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Mariottini A, Barilaro A, Lotti A, Marra F, Massacesi L. Successful switch to ofatumumab after liver injury associated with ocrelizumab treatment in multiple sclerosis: a case report. Front Neurol 2024; 15:1363493. [PMID: 38487332 PMCID: PMC10937462 DOI: 10.3389/fneur.2024.1363493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Drug-induced liver injury (DILI) is a potential adverse event of disease-modifying therapies (DMTs) for the treatment of multiple sclerosis (MS), as well as of methylprednisolone pulsed therapy used in case of MS relapse. DILI may be induced by different mechanisms, including idiosyncratic reaction, autoimmune hepatitis or viral reactivation. In patients receiving the humanized anti-CD20 monoclonal antibody (mAb) ocrelizumab, DILI has been rarely reported and was mostly associated with hepatitis B virus (HBV) reactivation. Here we present the case of a woman with highly active relapsing-remitting MS who had experienced two episodes of DILI while receiving different DMTs, and was successfully switched to ofatumumab, a fully human anti-CD20 mAb, after a further event associated with ocrelizumab treatment and unrelated to HBV reactivation. Despite sharing the mechanism of action, differences in structure, pharmacokinetic/pharmacodynamic profile, and use of ancillary drugs (only needed for ocrelizumab) may have accounted for the successful switch. To our knowledge, this is the first report of a successful switch from ocrelizumab to ofatumumab due to DILI. Ofatumumab may therefore represent a valid therapeutic option for patients experiencing DMTs- and ocrelizumab-induced liver injury, providing that HBV reactivation has been ruled out.
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Affiliation(s)
- Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Antonio Lotti
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Fabio Marra
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
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Mariottini A, Nozzoli C, Carli I, Landi F, Gigli V, Repice AM, Ipponi A, Cecchi M, Boncompagni R, Saccardi R, Massacesi L. Cost and effectiveness of autologous haematopoietic stem cell transplantation and high-efficacy disease-modifying therapies in relapsing-remitting multiple sclerosis. Neurol Sci 2024:10.1007/s10072-024-07308-y. [PMID: 38277051 DOI: 10.1007/s10072-024-07308-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Autologous haematopoietic stem cell transplantation (AHSCT) is a highly effective one-off treatment for relapsing-remitting multiple sclerosis (RR-MS), potentially representing an optimal front-loading strategy for costs. OBJECTIVE Exploring cost/effectiveness of AHSCT and high-efficacy disease-modifying treatments (HE-DMTs) in RR-MS, estimating costs at our centre in Italy, where National Health Service (NHS) provides universal health coverage. METHODS Costs (including drugs, inpatient/outpatient management) for treatment with AHSCT and HE-DMTs were calculated as NHS expenditures over 2- and 5-year periods. Cost-effectiveness for each treatment was estimated as "cost needed to treat" (CNT), i.e. expense to prevent relapses, progression, or disease activity (NEDA) in one patient over n-years, retrieving outcomes from published studies. RESULTS Costs of AHSCT and HE-DMTs were similar over 2 years, whereas AHSCT was cheaper than most HE-DMTs over 5 years (€46 600 vs €93 800, respectively). When estimating cost-effectiveness of treatments, over 2 years, mean CNT of HE-DMTs for NEDA was twofold that of AHSCT, whereas it was similar for relapses and disability. Differences in CNT were remarkable over 5 years, especially for NEDA, being mean CNT of HE-DMTs €382 800 vs €74 900 for AHSCT. CONCLUSIONS AHSCT may be highly cost-effective in selected aggressive RR-MS. Besides priceless benefits for treated individuals, cost-savings generated by AHSCT may contribute to improving healthcare assistance at a population level.
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Affiliation(s)
- Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy.
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy.
| | - Chiara Nozzoli
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Ilaria Carli
- Hospital Management, UOC Controllo Direzionale, Careggi University Hospital, Florence, Italy
| | - Filippo Landi
- Hospital Management, UOC Controllo Direzionale, Careggi University Hospital, Florence, Italy
| | - Valentina Gigli
- Hospital Management, UOC Controllo Direzionale, Careggi University Hospital, Florence, Italy
| | - Anna Maria Repice
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | | | - Michele Cecchi
- Hospital Pharmacy, Careggi University Hospital, Florence, Italy
| | - Riccardo Boncompagni
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Riccardo Saccardi
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
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Bellanca CM, Augello E, Mariottini A, Bonaventura G, La Cognata V, Di Benedetto G, Cantone AF, Attaguile G, Di Mauro R, Cantarella G, Massacesi L, Bernardini R. Disease Modifying Strategies in Multiple Sclerosis: New Rays of Hope to Combat Disability? Curr Neuropharmacol 2024; 22:1286-1326. [PMID: 38275058 PMCID: PMC11092922 DOI: 10.2174/1570159x22666240124114126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 01/27/2024] Open
Abstract
Multiple sclerosis (MS) is the most prevalent chronic autoimmune inflammatory- demyelinating disorder of the central nervous system (CNS). It usually begins in young adulthood, mainly between the second and fourth decades of life. Usually, the clinical course is characterized by the involvement of multiple CNS functional systems and by different, often overlapping phenotypes. In the last decades, remarkable results have been achieved in the treatment of MS, particularly in the relapsing- remitting (RRMS) form, thus improving the long-term outcome for many patients. As deeper knowledge of MS pathogenesis and respective molecular targets keeps growing, nowadays, several lines of disease-modifying treatments (DMT) are available, an impressive change compared to the relative poverty of options available in the past. Current MS management by DMTs is aimed at reducing relapse frequency, ameliorating symptoms, and preventing clinical disability and progression. Notwithstanding the relevant increase in pharmacological options for the management of RRMS, research is now increasingly pointing to identify new molecules with high efficacy, particularly in progressive forms. Hence, future efforts should be concentrated on achieving a more extensive, if not exhaustive, understanding of the pathogenetic mechanisms underlying this phase of the disease in order to characterize novel molecules for therapeutic intervention. The purpose of this review is to provide a compact overview of the numerous currently approved treatments and future innovative approaches, including neuroprotective treatments as anti-LINGO-1 monoclonal antibody and cell therapies, for effective and safe management of MS, potentially leading to a cure for this disease.
