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Solaro C, Di Giovanni R, Grange E, Mueller M, Messmer Uccelli M, Bertoni R, Brichetto G, Tacchino A, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Marengo D. Box and block test, hand grip strength and nine-hole peg test: correlations between three upper limb objective measures in multiple sclerosis. Eur J Neurol 2020; 27:2523-2530. [PMID: 32619066 DOI: 10.1111/ene.14427] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/03/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Limited data are available in the literature for upper limb impairment in multiple sclerosis (MS). This study aimed to report the distribution of values of hand grip strength (HGS), of the box and block test (BBT) and of the nine-hole peg test (9HPT) correlated with demographic and clinical data in subjects with MS. METHODS This study involved five Italian neurological centres. The inclusion criteria were age ≥ 18, MS diagnosis, stable disease phase, right-hand dominance. All subjects underwent HGS, BBT and 9-HPT evaluation. RESULTS In all, 202 subjects with MS were enrolled: 137 females; mean age 48.4 years; mean Expanded Disability Status Scale (EDSS) 4.17; mean disease duration 14.12 years; disease course 129 relapsing-remitting, 21 primary progressive and 52 secondary progressive MS subjects; mean right HGS 25.3 kg, left 23.2 kg; mean right BBT 45.7 blocks, left 44.9 blocks; mean right 9-HPT 30.7 s, left 33.4 s. All results were statistically significantly different compared to healthy controls. HGS, BBT and 9-HPT were associated with age, EDSS and disease duration, whilst disease course correlated with BBT and 9-HPT. The BBT and 9-HPT scores significantly differed according to level of disability (EDSS ≤3.0, 3.5-5.5, ≥6.0). CONCLUSION Hand grip strength and BBT value distribution in a large MS population is reported. Correlations between HGS, BBT and 9-HPT were generally low.
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Affiliation(s)
- C Solaro
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - R Di Giovanni
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - E Grange
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - M Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - M Messmer Uccelli
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - R Bertoni
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - A Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - F Patti
- MS Center Institute of Neurological Sciences - University of Catania, Catania, Italy
| | - A Pappalardo
- MS Center Institute of Neurological Sciences - University of Catania, Catania, Italy
| | - L Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - L Castelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC neuroriabilitazione ad Alta Intensità, Roma, Italy
| | - R Rosato
- Department of Psychology, University of Turin, Torino, Italy
| | - D Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - D Marengo
- Department of Psychology, University of Turin, Torino, Italy
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Solaro C, Grange E, Di Giovanni R, Cattaneo D, Bertoni R, Prosperini L, Messmer Uccelli M, Marengo D. Nine Hole Peg Test asymmetry in refining upper limb assessment in multiple sclerosis. Mult Scler Relat Disord 2020; 45:102422. [PMID: 32731199 DOI: 10.1016/j.msard.2020.102422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/02/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Expanded Disability Status Scale (EDSS) is the most frequently used scale to measure neurologic impairment and quantify the level of disability in Multiple Sclerosis (MS) even though the scale focuses on ambulation and undervalues upper limb (UL) impairment. The 9-Hole Peg Test (9-HPT) is the gold standard for UL assessment in MS, calculating a mean score from right and left arms, even though subjects with MS often show a lateralization of neurological deficit. OBJECTIVE The study aimed to determine whether an interaction exists between mean right-left 9-HPT scores or 9HPT score asymmetry (difference between right and left side) in predicting EDSS in MS subjects. METHODS Demographic and disease variables and 9-HPT scores were obtained from medical records of individuals with MS collected in an ad-hoc database. Subjects with 9-HPT score ≤180 s for each arm were included. An asymmetry score was represented as the absolute value of the difference between 9-HPT scores for both arms. RESULTS 549 subjects were included: 67.8% female, mean age 45±13.14 years, mean EDSS 3.98±2.12, 356 relapsing-remitting, 68 primary and 125 secondary progressive, mean 9-HPT scores: right arm 30.20 ± 19.99 s, left arm 31.80 ± 20.35 s. Mean asymmetry was 9.35±18.20 s. Correlation between mean right-left 9-HPT scores and EDSS was 0.58 (p<.001). Significant interaction between mean right-left 9-HPT scores and 9-HPT asymmetry in predicting EDSS scores was found. Regression slope of EDSS on mean right-left 9-HPT score decreases as asymmetry value increases (non-significance area values ≥ 40.93 s). CONCLUSIONS Findings suggest interaction exists between mean right-left 9-HPT scores and asymmetry in predicting EDSS. A consequence of this is that, by disregarding information about asymmetry, studies exploring the association between mean right-left 9-HPT scores and global measures of disability may provide biased results. The bias tends to increase as asymmetry increases, and to be most prevalent among patients with EDSS scores > 6.
