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Kalnina J, Trapina I, Sjakste N, Paramonova N. Clinical characteristics and dynamics of disability progression in a cohort of patients with multiple sclerosis in Latvians. Neurol Sci 2024:10.1007/s10072-024-07404-z. [PMID: 38393441 DOI: 10.1007/s10072-024-07404-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: 07/19/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
There is wide variation in the time from the onset to secondary progressive multiple sclerosis (MS) and some controversy regarding the clinical characteristics of the courses (phenotypes) of MS. The present study aimed to characterize demographic and clinical factors that potentially influence long-term disability progression in the cohort of Latvian MS patients. A descriptive longitudinal incidence study was conducted using a cohort of 288 MS patients beginning in 2011 (disease duration from 1 to 51 years). Socio-demographic and clinical information from the first visit to 15/20 years was analysed in groups stratified by gender and visits at five-time points (the first visit; after a year or 2; after 5 ± 1 year; after 10 ± 2 years; after 15-20 years). Our study was dominated by patients from urban areas and non-smokers. The female/male ratio was 2.4:1; the distribution of clinical courses at the first visit was consistent with most European studies. The most common symptom at presentation in our study was optic manifestations, followed by sensory disturbances and motor deficits. In the Latvian study, gender was not a significant influencing factor on the rate of disease progression; however, patient age was statistically significantly associated with EDSS (Expanded Disability Status Scale) value at the first visit. Early clinical features of MS are important in predicting the disability accumulation of patients. Despite the small differences regarding the first MS symptoms, the disability outcomes in the cohort of Latvian patients are similar to other regions of the world.
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Affiliation(s)
- Jolanta Kalnina
- Genomics and Bioinformatics, Institute of Biology of the University of Latvia, Riga, LV-1004, Latvia
| | - Ilva Trapina
- Genomics and Bioinformatics, Institute of Biology of the University of Latvia, Riga, LV-1004, Latvia.
| | - Nikolajs Sjakste
- Genomics and Bioinformatics, Institute of Biology of the University of Latvia, Riga, LV-1004, Latvia
- Department of Medical Biochemistry of the University of Latvia, Riga, LV-1004, Latvia
| | - Natalia Paramonova
- Genomics and Bioinformatics, Institute of Biology of the University of Latvia, Riga, LV-1004, Latvia
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Sedaghat S, Jang H, Athertya JS, Groezinger M, Corey-Bloom J, Du J. The signal intensity variation of multiple sclerosis (MS) lesions on magnetic resonance imaging (MRI) as a potential biomarker for patients' disability: A feasibility study. Front Neurosci 2023; 17:1145251. [PMID: 36992852 PMCID: PMC10040653 DOI: 10.3389/fnins.2023.1145251] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction Although many lesion-based MRI biomarkers in multiple sclerosis (MS) patients were investigated, none of the previous studies dealt with the signal intensity variations (SIVs) of MS lesions. In this study, the SIVs of MS lesions on direct myelin imaging and standard clinical sequences as possible MRI biomarkers for disability in MS patients were assessed. Methods Twenty seven MS patients were included in this prospective study. IR-UTE, FLAIR, and MPRAGE sequences were employed on a 3T scanner. Regions of interest (ROIs) were manually drawn within the MS lesions, and the cerebrospinal fluid (CSF) and signal intensity ratios (SIR) were calculated from the derived values. Variations coefficients were determined from the standard deviations (Coeff 1) and the absolute differences (Coeff 2) of the SIRs. Disability grade was assessed by the expanded disability status scale (EDSS). Cortical/gray matter, subcortical, infratentorial, and spinal lesions were excluded. Results The mean diameter of the lesions was 7.8 ± 1.97 mm, while the mean EDSS score was 4.5 ± 1.73. We found moderate correlations between the EDSS and Coeff 1 and 2 on IR-UTE and MPRAGE images. Accordingly, Pearson's correlations on IR-UTE were R = 0.51 (p = 0.007) and R = 0.49 (p = 0.01) for Coeff 1 and 2, respectively. For MPRAGE, Pearson's correlations were R = 0.5 (p = 0.008) and R = 0.48 (p = 0.012) for Coeff 1 and 2, respectively. For FLAIR, only poor correlations could be found. Conclusion The SIVs of MS lesions on IR-UTE and MPRAGE images, assessed by Coeff 1 and 2, could be used as novel potential MRI biomarkers for patients' disability.