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Affiliation(s)
- Carlo Maria Bellanca
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Egle Augello
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Alice Mariottini
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Gabriele Bonaventura
- Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, 95126 Catania, Italy
| | - Valentina La Cognata
- Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, 95126 Catania, Italy
| | - Giulia Di Benedetto
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Anna Flavia Cantone
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Giuseppe Attaguile
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Rosaria Di Mauro
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Luca Massacesi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
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Biggi M, Contento M, Magliani M, Giovannelli G, Barilaro A, Bessi V, Lombardo I, Massacesi L, Rosati E. Alice in wonderland syndrome "through the looking-glass" in a rare presentation of non-convulsive status epilepticus in cerebral venous sinus thrombosis and COVID-19. Cortex 2023; 167:218-222. [PMID: 37572532 DOI: 10.1016/j.cortex.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 08/14/2023]
Abstract
Alice in Wonderland Syndrome (AIWS) is a rare perceptual disorder, rarely associated with epileptic etiology. We report the case of a 23-year-old man with subacute onset of right peri-orbital headache and visual misperceptions consistent with AIWS Type B, who underwent laboratory tests, brain CT with venography, ophthalmic examination, and neurological assessment that turned out to be normal except for visuospatial difficulties and constructional apraxia. A nasopharyngeal SARS-CoV2 swab taken as screening protocol was positive. The EEG performed because of the persistence of AIWS showed a focal right temporo-occipital non-convulsive status epilepticus; a slow resolution of clinical and EEG alterations was achieved with anti-seizure medications. Brain MRI showed right cortical temporo-occipital signal abnormalities consistent with peri-ictal changes and post-contrast T1 revealed a superior sagittal sinus thrombosis, thus anticoagulant therapy was initiated. AIWS is associated with temporo-parieto-occipital carrefour abnormalities, where visual and somatosensory inputs are integrated to generate the representation of body schema. In this patient, AIWS is caused by temporo-occipital status epilepticus without anatomical and electroencephalographic involvement of the parietal region, consistent with the absence of somatosensory symptoms of the syndrome. Status epilepticus can be the presenting symptom of cerebral venous sinus thrombosis (CVST) which, in this case, is possibly due to the hypercoagulable state associated with COVID-19.
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Affiliation(s)
- M Biggi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - M Contento
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology, Pordenone Hospital, Pordenone, Italy
| | - M Magliani
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - G Giovannelli
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - A Barilaro
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - V Bessi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - I Lombardo
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
| | - L Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - E Rosati
- Department of Neurology 2, Careggi University Hospital, Florence, Italy.
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Mariottini A, Lotti A, Innocenti C, Repice AM, Nozzoli C, Boncompagni R, Fainardi E, Saccardi R, Massacesi L. Effect of the COVID-19 pandemic on disease activity in multiple sclerosis patients treated with hematopoietic stem cell transplantation. Eur J Neurol 2023; 30:3362-3366. [PMID: 37483174 DOI: 10.1111/ene.15989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND PURPOSE It is still debated whether the COVID-19 pandemic affected disease activity in people with autoimmune diseases, including multiple sclerosis (MS). The aim of this study, therefore, was to explore the impact of COVID-19 in people with MS (pwMS) not receiving continuative disease-modifying therapy (DMT) after previous treatment with autologous hematopoietic stem cell transplantation (AHSCT). MATERIALS AND METHODS We included pwMS treated with AHSCT who were in disease remission without receiving DMTs during the pandemic and who were followed up at our centre during the study period. Data on SARS-CoV-2 infection and vaccination were recorded, with details of adverse events and clinical-radiological disease activity. RESULTS A total of 36 pwMS (31 females; 86%) were included, of whom 23 (64%) had relapsing-remitting (RR-MS) and 13 had secondary progressive MS (SP-MS). Thirty-three pwMS (92%) received anti-SARS-CoV-2 mRNA vaccines. Thirteen patients (36%) developed mild to moderate COVID-19 a median (range) of 58 (4-224) months after AHSCT; seven (54%) of these patients were not yet vaccinated. Transient neurological symptoms after vaccination or infection were reported in 9% and 36% of the patients, respectively. The rate of new inflammatory events (relapses or asymptomatic magnetic resonance imaging [MRI] activity) after AHSCT increased from 0.006 (one asymptomatic new lesion/159 patient-years) before the pandemic to 0.083 (five relapses plus two cases of asymptomatic MRI activity/84 patient-years) since the pandemic start (p = 0.004). CONCLUSIONS People with MS with a history of highly active disease, who are untreated or receiving moderate-efficacy DMTs might be more vulnerable to disease reactivation, possibly elicited by exogenous triggers. Careful monitoring and further investigation are warranted to ascertain whether special precautions are needed in these cases.