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Affiliation(s)
- C Solaro
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy.
| | - E Grange
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
| | - R Di Giovanni
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
| | - D Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - R Bertoni
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - L Prosperini
- Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - D Marengo
- Department of Psychology, University of Turin, Torino, Italy
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Tortorella C, Solaro C, Annovazzi P, Boffa L, Buscarinu MC, Buttari F, Calabrese M, Cavalla P, Cocco E, Cordioli C, De Luca G, Di Filippo M, Fantozzi R, Ferraro D, Gajofatto A, Gallo A, Lanzillo R, Laroni A, Fermo SL, Malucchi S, Maniscalco GT, Moccia M, Nociti V, Paolicelli D, Pesci I, Prosperini L, Ragonese P, Tomassini V, Clerici VLAT, Rodegher M, Gherardi M, Gasperini C. Informing MS patients on treatment options: a consensus on the process of consent taking. Neurol Sci 2020; 41:2249-2253. [PMID: 32240416 DOI: 10.1007/s10072-020-04339-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
In the last years, change in multiple sclerosis (MS) therapeutic scenario has highlighted the need for an improved doctor-patient communication in advance of treatment initiation in order to allow patient's empowerment in the decision-making process. AIMS: The aims of our project were to review the strategies used by Italian MS specialists to inform patients about treatment options and to design a multicentre shared document that homogenizes the information about disease-modifying treatment (DMTs) and the procedure of taking informed consent in clinical practice. RESULTS: The new resource, obtained by consensus among 31 neurologists from 27 MS Centres in Italy with the supervision of a medico-legal advisor, received the aegis of Italian Neurological Society (SIN) and constitutes a step toward a standardized decision process around DMTs in MS.
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Affiliation(s)
- C Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.
| | - C Solaro
- Department of Rehabilitation, Mons L Novarese Hospital, Moncrivello, Italy
| | - P Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona, PO di Gallarate, (VA), Italy
| | - L Boffa
- Department of Neurosciences, MS Center, Tor Vergata University, Rome, Italy
| | - M C Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs Sapienza University Rome, Rome, Italy
| | - F Buttari
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - M Calabrese
- Neurology B, Department of Neurosciences Biomedicine and Movements, University of Verona, Verona, Italy
| | - P Cavalla
- MS Center (P.C.), City of Health & Science University Hospital, Turin, Italy
| | - E Cocco
- Department Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - C Cordioli
- Multiple Sclerosis Center, ospedale di Montichiari, Spedali Civili di Brescia, Montichiari, Italy
| | - G De Luca
- Neurology Clinic, Multiple Sclerosis Center SS. Annunziata Hospital, Chieti, Italy
| | - M Di Filippo
- Clinica Neurologica, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - R Fantozzi
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - D Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Science, University of Campania, Naples, Italy
| | - R Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - A Laroni
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Lo Fermo
- Clinica Neurologica A.O.U. Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - S Malucchi
- Neurologia 2-CRESM, AOU San Luigi Gonzaga, Orbassano, Italy
| | - G T Maniscalco
- Department of Neurology and Stroke Unit, "A. Cardarelli Hospital", Naples, Italy
| | - M Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.,Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - V Nociti
- Istituto di Neurologia, Fondazione Policlinico Universitario 'A Gemelli' IRCCS, Rome, Italy
| | - D Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - I Pesci
- Ospedale di Vaio, Centro SM, Fidenza, Parma, Italy
| | - L Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - P Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Palermo, Italy
| | - V Tomassini
- Department of Neurosciences, Imaging and Clinical Sciences, School of Medicine, Institute for Advanced Biomedical Technologies (ITAB), University of Chieti-Pescara "G. d'Annunzio, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - V L A Torri Clerici