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Affiliation(s)
- Sam Sedaghat
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- University Hospital Heidelberg, Heidelberg, Germany
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Jiyo S. Athertya
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | | | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Jiang Du
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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Mathew T, Kamath V, John SK, Netravathi M, Iyer RB, Raghavendra S, Kumar S, Neeharika ML, Gupta S, Murgod U, Shivakumar R, Annadure RK, Ichaporia N, Rohatgi A, Nair SS, Yareeda S, Anand B, Singh P, Renukaradhya U, Arulselvan V, Reddy YM, Surya N, Sarma GRK, Nadig R, Deepalam S, Sharath Kumar GG, Satishchandra P, Singhal BS, Parry G. A real world multi center study on efficacy and safety of natalizumab in Indian patients with multiple sclerosis. Mult Scler Relat Disord 2022; 66:104059. [PMID: 35908446 DOI: 10.1016/j.msard.2022.104059] [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: 06/18/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Natalizumab (NTZ) is increasingly being used in Indian multiple sclerosis (MS) patients. There are no reports on its safety and efficacy, especially with respect to the occurrence of progressive multifocal leukoencephalopathy (PML). OBJECTIVES To describe the patient characteristics, treatment outcomes, and adverse events, especially the occurrence of PML in NTZ-treated patients. METHODS A multicentre ambispective study was conducted across 18 centres, from Jan 2012 to Dec 2021. Patients at and above the age of 18 years treated with NTZ were included. Descriptive and comparative statistics were applied to analyze data. RESULTS During the study period of 9 years, 116 patients were treated with NTZ. Mean age of the cohort was 35.6 ± 9.7 years; 83/116 (71.6%) were females. Relapse rate for the entire cohort in the year before NTZ was 3.1 ± 1.51 while one year after was 0.20±0.57 (p = 0.001; CI 2.45 -3.35). EDSS of the entire cohort in the year before NTZ was 4.5 ± 1.94 and one year after was 3.8 ± 2.7 (p = 0.013; CI 0.16-1.36). At last follow up (38.3 ± 22.78 months) there were no cases of PML identified. CONCLUSIONS Natalizumab is highly effective and safe in Indian MS patients, with no cases of PML identified at last follow up.
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Affiliation(s)
- Thomas Mathew
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India.
| | - Vikram Kamath
- Department of Neurology, Trustwell Hospitals, Chandrika tower 5 JC Road Sudama Nagar, Bengaluru, Karnataka 560002, India
| | - Saji K John
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - M Netravathi
- Department of Neurology, NIMHANS, Hosur Road, Near Banglore Milk Dairy, Hombegowda Nagar, Bengaluru 560029, India
| | - Rajesh B Iyer
- Department of Neurology, Manipal Hospital, Millers Road 71/1 Millers Road Opp to St Annes College, Vasant Nagar, Bengaluru 560052
| | - S Raghavendra
- Department of Neurology, Manipal Hospital, Millers Road 71/1 Millers Road Opp to St Annes College, Vasant Nagar, Bengaluru 560052
| | - Suresh Kumar
- Department of Neurology, Renai Medicity Multi Super Speciality Hospital, Palarivattom Edapally, Road Near Palarivattom Metro Station Palarivattom, Kochi, Kerala 682025, India
| | - M L Neeharika
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta rd, Punjagutta market, Hyderabad, Telengana 500082
| | - Salil Gupta
- Department of Neurology, Command Hospital Air force, Agram post, Bengaluru 560007, India
| | - Uday Murgod
- Department of Neurology, Manipal Hospital, HAL Airport Road, Banglore 560017, India
| | - R Shivakumar
- Department of Neurology, Sakra World Hospital, Devarabeesanahalli Varthur Hobli Opp intel, Outer Ring Road, Marathahalli, Bengaluru 560103, India
| | - Ravi K Annadure
- Department of Neurology, AFC Delhi, Defence Office Complex, Central Vista, KG Marg, New Delhi 110011
| | - Nasli Ichaporia