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Affiliation(s)
- Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Antonio Lotti
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Chiara Innocenti
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Anna Maria Repice
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Chiara Nozzoli
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Riccardo Boncompagni
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Riccardo Saccardi
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
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Beretta S, Cristillo V, Camera G, Morotti Colleoni C, Pellitteri G, Viti B, Bianchi E, Gipponi S, Grimoldi M, Valente M, Guttmann S, Cotelli MS, Palumbo P, Gelosa G, Meletti S, Schenone C, Ottaviani D, Filippi M, Zini A, Basilico P, Tancredi L, Cortelli P, Braga M, De Giuli V, Servidei S, Paolicelli D, Verde F, Caproni S, Pisani A, Lo Re V, Massacesi L, Roccatagliata DV, Manganotti P, Spitaleri D, Formenti A, Piccioli M, Marino S, Polverino P, Aguglia U, Ornello R, Perego E, Siciliano G, Merlo P, Capobianco M, Pantoni L, Lugaresi A, Angelocola S, De Rosa A, Sessa M, Beghi E, Agostoni EC, Monaco S, Padovani A, Priori A, Silani V, Tedeschi G, Ferrarese C. Incidence and Long-term Functional Outcome of Neurologic Disorders in Hospitalized Patients With COVID-19 Infected With Pre-Omicron Variants. Neurology 2023; 101:e892-e903. [PMID: 37414564 PMCID: PMC10501088 DOI: 10.1212/wnl.0000000000207534] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/06/2022] [Accepted: 05/04/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A variety of neurologic disorders have been reported as presentations or complications of coronavirus disease 2019 (COVID-19) infection. The objective of this study was to determine their incidence dynamics and long-term functional outcome. METHODS The Neuro-COVID Italy study was a multicenter, observational, cohort study with ambispective recruitment and prospective follow-up. Consecutive hospitalized patients presenting new neurologic disorders associated with COVID-19 infection (neuro-COVID), independently from respiratory severity, were systematically screened and actively recruited by neurology specialists in 38 centers in Italy and the Republic of San Marino. The primary outcomes were incidence of neuro-COVID cases during the first 70 weeks of the pandemic (March 2020-June 2021) and long-term functional outcome at 6 months, categorized as full recovery, mild symptoms, disabling symptoms, or death. RESULTS Among 52,759 hospitalized patients with COVID-19, 1,865 patients presenting 2,881 new neurologic disorders associated with COVID-19 infection (neuro-COVID) were recruited. The incidence of neuro-COVID cases significantly declined over time, comparing the first 3 pandemic waves (8.4%, 95% CI 7.9-8.9; 5.0%, 95% CI 4.7-5.3; 3.3%, 95% CI 3.0-3.6, respectively; p = 0.027). The most frequent neurologic disorders were acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), acute ischemic stroke (18.4%), and cognitive impairment (13.7%). The onset of neurologic disorders was more common in the prodromic phase (44.3%) or during the acute respiratory illness (40.9%), except for cognitive impairment whose onset prevailed during recovery (48.4%). A good functional outcome was achieved by most patients with neuro-COVID (64.6%) during follow-up (median 6.7 months), and the proportion of good outcome increased throughout the study period (r = 0.29, 95% CI 0.05-0.50; p = 0.019). Mild residual symptoms were frequently reported (28.1%) while disabling symptoms were common only in stroke survivors (47.6%). DISCUSSION Incidence of COVID-associated neurologic disorders decreased during the prevaccination phase of the pandemic. Long-term functional outcome was favorable in most neuro-COVID disorders, although mild symptoms commonly lasted more than 6 months after infection.
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Affiliation(s)
- Simone Beretta
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy.