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - M Rodegher
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Gherardi
- SC Medicina Legale AUSL Valle D'Aosta, Aosta, Italy
| | - C Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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Mancini P, Bottaro V, Capitani F, De Soccio G, Prosperini L, Restaino P, De Vincentiis M, Greco A, Bertoli GA, De Seta D. Recurrent Bell's palsy: outcomes and correlation with clinical comorbidities. Acta Otorhinolaryngol Ital 2019; 39:316-321. [PMID: 31708578 PMCID: PMC6843582 DOI: 10.14639/0392-100x-2415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 11/18/2018] [Indexed: 11/23/2022]
Affiliation(s)
- P Mancini
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - V Bottaro
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - F Capitani
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - G De Soccio
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - L Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - P Restaino
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - M De Vincentiis
- Department of Oral and Maxillo-Facial Surgery, University Sapienza of Rome, Italy
| | - A Greco
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - G A Bertoli
- Department of Sense Organs, University Sapienza of Rome, Italy
| | - D De Seta
- Department of Oral and Maxillo-Facial Surgery, University Sapienza of Rome, Italy
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Scarpazza C, Prosperini L, Mancinelli C, De Rossi N, Lugaresi A, Capobianco M, Moiola L, Naldi P, Imberti L, Gerevini S, Capra R. Corrigendum to “Is maraviroc useful in multiple sclerosis patients with natalizumab-related progressive multifocal leukoencephalopathy?” [J. Neurol. Sci. 378 (2017) 233–237]. J Neurol Sci 2017; 380:19. [DOI: 10.1016/j.jns.2017.06.037] [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: 10/19/2022]
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De Giglio L, Upadhyay N, De Luca F, Prosperini L, Tona F, Petsas N, Pozzilli C, Pantano P. Corpus callosum microstructural changes associated with Kawashima Nintendo Brain Training in patients with multiple sclerosis. J Neurol Sci 2016; 370:211-213. [DOI: 10.1016/j.jns.2016.09.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 12/24/2022]
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Giovannelli M, Borriello G, Castri P, Prosperini L, Pozzilli C. Early physiotherapy after injection of botulinum toxin increases the beneficial effects on spasticity in patients with multiple sclerosis. Clin Rehabil 2016; 21:331-7. [PMID: 17613573 DOI: 10.1177/0269215507072772] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective : To determine whether additional physiotherapy increases botulinum toxin type A effects in reducing spasticity in patients with multiple sclerosis. Design : A single-blind, randomized, controlled pilot trial with a 12-week study period. Subjects : Thirty-eight patients with progressive multiple sclerosis affected by focal spasticity and who were observed at the Multiple Sclerosis Centre operating in the S. Andrea Hospital in Rome. Interventions : For intervention all patients received botulinum toxin type A; the treatment group also received additional physiotherapy to optimize management through passive or active exercise and stretching regimens. Main measures : To measure objective and subjective level of spasticity, patients were assessed at baseline, 2, 4 and 12 weeks post treatment by Modified Ashworth Scale and visual analogue scale. Results : When compared with the control group, we found a significant decrease of spasticity by Modified Ashworth Scale (P < 0.01 by t-test) in the treatment group at week 2 (2.73 versus 3.22), week 4 (2.64 versus 3.33) and week 12 (2.68 versus 3.33). The mean (%) difference in Modified Ashworth Scale score between baseline and the end of follow-up was —0.95 (26.1) in the treatment group and —0.28 (7.7) in the control group (P < 0.01). The combined treatment proved also to be more effective by visual analogue scale (P < 0.01) at week 4 (6.95 versus 5.50) and at week 12 (7.86 versus 6.56) but not at week 2 (5.18 versus 5.50; P = 0.41). Conclusions : Our data suggest that physiotherapy in combination with botulinum toxin type A injection can improve overall response to botulinum toxin.
