1
|
Aprea MG, Schiavetti I, Portaccio E, Ballerini C, Bonavita S, Buscarinu M, Calabrese M, Cavalla P, Cellerino M, Cordioli C, Dattola V, De Biase S, De Meo E, Fantozzi R, Gallo A, Iasevoli L, Karabudak R, Landi D, Lorefice L, Moiola L, Ragonese P, Ruscica F, Sen S, Sinisi L, Signoriello E, Toscano S, Verrengia E, Siva A, Masciulli C, Sormani MP, Amato MP. Impact of COVID-19 on pregnancy and fetal outcomes in women with multiple sclerosis. Mult Scler 2024; 30:707-713. [PMID: 38456445 DOI: 10.1177/13524585241232266] [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] [Indexed: 03/09/2024]
Abstract
BACKGROUND In the general population, maternal COVID-19 is associated with worse maternal and fetal outcomes. Two previous studies have assessed COVID-19 clinical outcomes in pregnant women with multiple sclerosis (MS), but there are no data about maternal and fetal outcomes. OBJECTIVES In this multicenter study, we aimed to assess maternal and fetal outcomes in pregnant women with MS and COVID-19 infection. METHODS We recruited pregnant patients with MS who contracted COVID-19 and were followed up in Italian and Turkish Centers, during 2020-2022. A control group was extracted from a previous Italian cohort. Associations between group (COVID-19 or healthy patients) and clinical outcomes (maternal complications, fetal malformations, and spontaneous abortion) were investigated with a weighted logistic regression where propensity score-based inverse probability of treatment weighting (IPTW) approach was applied for adjusting for difference in baseline confounders. RESULTS In the multivariable analysis, COVID-19 during pregnancy was associated with a higher risk of maternal complications (odd ratio (OR) = 2.12; 95% confidence interval (CI) = 1.32-3.48; p = 0.002), while it was not associated with higher risk of spontaneous abortion and fetal malformations. CONCLUSION Our data indicate that COVID-19 during pregnancy increases the risk of maternal complications, while it seems to have no significant impact on fetal outcomes.
Collapse
Affiliation(s)
| | - Irene Schiavetti
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Chiara Ballerini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Simona Bonavita
- II Division, Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Massimiliano Calabrese
- The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari Hospital, Brescia, Italy
| | - Vincenzo Dattola
- MS Center, Bianchi Melacrino Morelli Great Metropolitan Hospital, Reggio Calabria, Italy
| | | | - Ermelinda De Meo
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Antonio Gallo
- MS Center, I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Rana Karabudak
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Lorena Lorefice
- Multiple Sclerosis Centre, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Lucia Moiola
- Multiple Sclerosis Center and Neurology Department IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Sedat Sen
- School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Elisabetta Signoriello
- II Division, Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Simona Toscano
- Multiple Sclerosis Unit, University Hospital G. Rodolico, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Elena Verrengia
- Multiple Sclerosis Centre, ASST OVEST MI, Legnano Hospital, Legnano, Italy
| | - Aksel Siva
- Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | | | - Maria Pia Sormani
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| |
Collapse
|
2
|
Iaffaldano P, Portaccio E, Lucisano G, Simone M, Manni A, Guerra T, Paolicelli D, Betti M, De Meo E, Pastò L, Razzolini L, Rocca MA, Ferrè L, Brescia Morra V, Patti F, Zaffaroni M, Gasperini C, De Luca G, Ferraro D, Granella F, Pozzilli C, Romano S, Gallo P, Bergamaschi R, Coniglio MG, Lus G, Vianello M, Banfi P, Lugaresi A, Totaro R, Spitaleri D, Cocco E, Di Palma F, Maimone D, Valentino P, Torri Clerici V, Protti A, Maniscalco GT, Salemi G, Pesci I, Aguglia U, Lepore V, Filippi M, Trojano M, Amato MP. Multiple Sclerosis Progression and Relapse Activity in Children. JAMA Neurol 2024; 81:50-58. [PMID: 38010712 PMCID: PMC10682937 DOI: 10.1001/jamaneurol.2023.4455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
Importance Although up to 20% of patients with multiple sclerosis (MS) experience onset before 18 years of age, it has been suggested that people with pediatric-onset MS (POMS) are protected against disability because of greater capacity for repair. Objective To assess the incidence of and factors associated with progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) in POMS compared with typical adult-onset MS (AOMS) and late-onset MS (LOMS). Design, Setting, and Participants This cohort study on prospectively acquired data from the Italian MS Register was performed from June 1, 2000, to September 30, 2021. At the time of data extraction, longitudinal data from 73 564 patients from 120 MS centers were available in the register. Main Outcomes and Measures The main outcomes included age-related cumulative incidence and adjusted hazard ratios (HRs) for PIRA and RAW and associated factors. Exposures Clinical and magnetic resonance imaging features, time receiving disease-modifying therapy (DMT), and time to first DMT. Results After applying the inclusion and exclusion criteria, the study assessed 16 130 patients with MS (median [IQR] age at onset, 28.7 [22.8-36.2 years]; 68.3% female). Compared with AOMS and LOMS, patients with POMS had less disability, exhibited more active disease, and were exposed to DMT for a longer period. A first 48-week-confirmed PIRA occurred in 7176 patients (44.5%): 558 patients with POMS (40.4%), 6258 patients with AOMS (44.3%), and 360 patients with LOMS (56.8%) (P < .001). Factors associated with PIRA were older age at onset (AOMS vs POMS HR, 1.42; 95% CI, 1.30-1.55; LOMS vs POMS HR, 2.98; 95% CI, 2.60-3.41; P < .001), longer disease duration (HR, 1.04; 95% CI, 1.04-1.05; P < .001), and shorter DMT exposure (HR, 0.69; 95% CI, 0.64-0.74; P < .001). The incidence of PIRA was 1.3% at 20 years of age, but it rapidly increased approximately 7 times between 21 and 30 years of age (9.0%) and nearly doubled for each age decade from 40 to 70 years (21.6% at 40 years, 39.0% at 50 years, 61.0% at 60 years, and 78.7% at 70 years). The cumulative incidence of RAW events followed a similar trend from 20 to 60 years (0.5% at 20 years, 3.5% at 30 years, 7.8% at 40 years, 14.4% at 50 years, and 24.1% at 60 years); no further increase was found at 70 years (27.7%). Delayed DMT initiation was associated with higher risk of PIRA (HR, 1.16; 95% CI, 1.00-1.34; P = .04) and RAW (HR, 1.75; 95% CI, 1.28-2.39; P = .001). Conclusions and Relevance PIRA can occur at any age, and although pediatric onset is not fully protective against progression, this study's findings suggest that patients with pediatric onset are less likely to exhibit PIRA over a decade of follow-up. However, these data also reinforce the benefit for DMT initiation in patients with POMS, as treatment was associated with reduced occurrence of both PIRA and RAW regardless of age at onset.