- Department of Neurology, Sahyadri Super Speciality Hospital Nagar Raod Shastrinagar, Yerawada, Pune, Maharashtra 411006, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, Rajinder Nagar New Delhi 110060, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, GWCG, Jai nagar w Rd chalakkuzhi, Thiruvananthapuram, Kerala 695011, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta rd, Punjagutta market, Hyderabad, Telengana 500082
| | - Bawani Anand
- Department of Neurology, Manipal Hospital, HAL Airport Road, Banglore 560017, India; Department of Neurology, Sakra World Hospital, Devarabeesanahalli Varthur Hobli Opp intel, Outer Ring Road, Marathahalli, Bengaluru 560103, India
| | - Prabhjeet Singh
- Department of Neurology, Dr Prabhjeets Neuro Centre, F-1/338, Kashmir Avenue, Amritsar 143001, India
| | - Umashankar Renukaradhya
- Department of Neurology, Bengaluru Neuro Centre, 10th Cross Margosa road, Malleshwaram, Banglore 560003, India
| | - V Arulselvan
- Department of Neurology, Royal Care Super Speciality Hospital, NO 1/520, L&T Road Neelambur, Coimbatore 641062, India
| | - Y Muralidhar Reddy
- Department of Neurology, Care Hospital, Rd Number 1 Prem Nagar, Banjara Hills, Hyderabad, Telangana 500034, India
| | - Nirmal Surya
- Department of Neurology, Bombay Hospital and Medical Research Centre, 12 Vitthaldas, Thackersey Marg, Near Liberty Cinema, New Marine Lines Mumbai 400020, India
| | - G R K Sarma
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - Raghunandan Nadig
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - Saikanth Deepalam
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - G G Sharath Kumar
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - P Satishchandra
- Department of Neurology, Apollo Speciality Hospital, 14 th Cross 3rd Block Near Madhavan Park, Jaynagar, Bengaluru 560011, India
| | - Bhim Sen Singhal
- Department of Neurology, Bombay Hospital and Medical Research Centre, 12 Vitthaldas, Thackersey Marg, Near Liberty Cinema, New Marine Lines Mumbai 400020, India
| | - Gareth Parry
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
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D'Amico E, Zanghì A, Romeo M, Cocco E, Maniscalco GT, Brescia Morra V, Paolicelli D, De Luca G, Galgani S, Amato MP, Salemi G, Inglese M, Confalonieri PA, Lus G, Avolio C, Gallo A, Vianello M, Onofrj M, Filippi M, Trojano M, Patti F. Injectable Versus Oral First-Line Disease-Modifying Therapies: Results from the Italian MS Register. Neurotherapeutics 2021; 18:905-919. [PMID: 33528815 PMCID: PMC8423935 DOI: 10.1007/s13311-020-01001-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
The current study aims to compare injectable and oral first-line disease-modifying therapies (DMTs) for time to first relapse, time to confirmed disability progression (CDP), and time to discontinuation using a cohort of relapsing remitting multiple sclerosis (RRMS) patients, with data extracted from the Italian MS Register. This multicenter, observational, retrospectively acquired, and propensity-adjusted cohort study utilized RRMS-naïve patients from the Italian MS Register who started either injectable or oral first-line DMTs between January 1, 2010, and December 31, 2017, to evaluate the impact on disability outcomes in patients. Enrolled patients were divided into two groups, namely the injectable group (IG) and the oral group (OG). Of a cohort of 11,416 patients, 4602 were enrolled (3919 in the IG and 683 in the OG). The IG had a higher rate of women (67.3% vs 63.4%, p < 0.05) and a lower mean age (36.1 ± 10.9 vs 38.9 ± 11.8, p < 0.001). The event time to first relapse demonstrated a lower risk in the OG (HR = 0.58; CI 95% 0.48-0.72, p < 0.001). However, no differences were found between the two groups with respect to the risk of CDP (HR = 0.94; CI 95% 0.76-1.29, p = 0.941), while a lower risk of DMT was found in the OG (HR = 0.72; CI 95% 0.58-0.88, p = 0.002) for the event time to discontinuation. Real-world data from the Italian MS Register suggests that first-line oral DMTs are associated with a lower risk of experiencing a new relapse and of therapy discontinuation compared to injectable DMTs.