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Affiliation(s)
- M Giovannelli
- Multiple Sclerosis Centre, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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Annovazzi P, Capobianco M, Moiola L, Patti F, Frau J, Uccelli A, Centonze D, Perini P, Tortorella C, Prosperini L, Lus G, Fuiani A, Falcini M, Martinelli V, Comi G, Ghezzi A. Rituximab in the treatment of Neuromyelitis optica: a multicentre Italian observational study. J Neurol 2016; 263:1727-35. [PMID: 27286847 DOI: 10.1007/s00415-016-8188-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 01/10/2023]
Abstract
Rituximab (RTX) efficacy in NMO is suggested by several case series. No consensus exists on optimal dosing strategies. At present the treatment schedules more frequently used are 375 mg/m2/week iv for 4 weeks (RTX-A) and 1000 mg iv twice, 2 weeks apart (RTX-B). Aim of this study is to confirm RTX efficacy and safety in the treatment of NMO and to evaluate whether a most favourable dosage regimen exists. Data on RTX-treated NMO patients were collected from 13 Italian Hospitals. 73 patients (64 F), were enlisted. RTX-A was administered in 42/73 patients, RTX-B in 31/73. Median follow-up was 27 months (range 7-106). Mean relapse rate in the previous year before RTX start was 2.2 ± 1.3 for RTX-A and 2.3 ± 1.2 for RTX-B. ARR in the first year of treatment was 0.8 ± 0.9 for RTX-A and 0.2 ± 0.4 for RTX-B, in the second year of treatment was 0.9 ± 1.5 for RTX-A and 0.4 ± 0.8 for RTX-B patients (p = 0.001 for the first year, ns (0.09) for the second year). RTX-B was more effective in delaying the occurrence of a relapse (HR 2.2 (95 % IC 1.08-4.53) p = 0.02). Adverse events were described in 19/73 patients (mainly urinary tract and respiratory infections, and infusion reactions). Two deaths were reported in severely disabled patients. Though with the limitations of an observational study, our data support RTX efficacy in NMO and suggest that high dose pulses might be more effective than a more fractioned dose.
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Affiliation(s)
- Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy.
| | - M Capobianco
- Regional MS Center, University Hospital S. Luigi Gonzaga, Orbassano (TO), Italy
| | - L Moiola
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - F Patti
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - J Frau
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - A Uccelli
- Department of Neurosciences Ophtalmology and Genetics, University of Genoa, Genoa, Italy
| | - D Centonze
- Department of Neurology I and neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - P Perini
- Department of Neurology, AO University of Padova, Padua, Italy
| | - C Tortorella
- Departments of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - L Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - G Lus
- Department of Neurological Sciences, School of Medicine, Second University of Naples, Policlinico Federico II, Naples, Italy
| | - A Fuiani
- Department of Neurosciences, Multiple Sclerosis Unit, General Hospital, "OORR", Foggia, Italy
| | - M Falcini
- Multiple Sclerosis Center, Ospedale Misericordia e Dolce, Prato, Italy
| | - V Martinelli
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - G Comi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - A Ghezzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy
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9