Collapse
Affiliation(s)
- Pietro Iaffaldano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Emilio Portaccio
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Marta Simone
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Alessia Manni
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Tommaso Guerra
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Matteo Betti
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Ermelinda De Meo
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Luisa Pastò
- Department of Neurofarba, University of Florence, Florence, Italy
| | | | - Maria A. Rocca
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Ferrè
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Federico II University, Naples, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate (Varese), Italy
| | - Claudio Gasperini
- Centro Sclerosi Multipla–Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS. Annunziata, Chieti, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Department of Human Neuroscience, S. Andrea Hospital, Rome, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Paolo Gallo
- Department of Neurosciences, Multiple Sclerosis Centre–Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | | | | | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | | | - Paola Banfi
- Neurology and Stroke Unit, University of Insubria, Varese, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Rocco Totaro
- San Salvatore Hospital, Demyelinating Disease Center, L’Aquila, Italy
| | - Daniele Spitaleri
- Department of Neurology, AORN San G. Moscati di Avellino, Avellino, Italy
| | - Eleonora Cocco
- University of Cagliari, Department of Medical Science and Public Health, Centro Sclerosi Multipla, Cagliari, Italy
| | - Franco Di Palma
- Department of Neurology, ASST Lariana Ospedale S. Anna, Como, Italy
| | - Davide Maimone
- Department of Neurology, Ospedale Garibaldi, Catania, Italy
| | - Paola Valentino
- Institute of Neurology, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | | | | | | | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza Hospital, Fidenza, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Vito Lepore
- Public Health Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| |
Collapse
|
3
|
Bonacchi R, De Meo E. Editorial for "Deep Learning for Noninvasive Assessment of H3 K27M Mutation Status in Diffuse Midline Gliomas Using MR Imaging". J Magn Reson Imaging 2023; 58:862-863. [PMID: 36661197 DOI: 10.1002/jmri.28615] [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] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
| | - Ermelinda De Meo
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| |
Collapse
|
4
|
De Meo E, Portaccio E. It is time to define cognitive phenotypes in multiple sclerosis. Mult Scler 2022; 29:489-491. [PMID: 36515389 DOI: 10.1177/13524585221141263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ermelinda De Meo
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | |
Collapse
|
5
|
De Meo E, Filippi M, Trojano M, Comi G, Patti F, Brescia Morra V, Salemi G, Onofrj M, Lus G, Cocco E, Fonderico M, Torri Clerici V, Maniscalco GT, Valentino P, Bertolotto A, Lugaresi A, Bergamaschi R, Rovaris M, Sola P, Tedeschi G, Pesci I, Aguglia U, Cavalla P, Maimone D, Granella F, Vianello M, Simone M, Portaccio E, Amato MP. Comparing natural history of early and late onset pediatric multiple sclerosis. Ann Neurol 2022; 91:483-495. [PMID: 35150168 DOI: 10.1002/ana.26322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/05/2022] [Accepted: 02/08/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe and compare disease course and prognosis of early (i.e., disease onset before age 11 years) and late (i.e., disease onset after age 11 years) onset pediatric multiple sclerosis. METHODS Prospectively-collected clinical information from Italian Multiple Sclerosis Register of 1993 pediatric multiple sclerosis patients, of whom 172 with early onset, was analyzed. Cox models adjusted for sex, baseline Expanded Disability Status Scale score and disease-modifying treatments and stratified for diagnostic criteria adopted (Poser vs McDonald) were used to assess the risk of reaching irreversible Expanded Disability Status Scale scores of 3, 4, and 6, and conversion to secondary progressive phenotype in early vs late onset pediatric patients. Prognostic factors were also evaluated. RESULTS A greater proportion of males, isolated brainstem involvement, and longer time interval between first and second clinical episode was observed in early vs late onset pediatric patients. Compared to late onset, early onset pediatric patients took longer time from disease onset to convert to secondary progressive phenotype and to reach all disability milestones. Recovery from first demyelinating event, time to first relapse, annualized relapse rate during the first 3 years of disease and disease-modifying treatments exposure were independent predictors for long-term disability in early onset pediatric patients. In late onset pediatric patients, isolated optic neuritis, multifocal symptoms or progressive course at disease onset were additional predictors for long-term disability. INTERPRETATION These findings point towards the existence of a different natural history in early vs late onset pediatric multiple sclerosis patients. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Ermelinda De Meo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute.,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
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro' Policlinico, Bari, Italy
| | | | - Francasco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, University of Catania, Catania
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Napoli
| | - Giuseppe Salemi
- Dipartimento di Biomedicina Sperimentale e Neuroscienze, Palermo
| | | | - Giacomo Lus
- Università della Campania Luigi Vanvitelli, Naples
| | - Eleonora Cocco
- Centro Sclerosi Multipla, ASSL Cagliari; Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari
| | | | | | - Giorgia Teresa Maniscalco
- Multiple Sclerosis Center and Neurological Clinic/Stroke Unit "A. Cardarelli" Hospital, Naples, Italy
| | | | | | | | | | | | - Patrizia Sola
- Centro Malattie Demielinizzanti - Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria/OCSAE, UO Neurologia, University of Modena and Reggio Emilia, Modena
| | | | - Ilaria Pesci
- Centro SM UO Neurologia, Ospedale Di Vaio, Fidenza