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Affiliation(s)
- Emanuele D'Amico
- Department "G.F. Ingrassia", MS center, University of Catania, Policlinico G. Rodolico, V. Santa Sofia 78, 95123, Catania, Italy.
| | - Aurora Zanghì
- Department "G.F. Ingrassia", MS center, University of Catania, Policlinico G. Rodolico, V. Santa Sofia 78, 95123, Catania, Italy
| | - Marzia Romeo
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eleonora Cocco
- Department "Medical Science and Public Health", University of Cagliari, Cagliari, Italy
| | - Giorgia Teresa Maniscalco
- Multiple Sclerosis Center and Neurological Clinic Stroke Unit , "A. Cardarelli" Hospital, Naples, Italy
| | | | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Policlinico, Bari, Italy
| | - Giovanna De Luca
- Neurology Unit, University G. D'Annunzio, Policlinico SS Annunziata, Chieti, Italy
| | - Simonetta Galgani
- Multiple Sclerosis Center - Az. Osp. S. Camillo Forlanini, Rome, Italy
| | - Maria Pia Amato
- Department NEUROFARBA University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili, Clinica Neurologica (DiNOGMI), Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | | | - Giacomo Lus
- MS Center, II Division of Neurology, University della Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Avolio
- Centro Interdipartimentale Malattie Demielinizzanti, AOU Ospedali Riuniti Di Foggia, Foggia, Italy
| | - Antonio Gallo
- MS Center, I Division of Neurology, University della Campania "L. Vanvitelli", Naples, Italy
| | - Marika Vianello
- O.U. Neurology "Ca' Foncello" Hospital - Treviso - MS Unit, Treviso, Italy
| | - Marco Onofrj
- Neurology Unit, University G. D'Annunzio, Policlinico SS Annunziata, Chieti, Italy
| | - Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Policlinico, Bari, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS center, University of Catania, Policlinico G. Rodolico, V. Santa Sofia 78, 95123, Catania, Italy
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Mathey G, Pisché G, Soudant M, Pittion-Vouyovitch S, Guillemin F, Debouverie M, Epstein J. Long-term analysis of patients with benign multiple sclerosis: new insights about the disability course. J Neurol 2021; 268:3817-3825. [PMID: 33791847 DOI: 10.1007/s00415-021-10501-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the course of disability in patients with benign multiple sclerosis-i.e., with an expanded disability status scale score < 3 10 years after disease onset-for up to 30 years after disease onset. We evaluated the proportion of patients remaining in the benign state on the long term and the factor associated with this favorable outcome and determined the pattern of disability course after the loss of the benign status. METHODS Patients were selected from the ReLSEP, a French population-based registry. We studied the probability (Kaplan-Meier method) and predictors (multivariate Cox model) of remaining < 3 after year 10, and the course of disability after score 3 according to the duration of the benign phase in patients with ≥ 30 years of follow-up (graphs of the course of the mean expanded disability status scale scores in subgroups of patients). RESULTS 2295/3440 patients had benign multiple sclerosis (66.7%). The probability of remaining benign at year 30 was 0.26 (95% CI 0.26-0.32). A young age at disease onset and a good recovery after the first relapse were associated with remaining benign. Graphs illustrate that those who lost their benign status between years 10 and 30 follow a two-stage course. Beyond score 3, disability accumulation is similar in all but lower disability scores at advanced age are associated with longer benign periods. CONCLUSION The longer a patient remains in the benign state, the lower the final EDSS at advanced age.