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Cattaneo D, Carpinella I, Aprile I, Prosperini L, Montesano A, Jonsdottir J. Comparison of upright balance in stroke, Parkinson and multiple sclerosis. Acta Neurol Scand 2016; 133:346-54. [PMID: 26234280 DOI: 10.1111/ane.12466] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS), Parkinson's disease (PD) and stroke (ST) subjects show balance impairments due to damage of the balance control system. The objective of the study was to assess the impact of MS, PD and ST on upright posture in eyes open condition and when visual and/or proprioceptive inputs are altered. MATERIALS AND METHODS A total of 188 subjects with MS (n = 80), PD (n = 58) and ST (n = 50), mean age (SD), 57.9 (14.6) years, and 32 healthy subjects (HS) aged 53.7 (15.7) years were assessed by a stabilometric platform in a cross-sectional study. RESULTS Compared to HS, MS showed large deviations from normal performances with respect to magnitude (P < 0.001) and regularity (P < 0.05) of body sway irrespective of the altered sensory information. Similarly to MS, PD showed large and abnormal levels of body sway (P < 0.001) and postural tremor (P < 0.05), while ST was the least impaired except for an asymmetrical distribution of body weight between legs (P < 0.001). Finally, the MS group compared to PD and ST showed the largest body instability after eye closure (P < 0.05) and when visual and proprioceptive inputs were removed (P < 0.05). PD showed instability mainly after the alteration of proprioceptive inputs (P < 0.05), while ST showed the smallest increase of body instability when sensory inputs were reduced. DISCUSSION Objective assessment revealed pathology-specific balance disorders and showed the differential impact of MS, PD and ST on the ability to use sensory information for balance control.
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Affiliation(s)
- D. Cattaneo
- Don Gnocchi Foundation I.R.C.C.S.; Rome Italy
| | | | - I. Aprile
- Don Gnocchi Foundation I.R.C.C.S.; Rome Italy
| | - L. Prosperini
- Department of Neurology and Psychiatry; La Sapienza University; Rome Italy
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10
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Sbardella E, Tona F, Petsas N, Upadhyay N, Piattella MC, Filippini N, Prosperini L, Pozzilli C, Pantano P. Functional connectivity changes and their relationship with clinical disability and white matter integrity in patients with relapsing–remitting multiple sclerosis. Mult Scler 2015; 21:1681-92. [DOI: 10.1177/1352458514568826] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/22/2014] [Indexed: 11/15/2022]
Abstract
Background and objective: To define the pathological substrate underlying disability in multiple sclerosis by evaluating the relationship of resting-state functional connectivity with microstructural brain damage, as assessed by diffusion tensor imaging, and clinical impairments. Methods: Thirty relapsing–remitting patients and 24 controls underwent 3T-MRI; motor abilities were evaluated by using measures of walking speed, hand dexterity and balance capability, while information processing speed was evaluated by a paced auditory serial addiction task. Independent component analysis and tract-based spatial statistics were applied to RS-fMRI and diffusion tensor imaging data using FSL software. Group differences, after dual regression, and clinical correlations were modelled with General-Linear-Model and corrected for multiple comparisons. Results: Patients showed decreased functional connectivity in 5 of 11 resting-state-networks (cerebellar, executive-control, medial-visual, basal ganglia and sensorimotor), changes in inter-network correlations and widespread white matter microstructural damage. In multiple sclerosis, corpus callosum microstructural damage positively correlated with functional connectivity in cerebellar and auditory networks. Moreover, functional connectivity within the medial-visual network inversely correlated with information processing speed. White matter widespread microstructural damage inversely correlated with both the paced auditory serial addiction task and hand dexterity. Conclusions: Despite the within-network functional connectivity decrease and the widespread microstructural damage, the inter-network functional connectivity changes suggest a global brain functional rearrangement in multiple sclerosis. The correlation between functional connectivity alterations and callosal damage uncovers a link between functional and structural connectivity. Finally, functional connectivity abnormalities affect information processing speed rather than motor abilities.