| | | | - Paola Cavalla
- Multiple Sclerosis Center and I Neurology Unit, Department of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia ARNAS Garibaldi, Catania
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma
| | - Marika Vianello
- Centro Sclerosi Multipla - Ospedale Regionale 'Ca' Foncello', Neurology Unit, Treviso
| | - Marta Simone
- Child Neuropsychiatric Unit-Department of Biomedical Science and Human Oncology-University of Bari Aldo Moro
| | | | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| |
Collapse
|
6
|
De Meo E, Portaccio E, Prestipino E, Nacmias B, Bagnoli S, Razzolini L, Pastò L, Niccolai C, Goretti B, Bellinvia A, Fonderico M, Giorgio A, Stromillo ML, Filippi M, Sorbi S, De Stefano N, Amato MP. Effect of BDNF Val66Met polymorphism on hippocampal subfields in multiple sclerosis patients. Mol Psychiatry 2022; 27:1010-1019. [PMID: 34650209 DOI: 10.1038/s41380-021-01345-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 12/29/2020] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 01/20/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism was shown to strongly affect BDNF function, but its role in modulating gray matter damage in multiple sclerosis (MS) patients is still not clear. Given BDNF relevance on the hippocampus, we aimed to explore BDNF Val66Met polymorphism effect on hippocampal subfield volumes and its role in cognitive functioning in MS patients. Using a 3T scanner, we obtained dual-echo and 3DT1-weighted sequences from 50 MS patients and 15 healthy controls (HC) consecutively enrolled. MS patients also underwent genotype analysis of BDNF, neurological and neuropsychological evaluation. Hippocampal subfields were segmented by using Freesurfer. The BDNF Val66Met polymorphism was found in 22 MS patients (44%). Compared to HC, MS patients had lower volume in: bilateral hippocampus-amygdala transition area (HATA); cornus ammonis (CA)1, granule cell layer of dentate gyrus (GCL-DG), CA4 and CA3 of the left hippocampal head; molecular layer (ML) of the left hippocampal body; presubiculum of right hippocampal body and right fimbria. Compared to BDNF Val66Val, Val66Met MS patients had higher volume in bilateral hippocampal tail; CA1, ML, CA3, CA4, and GCL-DG of left hippocampal head; CA1, ML, and CA3 of the left hippocampal body; left HATA and presubiculum of the right hippocampal head. In MS patients, higher lesion burden was associated with lower volume of presubiculum of right hippocampal body; lower volume of left hippocampal tail was associated with worse visuospatial memory performance; lower volume of left hippocampal head with worse performance in semantic fluency. Our findings suggest the BNDF Val66Met polymorphism may have a protective role in MS patients against both hippocampal atrophy and cognitive impairment. BDNF genotype might be a potential biomarker for predicting cognitive prognosis, and an interesting target to study for neuroprotective strategies.
Collapse
Affiliation(s)
- Ermelinda De Meo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Emilio Portaccio
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Elio Prestipino
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Benedetta Nacmias
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Silvia Bagnoli
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | | | - Luisa Pastò
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Benedetta Goretti
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | | | | | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, 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.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sandro Sorbi
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| |
Collapse
|
7
|
Meo ED, Bonacchi R, Fonderico M, Filippi M, Patti F, Morra VB, Salemi G, Lus G, Onofrj M, Cocco E, Maniscalco G, Bertolotto A, Confalonieri P, Bergamaschi R, Lugaresi A, Valentino P, Cavalla P, Maimone D, Sola P, Granella F, Pesci I, Rovaris M, Simone M, Trojano M, Amato MP. Long-term disability progression in childhood and adolescent onset multiple sclerosis patients. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
Clarelli F, Assunta Rocca M, Santoro S, De Meo E, Ferrè L, Sorosina M, Martinelli Boneschi F, Esposito F, Filippi M. Assessment of the genetic contribution to brain magnetic resonance imaging lesion load and atrophy measures in multiple sclerosis patients. Eur J Neurol 2021; 28:2513-2522. [PMID: 33864731 DOI: 10.1111/ene.14872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/22/2021] [Accepted: 04/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) susceptibility is influenced by genetics; however, little is known about genetic determinants of disease expression. We aimed at assessing genetic factors influencing quantitative neuroimaging measures in two cohorts of progressive MS (PMS) and relapsing-remitting MS (RRMS) patients. METHODS Ninety-nine PMS and 214 RRMS patients underwent a 3-T brain magnetic resonance imaging (MRI) scan, with the measurement of five MRI metrics including T2 lesion volumes and measures of white matter, grey matter, deep grey matter, and hippocampal volumes. A candidate pathway strategy was adopted; gene set analysis was carried out to estimate cumulative contribution of genes to MRI phenotypes, adjusting for relevant confounders, followed by single nucleotide polymorphism (SNP) regression analysis. RESULTS Seventeen Kyoto Encyclopedia of Genes and Genomes pathways and 42 Gene Ontology (GO) terms were tested. We additionally included in the analysis genes with enriched expression in brain cells. Gene set analysis revealed a differential pattern of association across the two cohorts, with processes related to sodium homeostasis being associated with grey matter volume in PMS (p = 0.002), whereas inflammatory-related GO terms such as adaptive immune response and regulation of inflammatory response appeared to be associated with T2 lesion volume in RRMS (p = 0.004 and p = 0.008, respectively). As for SNPs, the rs7104613T mapping to SPON1 gene was associated with reduced deep grey matter volume (β = -0.731, p = 3.2*10-7 ) in PMS, whereas we found evidence of association between white matter volume and rs740948A mapping to SEMA3A gene (β = 22.04, p = 5.5*10-6 ) in RRMS. CONCLUSIONS Our data suggest a different pattern of associations between MRI metrics and functional processes across MS disease courses, suggesting different phenomena implicated in MS.