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Affiliation(s)
- Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Hôpital Central, service de neurologie, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France. .,Université de Lorraine, EA 4360 APEMAC, 54500, Nancy, France.
| | - Guillaume Pisché
- Department of Neurology, Nancy University Hospital, Hôpital Central, service de neurologie, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.,Department of Neurology, Haguenau Hospital, 67504, Haguenau, France
| | - Marc Soudant
- CIC-EC 1433, CHRU, Inserm, Université de Lorraine, 54500, Nancy, France
| | - Sophie Pittion-Vouyovitch
- Department of Neurology, Nancy University Hospital, Hôpital Central, service de neurologie, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Francis Guillemin
- Université de Lorraine, EA 4360 APEMAC, 54500, Nancy, France.,CIC-EC 1433, CHRU, Inserm, Université de Lorraine, 54500, Nancy, France
| | - Marc Debouverie
- Department of Neurology, Nancy University Hospital, Hôpital Central, service de neurologie, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, 54500, Nancy, France
| | - Jonathan Epstein
- Université de Lorraine, EA 4360 APEMAC, 54500, Nancy, France.,CIC-EC 1433, CHRU, Inserm, Université de Lorraine, 54500, Nancy, France
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Mirmosayyeb O, Brand S, Barzegar M, Afshari-Safavi A, Nehzat N, Shaygannejad V, Sadeghi Bahmani D. Clinical Characteristics and Disability Progression of Early- and Late-Onset Multiple Sclerosis Compared to Adult-Onset Multiple Sclerosis. J Clin Med 2020; 9:jcm9051326. [PMID: 32370288 PMCID: PMC7290335 DOI: 10.3390/jcm9051326] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS). Method: Data were taken from the Isfahan Hakim MS database. Cases were classified as EOMS (MS onset ≤18 years), LOMS (MS onset >50 years) and AOMS (MS >18 and ≤50 years). Patients’ demographic and clinical (initial symptoms; course of disease; disease patterns from MRI; disease progress) information were gathered and assessed. Kaplan–Meier and Cox proportional hazard regressions were conducted to determine differences between the three groups in the time lapse in conversion from relapsing remitting MS to secondary progressive MS. Results: A total of 2627 MS cases were assessed; of these 127 were EOMS, 84 LOMS and 2416 AOMS. The mean age of those with EOMS was 14.5 years; key symptoms were visual impairments, brain stem dysfunction, sensory disturbances and motor dysfunctions. On average, 24.6 years after disease onset, 14.2% with relapsing remitting MS (RRMS) were diagnosed with secondary progressive MS (SPMS). The key predictor variable was a higher Expanded Disability Status Scale (EDSS) score at disease onset. Compared to individuals with AOMS and LOMS, those with EOMS more often had one or two relapses in the first two years, and more often gadolinium-enhancing brain lesions. For individuals with AOMS, mean age was 29.4 years; key symptoms were sensory disturbances, motor dysfunctions and visual impairments. On average, 20.5 years after disease onset, 15.6% with RRMS progressed to SPMS. The key predictors at disease onset were: a higher EDSS score, younger age, a shorter inter-attack interval and spinal lesions. Compared to individuals with EOMS and LOMS, individuals with AOMS more often had either no or three and more relapses in the first two years. For individuals with LOMS, mean age was 53.8 years; key symptoms were motor dysfunctions, sensory disturbances and visual impairments. On average, 14 years after disease onset, 25.3% with RRMS switched to an SPMS. The key predictors at disease onset were: occurrence of spinal lesions and spinal gadolinium-enhancement. Compared to individuals with EOMS and AOMS, individuals with LOMS more often had no relapses in the first two years, and higher EDSS scores at disease onset and at follow-up. Conclusion: Among a large sample of MS sufferers, cases with early onset and late onset are observable. Individuals with early, adult and late onset MS each display distinct features which should be taken in consideration in their treatment.
