large research project which involved several neuropsychological and psychopathological studies. The literature survey was the result of several consecutive searches on Medline and PsycInfo databases. RESULTS The neurocognitive studies are reviewed in terms of scientificaly accepted aspects of attention and memory. In addition, we review possible explanations for cognitive dysfunction in CFS. This is preceded with a discussion of the methodological limitations that are considered to explain inconcistencies across neuropsychological studies in CFS. CONCLUSION The current research shows that slowed processing speed, impaired working memory and poor learning of information are the most prominent features of cognitive dysfunctioning in patients with CFS. Furthermore, to this date no specific pattern of cerebral abnormalities has been found that uniquely characterizes CFS patients. There is no overwhelming evidence that fatigue is related to cognitive performance in CFS, and researchers agree that their performance on neuropsychological tasks is unlikely to be accounted solely by the severity of the depression and anxiety.
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Affiliation(s)
- V Michiels
- Department of Psychology, Free University of Brussels, Belgium
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11
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Abstract
In this study a battery of attentional tests and a verbal memory task were administered to outpatients with Chronic Fatigue Syndrome (CFS) in order to evaluate aspects of attention that have not been explored in this group to date. In addition, this study was designed to further examine memory function and to extend the few reports investigating the rate of cognitive processing independent of motor speed and the possibility of a modality-specific impairment of information processing. Twenty-nine patients with CFS and 22 healthy controls matched for age, gender, intelligence, and education were included in this study. The results show that patients with CFS do not seem to be impaired for modification of phasic arousal level, nor for visual selective attention requiring shifting of attention in the visuospatial field. The results further support the presence of reduced information processing speed and efficiency, and strengthen the evidence of a global non-modality-specific attentional dysfunction in patients with CFS. In this study the poor performance of patients with CFS on recall of verbal information was due to poor initial storage rather than to a retrieval failure.
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Affiliation(s)
- V Michiels
- Free University of Brussels (VUB), Belgium
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12
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Abstract
Former neuropsychological studies with Chronic Fatigue Syndrome (CFS) patients evaluated a broad range of cognitive functions. Several, but not all, reported subtle attentional and memory impairments suggesting possible mild cerebral involvement. In this study, a battery of attentional tests and a verbal memory task were administered to 20 CFS patients and 22 healthy controls (HC) in order to clarify the specific nature of attention and memory impairment in these patients. The results provide evidence for attentional dysfunction in patients with CFS as compared to HC. CFS patients performed more poorly on a span test measuring attentional capacity and working memory. Speeded attentional tasks with a more complex element of memory scanning and divided attention seem to be a sensitive measure of reduced attentional capacity in these patients. Focused attention, defined as the ability to attend to a single stimulus while ignoring irrelevant stimuli, appears not to be impaired. CFS patients were poorer on recall of verbal information across learning trials, and poor performance on delayed recall may be due to poor initial learning and not only to a retrieval failure.
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Affiliation(s)
- V Michiels
- Department of Psychology, Free University of Brussels, Belgium.
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13
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Fischler B, Dendale P, Michiels V, Cluydts R, Kaufman L, De Meirleir K. Physical fatigability and exercise capacity in chronic fatigue syndrome: association with disability, somatization and psychopathology. J Psychosom Res 1997; 42:369-78. [PMID: 9160276 DOI: 10.1016/s0022-3999(96)00297-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [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] [Indexed: 02/04/2023]
Abstract
Physical fatigability and avoidance of physically demanding tasks in chronic fatigue syndrome (CFS) were assessed by the achievement or nonachievement of 85% of age-predicted maximal heart rate (target heart rate, THR) during incremental exercise. The association with functional status impairment, somatization, and psychopathology was examined. A statistically significant association was demonstrated between this physical fatigability variable and impairment, and a trend was found for an association with somatization. No association was demonstrated with psychopathology. These results are in accordance with the cognitive-behavioral model of CFS, suggesting a major contribution of avoidance behavior to functional status impairment; however, neither anxiety nor depression seem to be involved in the avoidance behavior. Aerobic work capacity was compared between CFS and healthy controls achieving THR. Physical deconditioning with early involvement of anaerobic metabolism was demonstrated in this CFS subgroup. Half of the CFS patients who did not achieve THR did not reach the anaerobic threshold. This finding argues against an association in CFS between avoidance of physically demanding tasks and early anaerobic metabolism during effort.
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Affiliation(s)
- B Fischler
- Department of Psychiatry, Academic Hospital, Free University of Brussels, Belgium
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14
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Abstract
A comprehensive battery of neuropsychological tests was administered to 35 outpatients suffering from Chronic Fatigue Syndrome (CFS). They were compared to 33 normal controls matched for age, gender, intelligence, and education. The patients displayed psychomotor slowing and impaired attention. The learning rate of verbal and visual material for patients with CFS was slower, and delayed recall of verbal and visual information was impaired. Because there was a high variability in cognitive impairment within the CFS group, it would be inappropriate to generalize results to the entire CFS population. Two neuropsychological variables indicating aspects of psychomotor performance and verbal memory were found to discriminate best between patients and controls.
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Affiliation(s)
- V Michiels
- Department of Psychology, Free University of Brussels (VUB), Belgium
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15
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Fischler B, D'Haenen H, Cluydts R, Michiels V, Demets K, Bossuyt A, Kaufman L, De Meirleir K. Comparison of 99m Tc HMPAO SPECT scan between chronic fatigue syndrome, major depression and healthy controls: an exploratory study of clinical correlates of regional cerebral blood flow. Neuropsychobiology 1996; 34:175-83. [PMID: 9121617 DOI: 10.1159/000119307] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [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] [Indexed: 02/04/2023]
Abstract
An explorative analysis of the relationship between symptomatology and cerebral blood flow in the chronic fatigue syndrome (CFS) as assessed with 99mTc HMPAO SPECT scan reveals statistically significant positive correlations between frontal blood flow on the one hand and objectively and subjectively assessed cognitive impairment, self-rating of physical activity limitations and total score on Hamilton Depression Rating Scale on the other. A pathophysiological role of frontal blood flow in the cognitive impairment and physical activity limitations in CFS is hypothesized. A comparison of cerebral blood flow between CFS, major depression (MD) and healthy controls (HC) has been performed. A lower superofrontal perfusion index is demonstrated in MD as compared with both CFS and HC. There is neither a global nor a marked regional hypoperfusion in CFS compared with HC. Asymmetry (R > L) of tracer uptake at parietotemporal level is demonstrated in CFS as compared with MD.
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Affiliation(s)
- B Fischler
- Department of Psychiatry, Academic Hospital, Free University of Brussels, Belgium
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