| | - Viviana Cristillo
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Giorgia Camera
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Carlo Morotti Colleoni
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Gaia Pellitteri
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Beatrice Viti
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Elisa Bianchi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Stefano Gipponi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Maria Grimoldi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Mariarosaria Valente
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Susanna Guttmann
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Maria Sofia Cotelli
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Pasquale Palumbo
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Giorgio Gelosa
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Stefano Meletti
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Cristina Schenone
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Donatella Ottaviani
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Massimo Filippi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Andrea Zini
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Paola Basilico
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Lucia Tancredi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Pietro Cortelli
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Massimiliano Braga
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Valeria De Giuli
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Serenella Servidei
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Damiano Paolicelli
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Federico Verde
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Stefano Caproni
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Antonio Pisani
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Vincenzina Lo Re
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Luca Massacesi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Daria Valeria Roccatagliata
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Paolo Manganotti
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Daniele Spitaleri
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Anna Formenti
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Marta Piccioli
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Silvia Marino
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Paola Polverino
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Umberto Aguglia
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Raffaele Ornello
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Elisabetta Perego
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Gabriele Siciliano
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Paola Merlo
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Marco Capobianco
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Leonardo Pantoni
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Alessandra Lugaresi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Stefania Angelocola
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Anna De Rosa
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Maria Sessa
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Ettore Beghi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Elio Clemente Agostoni
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Salvatore Monaco
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Alessandro Padovani
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Alberto Priori
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Vincenzo Silani
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Gioacchino Tedeschi
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
| | - Carlo Ferrarese
- From the Department of Neurology (S.B., C.M.C., C.F.), Fondazione IRCCS San Gerardo dei Tintori, Monza; Department of Medicine and Surgery (S.B., C.M.C., C.F.), University of Milano Bicocca; The Milan Center for Neuroscience (NeuroMI) (S.B., G.G., C.F.); Neurology Unit and Department of Clinical and Experimental Sciences (V.C., S. Gipponi, A. Padovani), University of Brescia; Unit of Neurology and Neurophysiology (G.C., M.G., M.S.), ASST PG23, Bergamo; Santa Maria della Misericordia University Hospital (G.P., M.V.), Udine, Italy; San Marino Neurological Unit (B.V., S. Guttmann), San Marino Hospital; The Mario Negri Institute for Pharmacological Research IRCCS (E. Bianchi, E. Beghi), Milan; Department of Medical Area (DAME) (M.V.), University of Udine; Neurology Unit (M.S.C.), ASST Valcamonica, Esine, Brescia; USL Centro Toscana (P. Palumbo), Neurology Unit, Nuovo Ospedale Santo Stefano, Prato; Department of Neurology and Stroke Unit (G.G., E.C.A.), Niguarda, Milan; Department of Neurology and Department of Clinical Neurophysiology AOU Modena (S. Meletti), University of Modena and Reggio Emilia; Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (C.S.), University of Genoa; Ospedale Santa Maria del Carmine di Rovereto (D.O.), Trento; Neurology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Neurology (A.Z.), Metropolitan Stroke Network, Ospedale Maggiore, Bologna; Department of Neurology (P.B.), Ospedale A. Manzoni ASST Lecco; University of Milan (L.T., L.P., A. Priori); Neurology Unit (L.T., A. Priori), ASST Santi Paolo e Carlo; Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics (L.T.), Milan; IRCCS Institute of Neurological Science of Bologna (P.C.); DIBINEM (P.C.), University of Bologna; UOC Neurology (M.B.), ASST Vimercate; Department of Neurology (V.D.G.), ASST Cremona; Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Department of Basic Medical Sciences, Neurosciences and Sense Organs (D.P.), University of Bari; Department of Neurology and Laboratory of Neuroscience (F.V., V.S.), IRCCS Istituto Auxologico Italiano; "Dino Ferrari" Center (F.V., V.S.), Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Neurology Division (S.C.), "S. Maria" University Hospital, Terni; IRCCS Mondino Foundation (A. Pisani), Department of Brain and Behavioral Sciences, University of Pavia; Department of Diagnostic and Therapeutic Services (V.L.R.), IRCCS ISMETT, Palermo; Department of Neurology 2 (L.M.), Careggi University Hospital, Florence; Department of Neurology and Neurosurgery (D.V.R.), ASST di Mantova; Clinical Neurology Unit (P. Manganotti), Cattinara University Hospital, University of Trieste; Department of Neurology (D.L.A.S.), AORN S.Giovanni Moscati, Avellino; Neurology and Stroke Unit (A.F.), Neuroscience Department, ASST-Lecco, Merate; Department of Neurology (M.P.), Ospedale San Filippo Neri, Rome; IRCCS Centro Neurolesi Bonino-Pulejo (S. Marino), Messina; Department of Neurology (P. Polverino), IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; Department of Biotechnological and Clinical Sciences (R.O.), University of L'Aquila; Department of Neurology (E.P.), Ospedale Valduce, Como; Neurological Clinic (G.S.), University of Pisa; Department of Neurology (P. Merlo), Humanitas Gavazzeni, Bergamo; Department of Neurology (M.C.), S. Luigi Gonzaga Hospital, Orbassano; Ospedale Luigi Sacco (L.P.), Milan; IRCCS Institute of Neurological Science of Bologna (A.L.), UOSI Multiple Sclerosis Rehabilitation; Department of Biomedical Science and Neuromotricity (A.L.), University of Bologna; Department of Neurology (S.A.), Fermo; Department of Neurosciences (A.D.R.), Federico II University, Naples; Neurology Unit and Department of Neurosciences (S. Monaco), University of Verona; IRCCS Fondazione Ospedale Maggiore Policlinico (A. Priori), Milan; and Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Naples, Italy