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Affiliation(s)
- Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 14197-33151, Iran
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Serge Brand
- Center of Depression, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, 4002 Basel, Switzerland; (S.B.); (D.S.B.)
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise, and Health, University of Basel, 4032 Basel, Switzerland
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- Sleep Disorders Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1416753955, Iran
| | - Mahdi Barzegar
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd 74877-94149, Iran;
| | - Nasim Nehzat
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 14197-33151, Iran
- Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6135715794, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (O.M.); (M.B.); (N.N.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
- Correspondence:
| | - Dena Sadeghi Bahmani
- Center of Depression, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, 4002 Basel, Switzerland; (S.B.); (D.S.B.)
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6719851351, Iran
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA
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7
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Bäcker-Koduah P, Bellmann-Strobl J, Scheel M, Wuerfel J, Wernecke KD, Dörr J, Brandt AU, Paul F. Vitamin D and Disease Severity in Multiple Sclerosis-Baseline Data From the Randomized Controlled Trial (EVIDIMS). Front Neurol 2020; 11:129. [PMID: 32158426 PMCID: PMC7052055 DOI: 10.3389/fneur.2020.00129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/05/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: To investigate the associations between hypovitaminosis D and disease activity in a cohort of relapsing remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS) patients. Methods: In 51 RRMS and 2 CIS patients on stable interferon-β-1b (IFN-β-1b) treatment recruited to the EVIDIMS study (Efficacy of Vitamin D Supplementation in Multiple Sclerosis (NCT01440062) baseline serum vitamin D levels were evaluated. Patients were dichotomized based on the definition of vitamin D deficiency which is reflected by a < 30 vs. ≥ 30 ng/ml level of 25-hydroxyvitamin D (25(OH)D). Possible associations between vitamin D deficiency and both clinical and MRI features of the disease were analyzed. Results: Median (25, 75% quartiles, Q) 25(OH)D level was 18 ng/ml (12, 24). Forty eight out of 53 (91%) patients had 25(OH)D levels < 30 ng/ml (p < 0.001). Patients with 25(OH)D ≥ 30 ng/ml had lower median (25, 75% Q) T2-weighted lesion counts [25 (24, 33)] compared to patients with 25(OH)D < 30 ng/ml [60 (36, 84), p = 0.03; adjusted for age, gender and disease duration: p < 0.001]. Expanded disability status scale (EDSS) score was negatively associated with serum 25(OH)D levels in a multiple linear regression, including age, sex, and disease duration (adjusted: p < 0.001). Interpretation: Most patients recruited in the EVIDIMS study were vitamin D deficient. Higher 25(OH)D levels were associated with reduced T2 weighted lesion count and lower EDSS scores.