Collapse
Affiliation(s)
- Ferdinando Clarelli
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Assunta 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
| | - Silvia Santoro
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ermelinda De Meo
- 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
| | - Laura Ferrè
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, 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
| | - Melissa Sorosina
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Martinelli Boneschi
- Department of Pathophysiology and Transplantation, Dino Ferrari Centre, Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit and MS Centre, Foundation IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Esposito
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, 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
- 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
| |
Collapse
|
9
|
De Meo E, Storelli L, Moiola L, Ghezzi A, Veggiotti P, Filippi M, Rocca MA. In vivo gradients of thalamic damage in paediatric multiple sclerosis: a window into pathology. Brain 2021; 144:186-197. [PMID: 33221873 DOI: 10.1093/brain/awaa379] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/12/2020] [Accepted: 08/21/2020] [Indexed: 01/01/2023] Open
Abstract
The thalamus represents one of the first structures affected by neurodegenerative processes in multiple sclerosis. A greater thalamic volume reduction over time, on its CSF side, has been described in paediatric multiple sclerosis patients. However, its determinants and the underlying pathological changes, likely occurring before this phenomenon becomes measurable, have never been explored. Using a multiparametric magnetic resonance approach, we quantified, in vivo, the different processes that can involve the thalamus in terms of focal lesions, microstructural damage and atrophy in paediatric multiple sclerosis patients and their distribution according to the distance from CSF/thalamus interface and thalamus/white matter interface. In 70 paediatric multiple sclerosis patients and 26 age- and sex-matched healthy controls, we tested for differences in thalamic volume and quantitative MRI metrics-including fractional anisotropy, mean diffusivity and T1/T2-weighted ratio-in the whole thalamus and in thalamic white matter, globally and within concentric bands originating from CSF/thalamus interface. In paediatric multiple sclerosis patients, the relationship of thalamic abnormalities with cortical thickness and white matter lesions was also investigated. Compared to healthy controls, patients had significantly increased fractional anisotropy in whole thalamus (f2 = 0.145; P = 0.03), reduced fractional anisotropy (f2 = 0.219; P = 0.006) and increased mean diffusivity (f2 = 0.178; P = 0.009) in thalamic white matter and a trend towards a reduced thalamic volume (f2 = 0.027; P = 0.058). By segmenting the whole thalamus and thalamic white matter into concentric bands, in paediatric multiple sclerosis we detected significant fractional anisotropy abnormalities in bands nearest to CSF (f2 = 0.208; P = 0.002) and in those closest to white matter (f2 range = 0.183-0.369; P range = 0.010-0.046), while we found significant mean diffusivity (f2 range = 0.101-0.369; P range = 0.018-0.042) and T1/T2-weighted ratio (f2 = 0.773; P = 0.001) abnormalities in thalamic bands closest to CSF. The increase in fractional anisotropy and decrease in mean diffusivity detected at the CSF/thalamus interface correlated with cortical thickness reduction (r range = -0.27-0.34; P range = 0.004-0.028), whereas the increase in fractional anisotropy detected at the thalamus/white matter interface correlated with white matter lesion volumes (r range = 0.24-0.27; P range = 0.006-0.050). Globally, our results support the hypothesis of heterogeneous pathological processes, including retrograde degeneration from white matter lesions and CSF-mediated damage, leading to thalamic microstructural abnormalities, likely preceding macroscopic tissue loss. Assessing thalamic microstructural changes using a multiparametric magnetic resonance approach may represent a target to monitor the efficacy of neuroprotective strategies early in the disease course.