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7
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Lotti A, Barilaro A, Mariottini A, Vannozzi L, Piergentili M, Fainardi E, Massacesi L. Case report: 3D intracranial vessel wall MRI in Susac syndrome: potential relevance for diagnosis and therapeutic management. Front Neurol 2023; 14:1201643. [PMID: 37638191 PMCID: PMC10456863 DOI: 10.3389/fneur.2023.1201643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023] Open
Abstract
Background Susac syndrome (SS) is a rare immune-mediated vasculitis affecting retina, inner ear and brain. Assessment of central nervous system (CNS) involvement is currently based on standard brain magnetic resonance imaging (MRI) sequences. Accuracy of three dimensional (3D)-vessel wall imaging (VWI) was compared to standard sequences and contrast-enhanced-3D T2-fluid attenuated inversion recovery (CE-FLAIR) to assess CNS disease activity in two cases of definite SS. Methods Brain MRI scan and retinal fluorescein angiogram (RFA) were performed at disease onset and at 1, 3, and 6 months after induction therapy start. CE-FLAIR and VWI based on 3D black-blood proton density weighted (PDW) with and without gadolinium were added to standard sequences on a 3 Tesla MRI scanner. Results Contrast enhanced-VWI (CE-VWI) detected an abnormal diffuse leptomeningeal enhancement (LME) in both cases at onset and during follow-up. Pathological enhancement on CE-VWI persisted at 6-month brain MRI, despite absence of new lesions and disappearance of LME on CE-FLAIR. Follow-up RFA revealed new arterial wall hyperfluorescence in both cases. Conclusions VWI may represent a useful tool for diagnosing and monitoring CNS disease activity in SS patients, as confirmed by concordance with RFA, leading treatment's choice and timing. Moreover, CE-VWI seemed at least as sensitive as CE-FLAIR in detecting LME, possibly being superior to the latter in posterior fossa. LME remission might be not accurate in predicting suppression of CNS inflammation in SS.
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Affiliation(s)
- Antonio Lotti
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | | | - Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Lorenzo Vannozzi
- Department of Ophthalmology, Careggi University Hospital, Florence, Italy
| | - Marco Piergentili
- Department of Ophthalmology, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
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8
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Farina A, Birzu C, Elsensohn MH, Picca A, Muñiz-Castrillo S, Vogrig A, Villagrán-García M, Ciano-Petersen NL, Massacesi L, Hervier B, Guégan S, Kramkimel N, Vano Y, Salem JE, Allenbach Y, Maisonobe T, Assaad S, Maureille A, Devic P, Weiss N, Pegat A, Maucort-Boulch D, Ricard D, Honnorat J, Psimaras D, Joubert B. Neurological outcomes in immune checkpoint inhibitor-related neurotoxicity. Brain Commun 2023; 5:fcad169. [PMID: 37389303 PMCID: PMC10306160 DOI: 10.1093/braincomms/fcad169] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023] Open
Abstract
While the spectrum of neurological immune checkpoint inhibitor-related adverse events is expanding, patients' outcomes are not well documented. This study aimed to assess outcomes of neurological immune-related adverse events and to identify prognostic factors. All patients experiencing grade ≥2 neurological immune-related adverse events identified at two clinical networks (French Reference Center for Paraneoplastic Neurological Syndromes, Lyon; and OncoNeuroTox, Paris) over five years were included. Modified Rankin scores were assessed at onset, 6, 12, 18 months, and last visit. A multi-state Markov model was used to estimate the transition rates between minor disability (mRS <3), severe disability (mRS 3-5), and death (mRS 6), over the study period. The state-to-state transition rates were estimated using maximum likelihood and variables were introduced into the different transitions to study their effects. A total of 147 patients were included out of 205 patients with a suspicion of neurological immune-related adverse events. The median age was 65 years (range 20-87) and 87/147 patients (59.2%) were male. Neurological immune-related adverse events involved the peripheral nervous system in 87/147 patients (59.2%), the central nervous system in 51/147 (34.7%), and both systems in 9/147 (6.1%). Paraneoplastic-like syndromes were observed in 30/147 patients (20.4%). Cancers included lung cancers (36.1%), melanoma (30.6%), urological cancers (15.6%), and others (17.8%). Patients were treated with programmed cell death protein (ligan) 1 (PD(L)1) inhibitors (70.1%), CTLA4 inhibitors (3.4%) or both (25.9%). Severe disability was reported in 108/144 patients (75.0%) at onset and in 33/146 patients (22.6%) at last visit (median follow-up duration: 12 months, range 0.5-50); 48/147 (32.7%) patients died, from cancer progression (17/48, 35.4%), neurological toxicity (15/48, 31.2%), other causes (10/48, 20.8%) or unknown causes (6/48, 12.5%). The rate of transition from severe to minor disability independently increased with melanoma [compared to lung cancer, hazard ratio = 3.26, 95%CI (1.27; 8.41)] and myositis/neuromuscular junction disorders [hazard ratio = 8.26, 95%CI (2.90; 23.58)], and decreased with older age [hazard ratio = 0.68, 95%CI (0.47; 0.99)] and paraneoplastic-like syndromes [hazard ratio = 0.29, 95%CI (0.09; 0.98)]. In patients with neurological immune-related adverse events, myositis/neuromuscular junction disorders and melanoma increase the transition rate from severe to minor disability, while older age and paraneoplastic-like syndromes result in poorer neurological outcomes; future studies are needed to optimize the management of such patients.