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Affiliation(s)
- Emilia Sbardella
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - F Tona
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - N Petsas
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - N Upadhyay
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - MC Piattella
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - N Filippini
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - L Prosperini
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - C Pozzilli
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - P Pantano
- Department of Neurology and Psychiatry, University of Rome, Italy
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Masera S, Cavalla P, Prosperini L, Mattioda A, Mancinelli CR, Superti G, Chiavazza C, Vercellino M, Pinessi L, Pozzilli C. Parity is associated with a longer time to reach irreversible disability milestones in women with multiple sclerosis. Mult Scler 2014; 21:1291-7. [PMID: 25533293 DOI: 10.1177/1352458514561907] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 07/16/2014] [Accepted: 11/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) frequently affects women of childbearing age. While short-term effects of pregnancy on MS course are well-known, whether pregnancy may influence long-term disability progression is debated. METHODS A two-centre retrospective study to investigate long-term effect of pregnancy on disability was performed in a population of MS women. Survival analyses and multivariate Cox proportional regression models (including early predictors of MS severity and exposure to disease-modifying treatments) were performed to compare time to reach well-established disability milestones in nulliparous women and in those with pregnancies after MS onset ('parous'). Women with pregnancies before MS onset were excluded from analyses as they represent a heterogeneous group. RESULTS Data about 445 women (261 nulliparous, 184 'parous') were analysed. A longer time to reach Expanded Disability Status Scale (EDSS) 4.0 and 6.0 was observed in parous women; Cox regression models revealed a lower risk for 'parous' than nulliparous women in reaching EDSS 4.0 and 6.0 (HR = 0.552, p = 0.008 and HR = 0.422, p = 0.012 respectively). CONCLUSION Our findings suggest that pregnancy after MS onset is associated with a slower long-term disability progression. Whether this represents a biological/immunological effect, or reflects a higher propensity toward childbearing in women with milder disease, it remains uncertain deserving further investigations.
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Affiliation(s)
- S Masera
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - P Cavalla
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - L Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - A Mattioda
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - C R Mancinelli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - G Superti
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - C Chiavazza
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - M Vercellino
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - L Pinessi
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - C Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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Bianchi V, De Giglio L, Prosperini L, Mancinelli C, De Angelis F, Barletta V, Pozzilli C. Mood and coping in clinically isolated syndrome and multiple sclerosis. Acta Neurol Scand 2014; 129:374-81. [PMID: 24172013 DOI: 10.1111/ane.12194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Few studies have examined behavioural changes in the early phase of multiple sclerosis (MS). The aim of the study is to investigate mood alterations and to explore coping strategies regarding patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS). MATERIALS AND METHODS The communication of diagnosis was made by one neurologist using a standardized approach. Depression, anxiety and coping questionnaires were filled in within 1 month from the diagnosis and at 3, 6, 12, 18 and 24 months subsequently. RESULTS Thirty-nine patients were examined (11 CIS, 28 RRMS), also 39 healthy controls. At entry, patients showed a lower degree of hostile behaviour and a higher level of depression than the controls. At follow-up, a reduction in depression, anxiety and a better coping adjustment was observed. A higher reliance on 'Accepting responsibilities' coping score was seen in patients with higher levels of depression and anxiety. No significant differences were revealed by group comparisons between CIS and RRMS. CONCLUSIONS This study highlights transient mood alterations and an improving of adaptive coping over a period of time in patients with CIS and RRMS. Similar emotional reactions and coping in clinical subgroups suggest that these factors are independent from the type of information provided during the communication of the diagnosis.