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Affiliation(s)
- Priscilla Bäcker-Koduah
- Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Judith Bellmann-Strobl
- Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Scheel
- Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany.,Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Wuerfel
- Department of Biomedical Engineering, Medical Imaging Analysis Center, Universitätsspital, Basel, Switzerland
| | - Klaus-Dieter Wernecke
- Institute of Biometry and Clinical Epidemiology, Charité -Universitatsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,CRO SOSTANA GmbH, Berlin, Germany
| | - Jan Dörr
- Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany.,Multiple Sclerosis Center Hennigsdorf, Oberhavel Clinics, Berlin, Germany
| | - Alexander Ulrich Brandt
- Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Friedemann Paul
- Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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8
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Luo Y, Yan W, Zhou Z, Liu B, Wang Z, Chen J, Wang H. Elevated Levels of NLRP3 in Cerebrospinal Fluid of Patients With Autoimmune GFAP Astrocytopathy. Front Neurol 2019; 10:1019. [PMID: 31681133 PMCID: PMC6812676 DOI: 10.3389/fneur.2019.01019] [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: 05/18/2019] [Accepted: 09/09/2019] [Indexed: 02/02/2023] Open
Abstract
Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy, a newly defined autoimmune encephalitis, is an antibody-mediated meningoencephalomyelitis. The pathogenesis of the disease is still unclear. Nod-like receptor protein 3 (NLRP3) inflammasome is a complex composed of a variety of proteins that recognizes a variety of ligands and ultimately leads to the development of inflammatory responses. This is important for infectious, inflammatory, and immune diseases. The aims of this study were to detect levels of cerebrospinal fluid (CSF) NLRP3 inflammasome and inflammatory factors in autoimmune GFAP astrocytopathy patients and to study the relationships between these profiles. Twenty autoimmune GFAP astrocytopathy patients, 17 viral meningoencephalitis (VM) patients, and 16 controls (CTLs) were recruited. The levels of NLRP3 inflammasomes, interleukin (IL)-1β, IL-6, and IL-17 were measured by enzyme-linked immunosorbent assay (ELISA). The Expanded Disability Status Scale (EDSS) score was used to assess the severity of clinical manifestations. The results showed that the levels of NLRP3 inflammasome and inflammatory cytokines (IL-1β, IL-6, IL-17) were significantly more elevated in CSF of patients with autoimmune GFAP astrocytopathy than that in CTLs. When compared with VM patients, significantly elevated NLRP3 inflammasome was found in GFAP astrocytopathy patients, while the levels of IL-1β, IL-6, and IL-17 were not different between the two groups. Significant positive correlations were found between NLRP3 inflammasome and inflammatory cytokines and they were all positively related to the severity of the disease. Moreover, we found that patients with positive anti-GFAP antibodies had higher levels of NLRP3 and inflammatory factors. And the severity of the disease was positively correlated with GFAP antibody titers. Taken together, the results suggested that NLRP3 inflammasome was involved in the pathogenesis of autoimmune GFAP astrocytopathy. It can be used to assess the severity of the disease or act as a new target for the therapy.
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Affiliation(s)
- Ying Luo
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Yan
- Department of Neurology, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Zheyi Zhou
- Department of Neurology, Liuzhou Traditional Chinese Medical Hospital, The Third Affiliated Hospital of Guangxi University of Chinese Medicine, Liuzhou, China
| | - Baozhu Liu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Zhanhang Wang
- Department of Neurology, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Jinyu Chen
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Honghao Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Paolicelli D, Lucisano G, Manni A, Avolio C, Bonavita S, Brescia Morra V, Capobianco M, Cocco E, Conte A, De Luca G, De Robertis F, Gasperini C, Gatto M, Gazzola P, Lus G, Iaffaldano A, Iaffaldano P, Maimone D, Mallucci G, Maniscalco GT, Marfia GA, Patti F, Pesci I, Pozzilli C, Rovaris M, Salemi G, Salvetti M, Spitaleri D, Totaro R, Zaffaroni M, Comi G, Amato MP, Trojano M. Retrospectively acquired cohort study to evaluate the long-term impact of two different treatment strategies on disability outcomes in patients with relapsing multiple sclerosis (RE.LO.DI.MS): data from the Italian MS Register. J Neurol 2019; 266:3098-3107. [PMID: 31535270 DOI: 10.1007/s00415-019-09531-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The increase in disease-modifying drugs (DMDs) allows individualization of treatment in relapsing multiple sclerosis (RMS); however, the long-term impact of different treatment sequences is not well established. This is particularly relevant for MS patients who may need to postpone more aggressive DMD strategies. OBJECTIVE To evaluate different therapeutic strategies and their long-term outcomes, measured as relapses and confirmed disability progression (CDP), in MS 'real-world' settings. METHODS Multicentre, observational, retrospectively acquired cohort study evaluating the long-term impact of different treatment strategies on disability outcomes in patients with RMS in the Italian MS Register. RESULTS We evaluated 1152 RMS-naïve patients after propensity-score adjustment. Patients included were receiving: interferon beta-1a (IFN-β1a) 44 µg switching to fingolimod (FTY; IFN-switchers; n = 97); FTY only (FTY-stayers; n = 157); IFN-β1a only (IFN-stayers; n = 849). CDP and relapses did not differ between FTY-stayers and IFN-switchers [HR (95% CI) 0.99 (0.48-2.04), p = 0.98 and 0.81 (0.42-1.58), p = 0.55, respectively]. However, IFN-stayers showed increased risk of relapses compared with FTY-stayers [HR (95% CI) 1.46 (1.00-2.12), p = 0.05]. CONCLUSION The ideal treatment option for MS is becoming increasingly complex, with the need to balance benefit and risks. Our results suggest that starting with FTY affects the long-term disease outcome similarly to escalating from IFN-β1a to FTY.