Collapse
Affiliation(s)
- Ermelinda De Meo
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Center, Ospedale di Gallarate, Gallarate, Italy
| | - Pierangelo Veggiotti
- Paediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy.,Biomedical and Clinical Science Department, University of Milan, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, 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.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, 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
| |
Collapse
|
10
|
De Meo E, Portaccio E, Giorgio A, Ruano L, Goretti B, Niccolai C, Patti F, Chisari CG, Gallo P, Grossi P, Ghezzi A, Roscio M, Mattioli F, Stampatori C, Simone M, Viterbo RG, Bonacchi R, Rocca MA, De Stefano N, Filippi M, Amato MP. Identifying the Distinct Cognitive Phenotypes in Multiple Sclerosis. JAMA Neurol 2021; 78:414-425. [PMID: 33393981 DOI: 10.1001/jamaneurol.2020.4920] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Cognitive impairment is a common and disabling feature of multiple sclerosis (MS), but a precise characterization of cognitive phenotypes in patients with MS is lacking. Objectives To identify cognitive phenotypes in a clinical cohort of patients with MS and to characterize their clinical and magnetic resonance imaging (MRI) features. Design, Setting, and Participants This multicenter cross-sectional study consecutively screened clinically stable patients with MS and healthy control individuals at 8 MS centers in Italy from January 1, 2010, to October 31, 2019. Patients with MS and healthy control individuals who were not using psychoactive drugs and had no history of other neurological or medical disorders, learning disability, severe head trauma, and alcohol or drug abuse were enrolled. Main Outcomes and Measures Participants underwent a neurological examination and a cognitive evaluation with the Rao Brief Repeatable Battery and Stroop Color and Word Test. A subgroup of participants also underwent a brain MRI examination. Latent profile analysis was used on cognitive test z scores to identify cognitive phenotypes. Linear regression and mixed-effects models were used to define clinical and MRI features of each phenotype. Results A total of 1212 patients with MS (mean [SD] age, 41.1 [11.1] years; 784 women [64.7%]) and 196 healthy control individuals (mean [SD] age, 40.4 [8.6] years; 130 women [66.3%]) were analyzed in this study. Five cognitive phenotypes were identified: preserved cognition (n = 235 patients [19.4%]), mild-verbal memory/semantic fluency (n = 362 patients [29.9%]), mild-multidomain (n = 236 patients [19.5%]), severe-executive/attention (n = 167 patients [13.8%]), and severe-multidomain (n = 212 patients [17.5%]) involvement. Patients with preserved cognition and mild-verbal memory/semantic fluency were younger (mean [SD] age, 36.5 [9.8] years and 38.2 [11.1] years) and had shorter disease duration (mean [SD] 8.0 [7.3] years and 8.3 [7.6] years) compared with patients with mild-multidomain (mean [SD] age, 42.6 [11.2] years; mean [SD] disease duration, 12.8 [9.6] years; P < .001), severe-executive/attention (mean [SD] age, 42.9 [11.7] years; mean [SD] disease duration, 12.2 [9.5] years; P < .001), and severe-multidomain (mean [SD] age, 44.0 [11.0] years; mean [SD] disease duration, 13.3 [10.2] years; P < .001) phenotypes. Severe cognitive phenotypes prevailed in patients with progressive MS. At MRI evaluation, compared with those with preserved cognition, patients with mild-verbal memory/semantic fluency exhibited decreased mean (SE) hippocampal volume (5.42 [0.68] mL vs 5.13 [0.68] mL; P = .04), patients with the mild-multidomain phenotype had decreased mean (SE) cortical gray matter volume (687.69 [35.40] mL vs 662.59 [35.48] mL; P = .02), patients with severe-executive/attention had higher mean (SE) T2-hyperintense lesion volume (51.33 [31.15] mL vs 99.69 [34.07] mL; P = .04), and patients with the severe-multidomain phenotype had extensive brain damage, with decreased volume in all the brain structures explored, except for nucleus pallidus, amygdala and caudate nucleus. Conclusions and Relevance This study found that by defining homogeneous and clinically meaningful phenotypes, the limitations of the traditional dichotomous classification in MS can be overcome. These phenotypes can represent a more meaningful measure of the cognitive status of patients with MS and can help define clinical disability, support clinicians in treatment choices, and tailor cognitive rehabilitation strategies.
Collapse
Affiliation(s)
- Ermelinda De Meo
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.,Institute of Experimental Neurology, Vita-Salute San Raffaele University, Milan, Italy.,Section Neurosciences, Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Emilio Portaccio
- Department of Neurology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luis Ruano
- EPIUnit, Instituto de Saúde Pública de Universidade do Porto, Porto, Portugal.,Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Benedetta Goretti
- Section Neurosciences, Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Claudia Niccolai
- Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Francesco Patti
- Department of Neurology, University of Catania, Catania, Italy
| | | | - Paolo Gallo
- Department of Neurology, University of Padova, Padova, Italy
| | - Paola Grossi
- Neuroimmunology Center, Cardiocerebrovascular, Azienda Socio Sanitaria Territoriale (ASST) of Crema, Crema, Italy
| | | | | | - Flavia Mattioli
- Neuropsychology Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | | | - Marta Simone
- Child and Adolescence Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs University Aldo Moro Bari, Bari, Italy
| | - Rosa Gemma Viterbo
- Child and Adolescence Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs University Aldo Moro Bari, Bari, Italy
| | - Raffaello Bonacchi
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.,Institute of Experimental Neurology, Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.,Institute of Experimental Neurology, Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Amato
- Section Neurosciences, Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy.,Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| |
Collapse
|
11
|