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Affiliation(s)
- V. Bianchi
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
| | - L. De Giglio
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
- Department of Psychology; Sapienza University; Rome Italy
| | - L. Prosperini
- Department of Neurology and Psychiatry; Sapienza University; Rome Italy
| | - C. Mancinelli
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
| | - F. De Angelis
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
| | - V. Barletta
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
| | - C. Pozzilli
- Department of Neurology and Psychiatry; Sapienza University; Rome Italy
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13
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Ruoppolo G, Schettino I, Frasca V, Giacomelli E, Prosperini L, Cambieri C, Roma R, Greco A, Mancini P, De Vincentiis M, Silani V, Inghilleri M. Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings. Acta Neurol Scand 2013; 128:397-401. [PMID: 23668293 DOI: 10.1111/ane.12136] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To characterize swallowing deficits in amyotrophic lateral sclerosis (ALS); investigate the delay in dysphagia onset; estimate correlations between dysphagia severity and patients' functional status; identify the symptom(s) most likely to predict dysphagia. MATERIALS AND METHODS A group of 49 consecutive patients with ALS, 14 with bulbar onset and 35 with spinal onset, underwent swallowing evaluation including bedside and fiberoptic endoscopic examination to detect dysphagia. RESULTS Patients with dysphagia were more likely than those without to have bulbar onset ALS (P = 0.02); more severely impaired chewing (P = 0.01); and tongue muscle deficits (P = 0.001). The only variable measured at first examination significantly associated with dysphagia was a more than mild tongue muscle deficit. The only variable useful in predicting dysphagia was a chewing deficit. In 10 of the 49 patients studied, swallowing evaluation disclosed an impaired cough reflex. CONCLUSIONS Dysphagia in patients with ALS correlates significantly with bulbar onset and with oral swallowing impairment. Fiberoptic swallowing evaluation is a useful tool for detecting swallowing deficits and laryngeal sensitivity in patients with ALS. An impaired cough reflex is an unexpected finding in many patients with ALS.
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Affiliation(s)
- G. Ruoppolo
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - I. Schettino
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - V. Frasca
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - E. Giacomelli
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - L. Prosperini
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - C. Cambieri
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - R. Roma
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - A. Greco
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - P. Mancini
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - M. De Vincentiis
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - V. Silani
- Department of Neurological Sciences; University of Milan; Milan Italy
| | - M. Inghilleri
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
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Borriello G, Prosperini L, Mancinelli C, Giannì C, Fubelli F, Pozzilli C. Pulse monthly steroids during an elective interruption of natalizumab: a post-marketing study. Eur J Neurol 2011; 19:783-7. [DOI: 10.1111/j.1468-1331.2011.03577.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Prosperini L, Borriello G, Fubelli F, Marinelli F, Pozzilli C. Natalizumab treatment in multiple sclerosis: the experience of S. Andrea MS Centre in Rome. Neurol Sci 2010; 31 Suppl 3:303-7. [DOI: 10.1007/s10072-010-0348-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND AND PURPOSE To define the predictive value of clinical and magnetic resonance imaging (MRI) characteristics in identifying relapsing-remitting multiple sclerosis (RR-MS) patients with sustained disability progression during interferon beta (IFNB) treatment. METHODS All patients receiving treatment with one of the available IFNB formulations for at least 1 year were included in this single-centre, prospective and post-marketing study. Demographic, clinical and MRI data were collected at IFNB start and at 1 year of therapy; patients were followed-up at least yearly. Poor clinical response was defined as the occurrence of a sustained disability progression of > or =1 point in the Expanded Disability Status Scale (EDSS) during the follow-up period. RESULTS Out of 454 RR-MS patients starting IFNB therapy, data coming from 394 patients with a mean follow-up of 4.8 (2.4) years were analysed. Sixty patients were excluded because of too short follow-up. Less than 1/3 (30.4%) of the patients satisfied the criterion of 'poor responders'. Patients presenting new lesions on T2-weighted MRI scan after 1 year of therapy (compared with baseline) had a higher risk of being poor responder to treatment with IFNB during the follow-up period (HR 16.8, 95% CI 7.6-37.1, P < 0.001). An augmented risk increasing the number of lesions was observed, with a 10-fold increase for each new lesion. CONCLUSIONS Developing new T2-hyperintense lesions during IFNB treatment was the best predictor of long-term poor response to therapy. MRI scans performed after 1 year of IFNB treatment may be useful in contributing to early identification of poor responders.