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Affiliation(s)
- Antonio Farina
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
- Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence 50139, Italy
| | - Cristina Birzu
- Department of Neurology 2 Mazarin, Sorbonne University, Brain Institute, INSERM UMR 1127, Groupe Hospitalier Pitié-Salpêtrière, Paris 75013, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
| | | | | | - Sergio Muñiz-Castrillo
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Alberto Vogrig
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Macarena Villagrán-García
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Nicolás Lundahl Ciano-Petersen
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Luca Massacesi
- Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence 50139, Italy
| | - Baptiste Hervier
- Department of Internal Medicine, AP-HP, Hôpital St Louis, Paris 75010, France
| | - Sarah Guégan
- Department of Dermatology, AP-HP, Hôpital Cochin, Paris 75014, France
- Department of Dermatology, Université de Paris Cité, Paris 75006, France
| | - Nora Kramkimel
- Department of Dermatology, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Yann Vano
- Department of Medical Oncology, AP-HP, Centre Hôpital Européen Georges-Pompidou, Paris 75015, France
| | - Joe Elie Salem
- Department of Pharmacology, Sorbonne University, INSERM, UNICO-GRECO Cardio-oncology Program, CIC-1901, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Yves Allenbach
- APHP, Department of Internal Medicine, Sorbonne University, Sorbonne University, INSERM Groupe Hospitalier Pitié-Salpêtrière, Paris 75651, France
| | - Thierry Maisonobe
- APHP, Department of Clinical Neurophysiology, Sorbonne University, Paris 75013, France
| | - Souad Assaad
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon 69008, France
| | - Aurélien Maureille
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon 69008, France
| | - Perrine Devic
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, 69002 Lyon, France
- Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon 69495, France
| | - Nicolas Weiss
- Department of Neurology, Sorbonne University, Hôpital de la Pitié-Salpêtrière, unité de Médecine Intensive Réanimation à orientation neurologique, Paris 75013, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Metabolic, Biliary and Fibro-Inflammatory Diseases of the Liver, Institute of Cardiometabolism and Nutrition (ICAN), Paris 75012, France
| | - Antoine Pegat
- Department of Neurological Functional Explorations, Hospices Civils de Lyon, Neurological Hospital, Bron 69500, France
| | - Delphine Maucort-Boulch
- Biostatistics—Bioinformatics Department, Public Health Unit. Hospices Civils de Lyon, Lyon 69003, France
- Laboratory of Biometry and Evolutionary Biology, University Claude Bernard Lyon 1, Villeurbanne 69622, France
- CNRS, UMR5558, Laboratory of Biometry and Evolutionary Biology, Biostatistics-Health Team, Villeurbanne 69622, France
| | - Damien Ricard
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
- Neurology Department, Hôpital d’Instruction des Armées Percy, Service de Santé des Armées, Clamart 92140, France
| | - Jérôme Honnorat
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, 69002 Lyon, France
| | - Dimitri Psimaras
- Department of Neurology 2 Mazarin, Sorbonne University, Brain Institute, INSERM UMR 1127, Groupe Hospitalier Pitié-Salpêtrière, Paris 75013, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
| | - Bastien Joubert
- Correspondence to: Bastien Joubert, MD, PhD French Reference Centre for Paraneoplastic Neurological Syndromes, Neurological Hospital 59 Boulevard Pinel, 69677 Bron Cedex, France E-mail:
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9
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Boffa G, Signori A, Massacesi L, Mariottini A, Sbragia E, Cottone S, Amato MP, Gasperini C, Moiola L, Meletti S, Repice AM, Brescia Morra V, Salemi G, Patti F, Filippi M, De Luca G, Lus G, Zaffaroni M, Sola P, Conte A, Nistri R, Aguglia U, Granella F, Galgani S, Caniatti LM, Lugaresi A, Romano S, Iaffaldano P, Cocco E, Saccardi R, Angelucci E, Trojano M, Mancardi GL, Sormani MP, Inglese M. Hematopoietic Stem Cell Transplantation in People With Active Secondary Progressive Multiple Sclerosis. Neurology 2023; 100:e1109-e1122. [PMID: 36543569 PMCID: PMC10074454 DOI: 10.1212/wnl.0000000000206750] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 03/13/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Uncontrolled evidence suggests that autologous hematopoietic stem cell transplantation (AHSCT) can be effective in people with active secondary progressive multiple sclerosis (SPMS). In this study, we compared the effect of AHSCT with that of other anti-inflammatory disease-modifying therapies (DMTs) on long-term disability worsening in active SPMS. METHODS We collected data from the Italian Bone Marrow Transplantation Study Group and the Italian Multiple Sclerosis Register. Patients were considered eligible if treatment had been started after the diagnosis of SPMS. Disability worsening was assessed by the cumulative proportion of patients with a 6-month confirmed disability progression (CDP) according to the Expanded Disability Status Scale (EDSS) score. Key secondary endpoints were the EDSS time trend after treatment start and the prevalence of disability improvement over time. Time to first CDP was assessed by means of proportional hazard Cox regression models. A linear mixed model with a time × treatment group interaction was used to assess the longitudinal EDSS time trends. Prevalence of improvement was estimated using a modified Kaplan-Meier estimator and compared between groups by bootstrapping the area under the curve. RESULTS Seventy-nine AHSCT-treated patients and 1975 patients treated with other DMTs (beta interferons, azathioprine, glatiramer-acetate, mitoxantrone, fingolimod, natalizumab, methotrexate, teriflunomide, cyclophosphamide, dimethyl fumarate, and alemtuzumab) were matched to reduce treatment selection bias using propensity score and overlap weighting approaches. Time to first CDP was significantly longer in transplanted patients (hazard ratio [HR] = 0.50; 95% CI = 0.31-0.81; p = 0.005), with 61.7% of transplanted patients free from CPD at 5 years. Accordingly, EDSS time trend over 10 years was higher in patients treated with other DMTs than in AHSCT-treated patients (+0.157 EDSS points per year compared with -0.013 EDSS points per year; interaction p < 0.001). Patients who underwent AHSCT were more likely to experience a sustained disability improvement: 34.7% of patients maintained an improvement (a lower EDSS than baseline) 3 years after transplant vs 4.6% of patients treated by other DMTs (p < 0.001). DISCUSSION The use of AHSCT in people with active SPMS is associated with a slowing of disability progression and a higher likelihood of disability improvement compared with standard immunotherapy. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that autologous hematopoietic stem cell transplants prolonged the time to CDP compared with other DMTs.
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Affiliation(s)
- Giacomo Boffa
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alessio Signori
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Luca Massacesi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alice Mariottini
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Elvira Sbragia
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Salvatore Cottone
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Pia Amato
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Claudio Gasperini
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Lucia Moiola
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Stefano Meletti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Anna Maria Repice
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Vincenzo Brescia Morra
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giuseppe Salemi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Francesco Patti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Massimo Filippi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giovanna De Luca
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giacomo Lus
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Mauro Zaffaroni
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Patrizia Sola
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Antonella Conte
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Riccardo Nistri
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Umberto Aguglia
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Franco Granella
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Simonetta Galgani
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Luisa Maria Caniatti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alessandra Lugaresi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Silvia Romano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Pietro Iaffaldano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Eleonora Cocco
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Riccardo Saccardi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Emanuele Angelucci
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Trojano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giovanni Luigi Mancardi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Pia Sormani
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Matilde Inglese
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy.
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10
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Bertozzi A, Mariottini A, Marchi L, Cristinzi MD, Nistri R, Damato V, Mechi C, Barilaro A, Massacesi L, Repice AM. Safety and effectiveness of the booster dose of mRNA COVID-19 vaccines in people with multiple sclerosis: A monocentric experience. Mult Scler Relat Disord 2023; 72:104582. [PMID: 36889098 PMCID: PMC9957336 DOI: 10.1016/j.msard.2023.104582] [Citation(s) in RCA: 4] [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: 10/19/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Long-term data on the effectiveness and safety of the booster dose of anti-SARS-CoV-2 vaccines in people affected by multiple sclerosis (pwMS) are lacking, hence a retrospective monocentric study exploring these issues was undertaken. MATERIALS AND METHODS PwMS who had received the booster dose of anti-COVID19 mRNA vaccines (either Comirnaty or Spikevax) according to the national regulation were included. The occurrence of adverse events or disease reactivation and SARS-CoV-2 infection were recorded up to last follow-up. Factors predictive of COVID-19 were explored using logistic regression analyses. A two-tailed p-value <0.05 was considered significant. RESULTS One hundred and fourteen pwMS were included: 80 females (70%); median age at the booster dose 42 years (range 21 - 73); 106/114 patients (93%) were receiving a disease-modifying treatment at vaccination. The median follow-up after the booster dose was 6 (range 2 - 7) months. Adverse events were experienced in 58% of the patients, being mild to moderate in most cases; 4 reactivations of MS were observed, two of which occurring within 4 weeks after the booster. SARS-CoV-2 infection was reported in 24/114 (21%) cases, occurring a median of 74 days (5-162) after the booster dose and requiring hospitalisation in 2 patients. Six cases received direct antiviral drugs. Age at vaccination and time between the primary vaccination cycle and the booster dose were independently and inversely associated with the risk of COVID-19 (HR 0.95 and 0.98, respectively). CONCLUSIONS The administration of the booster dose in pwMS showed an overall good safety profile and protected 79% of the patients from SARS-CoV-2 infection. The observed association between the risk of infection after the booster dose and both younger age at vaccination and shorter interval period to the booster dose suggest that unobserved confounders, possibly including behavioural and social factors, play a relevant role in determining the individual propensity to get infected with COVID-19.