De Meo E, Bonacchi R, Moiola L, Colombo B, Sangalli F, Zanetta C, Amato MP, Martinelli V, Rocca MA, Filippi M. Early Predictors of 9-Year Disability in Pediatric Multiple Sclerosis. Ann Neurol 2021; 89:1011-1022. [PMID: 33598931 DOI: 10.1002/ana.26052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to assess early predictors of 9-year disability in pediatric patients with multiple sclerosis. METHODS Clinical and magnetic resonance imaging (MRI) assessments of 123 pediatric patients with multiple sclerosis were obtained at disease onset and after 1 and 2 years. A 9-year clinical follow-up was also performed. Cox proportional hazard and multivariable regression models were used to assess independent predictors of time to first relapse and 9-year outcomes. RESULTS Time to first relapse was predicted by optic nerve lesions (hazard ratio [HR] = 2.10, p = 0.02) and high-efficacy treatment exposure (HR = 0.31, p = 0.005). Predictors of annualized relapse rate were: at baseline, presence of cerebellar (β = -0.15, p < 0.001), cervical cord lesions (β = 0.16, p = 0.003), and high-efficacy treatment exposure (β = -0.14, p = 0.01); considering also 1-year variables, number of relapses (β = 0.14, p = 0.002), and the previous baseline predictors; considering 2-year variables, time to first relapse (2-year: β = -0.12, p = 0.01) entered, whereas high-efficacy treatment exposure exited the model. Predictors of 9-year disability worsening were: at baseline, presence of optic nerve lesions (odds ratio [OR] = 6.45, p = 0.01); considering 1-year and 2-year variables, Expanded Disability Status Scale (EDSS) changes (1-year: OR = 26.05, p < 0.001; 2-year: OR = 16.38, p = 0.02), and ≥ 2 new T2-lesions in 2 years (2-year: OR = 4.91, p = 0.02). Predictors of higher 9-year EDSS score were: at baseline, EDSS score (β = 0.58, p < 0.001), presence of brainstem lesions (β = 0.31, p = 0.04), and number of cervical cord lesions (β = 0.22, p = 0.05); considering 1-year and 2-year variables, EDSS changes (1-year: β = 0.79, p < 0.001; 2-year: β = 0.55, p < 0.001), and ≥ 2 new T2-lesions (1-year: β = 0.28, p = 0.03; 2-year: β = 0.35, p = 0.01). INTERPRETATION A complete baseline MRI assessment and an accurate clinical and MRI monitoring during the first 2 years of disease contribute to predict 9-year prognosis in pediatric patients with multiple sclerosis. ANN NEUROL 2021;89:1011-1022.
Collapse
Affiliation(s)
- Ermelinda De Meo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaello Bonacchi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Chiara Zanetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Maria Assunta Rocca
- 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
| | - 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
| |
Collapse
|
12
|
Amato MP, Portaccio E, De Meo E. Understanding the pathophysiology of cognitive changes in MS: A step forward. Mult Scler 2020; 27:4-5. [PMID: 33146049 DOI: 10.1177/1352458520968038] [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: 11/15/2022]
Affiliation(s)
- Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Emilio Portaccio
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy/Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermelinda De Meo
- Department NEUROFARBA, University of Florence, Florence, Italy/Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
13
|
Bonacchi R, Pagani E, Meani A, Cacciaguerra L, Preziosa P, De Meo E, Filippi M, Rocca MA. Clinical Relevance of Multiparametric MRI Assessment of Cervical Cord Damage in Multiple Sclerosis. Radiology 2020; 296:605-615. [PMID: 32573387 DOI: 10.1148/radiol.2020200430] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background In multiple sclerosis (MS), knowledge about how spinal cord abnormalities translate into clinical manifestations is incomplete. Comprehensive, multiparametric MRI studies are useful in this perspective, but studies for the spinal cord are lacking. Purpose To identify MRI features of cervical spinal cord damage that could help predict disability and disease course in MS by using a comprehensive, multiparametric MRI approach. Materials and Methods In this retrospective hypothesis-driven analysis of longitudinally acquired data between June 2017 and April 2019, 120 patients with MS (58 with relapsing-remitting MS [RRMS] and 62 with progressive MS [PMS]) and 30 age- and sex-matched healthy control participants underwent 3.0-T MRI of the brain and cervical spinal cord. Cervical spinal cord MRI was performed with three-dimensional (3D) T1-weighted, T2-weighted, and diffusion-weighted imaging; sagittal two-dimensional (2D) short inversion time inversion-recovery imaging; and axial 2D phase-sensitive inversion-recovery imaging at the C2-C3 level. Brain MRI was performed with 3D T1-weighted, fluid-attenuated inversion-recovery and T2-weighted sequences. Associations between MRI variables and disability were explored with age-, sex- and phenotype-adjusted linear models. Results In patients with MS, multivariable analysis identified phenotype, cervical spinal cord gray matter (GM) cross-sectional area (CSA), lateral funiculi fractional anisotropy (FA), and brain GM volume as independent predictors of Expanded Disability Status Scale (EDSS) score (R2 = 0.86). The independent predictors of EDSS score in RRMS were lateral funiculi FA, normalized brain volume, and cervical spinal cord GM T2 lesion volume (R2 = 0.51). The independent predictors of EDSS score in PMS were cervical spinal cord GM CSA and brain GM volume (R2 = 0.44). Logistic regression analysis identified cervical spinal cord GM CSA and T2 lesion volume as independent predictors of phenotype (area under the receiver operating characteristic curve = 0.95). An optimal cervical spinal cord GM CSA cut-off value of 11.1 mm2 was found to enable accurate differentiation of patients with PMS, having values below the threshold, from those with RRMS (sensitivity = 90% [56 of 62], specificity = 91% [53 of 58]). Conclusion Cervical spinal cord MRI involvement has a central role in explaining disability in multiple sclerosis (MS): Lesion-induced damage in the lateral funiculi and gray matter (GM) in relapsing-remitting MS and GM atrophy in patients with progressive MS are the most relevant variables. Cervical spinal cord GM atrophy is an accurate predictor of progressive phenotype. Cervical spinal cord GM lesions may subsequently cause GM atrophy, which may contribute to evolution to PMS. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zivadinov and Bergsland in this issue.