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Affiliation(s)
- Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy.
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University of Naples, Naples, Italy
| | - Marco Capobianco
- Department of Neurology and Regional Multiple Sclerosis Centre, University Hospital San Luigi, Orbassano, TO, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health, University of Cagliari and Multiple Sclerosis Center, Cagliari, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giovanna De Luca
- Neurology Clinic, Multiple Sclerosis Centre, SS Annunziata Hospital, Chieti, Italy
| | | | | | - Maurizia Gatto
- Neurology Unit, "F. Miulli" Hospital, Acquaviva delle Fonti BA, Italy
| | - Paola Gazzola
- Departemental Center for the Diagnosis and Treatment of Demyelinating Diseases, Sestri Ponente, Genoa, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Antonio Iaffaldano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Maimone
- Multiple Sclerosis Center, Garibaldi Hospital, Catania, Italy
| | - Giulia Mallucci
- Multiple Sclerosis Center of IRCCS Mondino Foundation, Pavia, Italy
| | | | - Girolama A Marfia
- Department of Systems Medicine, Multiple Sclerosis Clinical and Research Center, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, Ospedale di Vaio (I.P.), Fidenza, PR, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.,Department of Neurology, University La Sapienza, Rome, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Rome, Italy.,Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Isernia, Italy
| | | | - Rocco Totaro
- Department of Neurology, Demyelinating Disease Center, San Salvatore Hospital, L'Aquila, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, Gallarate, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS and Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
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Mazdeh M, Kargar Monhaser S, Taheri M, Ghafouri-Fard S. A non-randomized clinical trial to evaluate the effect of fingolimod on expanded disability status scale score and number of relapses in relapsing-remitting multiple sclerosis patients. Clin Transl Med 2019; 8:11. [PMID: 30957197 PMCID: PMC6451934 DOI: 10.1186/s40169-019-0228-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease characterized by demyelination, glial activation and axonal degeneration in the central nervous system. At the present, there is no certain remedy for this disease. However, available therapies often attenuate disease progress. METHODS This study aims at identification of the effect of fingolimod on expanded disability status scale (EDSS) score and number of relapses in relapsing-remitting MS (RRMS) patients in comparison with IFNβ. In the present 12-month non-randomized clinical trial, 55 RRMS patients aged between 18 and 45 with EDSS scores between 0 and 5.5 were divided into two groups. Twenty-five patients received 0.5 mg oral fingolimod once a day for 12 months and 30 patients were under treatment with IFNβ. EDSS scores and number of relapses were recorded for all study participants monthly. RESULTS No significant difference was found in age and sex of patients recruited in two study groups. EDSS score was significantly lower in treatment group in month 10, 11 and 12 after treatment compared with control group (p values of 0.004, 0.006 and 0.007 respectively). CONCLUSION Treated patients experienced no relapse during the study period. Fingolimod is effective in reduction of EDSS score and number of relapses in Iranian MS patients.
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Affiliation(s)
- Mehrdokht Mazdeh
- Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran.,Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mohammad Taheri
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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