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Affiliation(s)
- L Prosperini
- Multiple Sclerosis Centre, Department of Neurological Sciences, S. Andrea Hospital, La Sapienza University, Rome, Italy
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Pozzilli C, Prosperini L, Sbardella E, Paolillo A. Interferon after 10 years in patients with multiple sclerosis. Neurol Sci 2006; 27 Suppl 5:S369-72. [PMID: 16998723 DOI: 10.1007/s10072-006-0697-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 03/27/2006] [Accepted: 07/19/2006] [Indexed: 11/25/2022]
Abstract
Multiple sclerosis (MS) is a life-long disease that typically affects young adults. The introduction of disease-modifying therapy has changed the clinical and social burden of the disease. Safety, tolerability and efficacy profiles of Interferon beta (IFNbeta) therapy in MS have been widely highlighted both in trial settings and in daily clinical practice. However, there is a relative lack of information on the long-term period: all pivotal trials must be considered short-term in a disease with an average duration of 30-40 years and post-marketing studies suffer from some limitations. Moreover, current available IFNbeta preparations are only partially effective and are difficult to administer, which has led to poor patient compliance. Over the treatment period, a problem could be the development of neutralising antibodies (NAbs) against the drug, which have been related to lessening treatment benefits. Despite these restrictions, IFNbeta still remains the first choice treatment in MS.
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Affiliation(s)
- C Pozzilli
- Department of Neurological Sciences, La Sapienza University, Viale dell'Università 30, I-00185 Rome, Italy.
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Pozzilli C, Prosperini L, Sbardella E, De Giglio L, Onesti E, Tomassini V. Post-marketing survey on clinical response to interferon beta in relapsing multiple sclerosis: the Roman experience. Neurol Sci 2006; 26 Suppl 4:S174-8. [PMID: 16388353 DOI: 10.1007/s10072-005-0510-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Safety, tolerability and efficacy profiles of interferon beta (IFNbeta) therapy in relapsing multiple sclerosis (MS) has been widely verified both in trial settings and in daily clinical practice. However, for a variable percentage of treated patients, it remains only partially effective. In this study, we reported the post-marketing experience of the efficacy of IFNbeta therapy for a large cohort of MS patients regularly attending the MS Outpatient Clinic of "La Sapienza University" in Rome. In this cohort we also sought clinical and paraclinical variables responsible for the clinical course of MS during IFNbeta therapy. Patients that received treatment with one of the IFNbeta formulations for at least 1 year were included. Clinical outcomes (i. e., relapses and disability score) were monitored throughout the entire study period. Magnetic resonance imaging (MRI) scans were performed twice for each subject: at baseline and after 1 year of therapy. The occurrence of more than one relapse during the study period or a sustained disability progression in the Expanded Disability Status Scale (EDSS) score were considered as criteria for the definition of suboptimal clinical response to IFNbeta therapy. During IFNbeta therapy (number of patients 242, mean length of treatment 4.3+/-2.3 years) a reduction in the annualised relapse rate of 59% (p<0.001) was observed. Eighty-six patients (35%) fulfilled the criterion for defining "suboptimal responder" on the basis of relapses, and 69 (28.5%) did the same on the basis of EDSS sustained progression. Twenty-seven (11.1%) patients showed both an EDSS progression and two or more relapses. The presence of T1-enhancing lesions and new T2 hyperintense lesions on the scan performed after the first year of therapy were the best MRI features associated with both the occurrence of relapses during the treatment period (OR for enhancing lesions and relapses 3.6; OR for new T2 lesion and relapses 2.8). The present post-marketing experience confirms the efficacy of IFNbeta in modifying the natural course of MS and encourages the use of paraclinical variables measuring subclinical disease activity as surrogate markers to monitor the clinical course of MS during IFNbeta therapy.
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Affiliation(s)
- C Pozzilli
- Department of Neurological Sciences, La Sapienza University, Viale dell'Università 30, I-00185, Rome, Italy.
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