Collapse
Affiliation(s)
- Raffaello Bonacchi
- From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (R.B., E.P., A.M., L.C., P.P., E.D.M., M.F., M.A.R.), Neurology Unit (R.B., L.C., P.P., E.D.M., M.F., M.A.R.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; and Vita-Salute San Raffaele University, Milan, Italy (R.B., L.C., E.D.M., M.F.)
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (R.B., E.P., A.M., L.C., P.P., E.D.M., M.F., M.A.R.), Neurology Unit (R.B., L.C., P.P., E.D.M., M.F., M.A.R.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; and Vita-Salute San Raffaele University, Milan, Italy (R.B., L.C., E.D.M., M.F.)
| | - Alessandro Meani
- From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (R.B., E.P., A.M., L.C., P.P., E.D.M., M.F., M.A.R.), Neurology Unit (R.B., L.C., P.P., E.D.M., M.F., M.A.R.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; and Vita-Salute San Raffaele University, Milan, Italy (R.B., L.C., E.D.M., M.F.)
| | - Laura Cacciaguerra
- From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (R.B., E.P., A.M., L.C., P.P., E.D.M., M.F., M.A.R.), Neurology Unit (R.B., L.C., P.P., E.D.M., M.F., M.A.R.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; and Vita-Salute San Raffaele University, Milan, Italy (R.B., L.C., E.D.M., M.F.)
| | - Paolo Preziosa
- From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (R.B., E.P., A.M., L.C., P.P., E.D.M., M.F., M.A.R.), Neurology Unit (R.B., L.C., P.P., E.D.M., M.F., M.A.R.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; and Vita-Salute San Raffaele University, Milan, Italy (R.B., L.C., E.D.M., M.F.)
| | - Ermelinda De Meo
- From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (R.B., E.P., A.M., L.C., P.P., E.D.M., M.F., M.A.R.), Neurology Unit (R.B., L.C., P.P., E.D.M., M.F., M.A.R.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; and Vita-Salute San Raffaele University, Milan, Italy (R.B., L.C., E.D.M., M.F.)
| | - Massimo Filippi
- From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (R.B., E.P., A.M., L.C., P.P., E.D.M., M.F., M.A.R.), Neurology Unit (R.B., L.C., P.P., E.D.M., M.F., M.A.R.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; and Vita-Salute San Raffaele University, Milan, Italy (R.B., L.C., E.D.M., M.F.)
| | - Maria A Rocca
- From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (R.B., E.P., A.M., L.C., P.P., E.D.M., M.F., M.A.R.), Neurology Unit (R.B., L.C., P.P., E.D.M., M.F., M.A.R.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; and Vita-Salute San Raffaele University, Milan, Italy (R.B., L.C., E.D.M., M.F.)
| |
Collapse
|
14
|
De Meo E, Meani A, Moiola L, Ghezzi A, Veggiotti P, Filippi M, Rocca MA. Dynamic gray matter volume changes in pediatric multiple sclerosis. Neurology 2019; 92:e1709-e1723. [DOI: 10.1212/wnl.0000000000007267] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/29/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectivesTo assess, using MRI, the spatial patterns of gray matter (GM) atrophy in pediatric patients with multiple sclerosis (MS), their dynamic changes over time, and their clinical relevance.MethodsSixty-eight pediatric patients with MS (30 with a clinical and MRI follow-up after 3.5 years) and 26 healthy controls (HC) underwent clinical and MRI evaluation. To overcome difficulties in obtaining longitudinal scans in pediatric HC, a group of 317 pediatric HC from an NIH-funded MRI Study of Normal Brain Development was used to estimate GM developmental trajectories. In pediatric patients with MS, deviations from normative GM volume values at the voxel level were assessed at baseline and during the follow-up, using linear mixed-effects models. Correlations between GM volume deviations and disability, IQ, and white matter (WM) lesion volumes (LV) were estimated.ResultsPediatric patients with MS showed failures in GM development in several cortical and subcortical regions, as well as GM atrophy progression in most of these regions, which were only partially related to focal WM LV. Significant correlations were found between regional GM atrophy (particularly of deep GM regions) and disability, whereas higher IQ was associated with reduced deviations from age-expected GM volumes of specific GM regions at baseline and during the follow-up.ConclusionsImpaired GM maturation occurs in pediatric patients with MS, which is only partially driven by WM inflammation, suggesting that early neurodegenerative phenomena contribute to disability. High IQ, a measure of reserve, may offer protection by promoting remodeling of GM pruning in this young age.
Collapse
|
15
|
Pagani E, Rocca MA, De Meo E, Horsfield MA, Colombo B, Rodegher M, Comi G, Filippi M. Structural connectivity in multiple sclerosis and modeling of disconnection. Mult Scler 2019; 26:220-232. [PMID: 30625050 DOI: 10.1177/1352458518820759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 01/14/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is characterized by focal white matter damage, and when the brain is modeled as a network, lesions can be treated as disconnection events. OBJECTIVE To evaluate whether modeling disconnection caused by lesions helps explain motor and cognitive impairment in MS. METHODS Pathways connecting 116 cortical regions were reconstructed with magnetic resonance imaging (MRI) tractography from diffusion tensors averaged across healthy controls (HCs); maps of pathways were applied to 227 relapse-onset MS patients and 50 HCs to derive structural connectivity. Then, the likelihood of individual connections passing through lesions was used to model disconnection. Patients were grouped according to clinical phenotype (113 relapsing-remitting multiple sclerosis (RRMS), 69 secondary progressive multiple sclerosis (SPMS), 45 benign MS), and then network metrics were compared between groups (analysis of variance (ANOVA)) and correlated with motor and cognitive scores (linear regression). RESULTS Global metrics differentiated RRMS from SPMS and benign MS patients, but not benign from SPMS patients. Nodal connectivity strength replicated global results. After disconnection, few nodes were significantly different between benign MS and RRMS patients. Correlations revealed nodes pertinent to motor and cognitive dysfunctions; these became slightly stronger after disconnection. CONCLUSION Connectivity did not change greatly after modeled disconnection, suggesting that the brain network is robust against damage caused by MS lesions.
Collapse
Affiliation(s)
- Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ermelinda De Meo
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Bruno Colombo
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Mariaemma Rodegher
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
16
|
De Meo E, Moiola L, Ghezzi A, Veggiotti P, Capra R, Amato MP, Pagani E, Fiorino A, Pippolo L, Pera MC, Comi G, Falini A, Filippi M, Rocca MA. MRI substrates of sustained attention system and cognitive impairment in pediatric MS patients. Neurology 2017; 89:1265-1273. [DOI: 10.1212/wnl.0000000000004388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023] Open
Abstract
Objective:To explore the structural and functional integrity of the sustained attention system in patients with pediatric multiple sclerosis (MS) and its effect on cognitive impairment.Methods:We enrolled 57 patients with pediatric MS and 14 age- and sex-matched healthy controls (HCs). Patients with >3 abnormal tests at neuropsychological evaluation were classified as cognitively impaired (CI). Sustained attention system activity was studied with fMRI during the Conners Continuous Performance Test (CCPT). Structural integrity of attention network connections was quantified with diffusion tensor (DT) MRI.Results:Within-group analysis showed similar patterns of recruitment of the attention network in HCs and patients with pediatric MS. Diffuse network DT MRI structural abnormalities were found in patients with MS. During CCPT, with increasing task demand, patients with pediatric MS showed increased activation of the left thalamus, anterior insula, and anterior cingulate cortex (ACC) and decreased recruitment of the right precuneus compared to HCs. Thirteen patients (23%) were classified as CI. Compared to cognitively preserved patients, CI patients with pediatric MS had decreased recruitment of several areas located mainly in parietal and occipital lobes and cerebellum and increased deactivation of the ACC, combined with more severe structural damage of white matter tracts connecting these regions.Conclusions:Our results suggest that the age-expected level of sustained attention system functional competence is achieved in patients with pediatric MS. Inefficient regulation of the functional interaction between different areas of this system, due to abnormal white matter integrity, may result in global cognitive impairment in these patients.
Collapse
|
17
|
Rocca MA, De Meo E, Amato MP, Copetti M, Moiola L, Ghezzi A, Veggiotti P, Capra R, Fiorino A, Pippolo L, Pera MC, Falini A, Comi G, Filippi M. Cognitive impairment in paediatric multiple sclerosis patients is not related to cortical lesions. Mult Scler 2014; 21:956-9. [DOI: 10.1177/1352458514557303] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/06/2014] [Indexed: 11/17/2022]
Abstract
We investigated the contribution of cortical lesions to cognitive impairment in 41 paediatric MS patients. Thirteen (32%) paediatric MS patients were considered as cognitively impaired. T2-hyperintense and T1-hypointense white matter lesion volumes did not differ between cognitively impaired and cognitively preserved MS patients. Cortical lesions number, cortical lesions volume and grey matter volume did not differ between cognitively impaired and cognitively preserved patients, whereas white matter volume was significantly lower in cognitively impaired versus cognitively preserved MS patients ( p=0.01). Contrary to adult MS, cortical lesions do not seem to contribute to cognitive impairment in paediatric MS patients, which is likely driven by white matter damage.
Collapse
Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ermelinda De Meo
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria P Amato
- Department of Neurology, University of Florence, Italy
| | - Massimiliano Copetti
- Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, Foggia, Italy
| | - Lucia Moiola
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Centre, Ospedale di Gallarate, Italy
| | | | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Italy
| | - Agnese Fiorino
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Maria C Pera
- Fondazione ‘Istituto Neurologico Casimiro Mondino’, Pavia, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
18
|
Bernelli C, Chieffo A, Montorfano M, Maisano F, Giustino G, Buchanan GL, Chan J, Costopoulos C, Latib A, Figini F, De Meo E, Giannini F, Covello RD, Gerli C, Franco A, Agricola E, Spagnolo P, Cioni M, Alfieri O, Camici PG, Colombo A. Usefulness of Baseline Activated Clotting Time–Guided Heparin Administration in Reducing Bleeding Events During Transfemoral Transcatheter Aortic Valve Implantation. JACC Cardiovasc Interv 2014; 7:140-151. [DOI: 10.1016/j.jcin.2013.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/20/2013] [Accepted: 10/24/2013] [Indexed: 10/25/2022]
|
19
|
Bernelli C, Chieffo A, Montorfano M, Maisano F, Chan J, Giustino G, Costopoulos C, De Meo E, Giannini F, Latib A, Carlino M, Figini F, Buchanan GL, Covello RD, Gerli C, Franco A, Agricola E, Spagnolo P, Cioni M, Alfieri O, Colombo A. TCT-761 Usefulness of Activated Clotting Time Guided Heparin Administration in Reducing Bleeding Events during Trans-femoral Transcatheter Aortic Valve Implantation. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
20
|
Chieffo A, Buchanan G, Latib A, Franzoni I, Montorfano M, Maisano F, Cioni M, Figini F, Agricola E, La Canna G, Covello R, Franco A, Gerli C, Spagnolo P, De Meo E, Durante A, Ferrari A, Alfieri O, Colombo A. TCT-841 One Year Outcomes following Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement In Patients Over 75 Years ‘The Elderly Pilot Study’. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|