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Affiliation(s)
- Andrea Bertozzi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy.
| | - Leonardo Marchi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Maria Di Cristinzi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Riccardo Nistri
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; University "La Sapienza", Rome, Italy
| | - Valentina Damato
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Claudia Mechi
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Anna Maria Repice
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
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11
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Cornacchini S, Farina A, Contento M, Berti V, Biggi M, Barilaro A, Massacesi L, Damato V, Rosati E. Long-term-video monitoring EEG and 18F-FDG-PET are useful tools to detect residual disease activity in anti-LGI1-Abs encephalitis: A case report. Front Neurol 2022; 13:949240. [PMID: 36051221 PMCID: PMC9425832 DOI: 10.3389/fneur.2022.949240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe use of CD20-depleting monoclonal antibodies has shown to improve the long-term outcome of patients with anti-leucine-rich glioma-inactivated protein 1 antibodies (anti-LGI1-Abs) encephalitis after first-line immunotherapy, but currently predictive markers of treatment response and disease activity are lacking.Case presentationA 75-year-old man presented cognitive impairment and faciobrachial dystonic seizures (FBDS), with mild abnormalities at electroencephalography (EEG), normal brain magnetic resonance and cerebrospinal fluid (CSF) analysis. Anti-LGI1-Abs were detected in serum and CSF, and corticosteroids and intravenous immunoglobulins were administered. Despite partial cognitive improvement, 18F-fluoridesoxyglucose-positron emission tomography (18F-FDG-PET) showed the persistence of temporo-mesial hypermetabolism, and FBDS were still detected by long-term monitoring video EEG (LTMV EEG). Rituximab was therefore administered with FBDS disappearance, further cognitive improvement, and resolution of 18F-FDG-PET temporo-mesial hypermetabolism.ConclusionsOur experience supports the use of 18F-FDG-PET and LTMVEEG as useful tools to measure disease activity, evaluate treatment response and guide therapeutic decisions in the long-term management of anti-LGI1-antibody encephalitis.
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Affiliation(s)
- Sara Cornacchini
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Antonio Farina
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Margherita Contento
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
- Department of Neurology, Pordenone Hospital, Pordenone, Italy
| | - Valentina Berti
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, Florence, Italy
- Nuclear Medicine, Careggi University Hospital, Florence, Italy
| | - Martina Biggi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | | | - Luca Massacesi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Valentina Damato
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
- *Correspondence: Valentina Damato
| | - Eleonora Rosati
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
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12
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Mariottini A, Repice AM, Barilaro A, Massacesi L. Anti-SARS-Cov2 vaccination at the time of the COVID-19 pandemic: suspected adverse events reporting is the milestone of post-marketing surveillance. Neurol Sci 2022; 43:4095-4097. [PMID: 35318561 PMCID: PMC8940562 DOI: 10.1007/s10072-022-05961-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Viale Gaetano Pieraccini, 6, 50139, Florence, FI, Italy
- Tuscany Region Multiple Sclerosis Referral Centre, Neurology 2, University Hospital of Careggi, Florence, Italy
| | - Anna Maria Repice
- Tuscany Region Multiple Sclerosis Referral Centre, Neurology 2, University Hospital of Careggi, Florence, Italy
| | - Alessandro Barilaro
- Tuscany Region Multiple Sclerosis Referral Centre, Neurology 2, University Hospital of Careggi, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Viale Gaetano Pieraccini, 6, 50139, Florence, FI, Italy.
- Tuscany Region Multiple Sclerosis Referral Centre, Neurology 2, University Hospital of Careggi, Florence, Italy.
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13
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Amoriello R, Rizzo R, Mariottini A, Bortolotti D, Gentili V, Bonechi E, Aldinucci A, Carnasciali A, Peruzzi B, Repice AM, Massacesi L, Fainardi E, Ballerini C. Investigating Serum sHLA-G Cooperation With MRI Activity and Disease-Modifying Treatment Outcome in Relapsing-Remitting Multiple Sclerosis. Front Neurol 2022; 13:872396. [PMID: 35693002 PMCID: PMC9174986 DOI: 10.3389/fneur.2022.872396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Relapsing-remitting multiple sclerosis (RRMS) is a demyelinating disease in which pathogenesis T cells have a major role. Despite the unknown etiology, several risk factors have been described, including a strong association with human leukocyte antigen (HLA) genes. Recent findings showed that HLA class I-G (HLA-G) may be tolerogenic in MS, but further insights are required. To deepen the HLA-G role in MS inflammation, we measured soluble HLA-G (sHLA-G) and cytokines serum level in 27 patients with RRMS at baseline and after 12 and 24 months of natalizumab (NTZ) treatment. Patients were divided into high (sHLA-G>20 ng/ml), medium (sHLA-G between 10 and 20 ng/ml), and low (sHLA-G <10 ng/ml) producers. Results showed a heterogeneous distribution of genotypes among producers, with no significant differences between groups. A significant decrease of sHLA-G was found after 24 months of NTZ in low producers carrying the +3142 C/G genotype. Finally, 83.3% of high and 100% of medium producers were MRI-activity free after 24 months of treatment, compared to 63.5% of low producers. Of note, we did not find any correlation of sHLA-G with peripheral cell counts or cytokines level. These findings suggest that serum sHLA-G level may partly depend on genotype rather than peripheral inflammation, and that may have impacted on MRI activity of patients over treatment.
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Affiliation(s)
- Roberta Amoriello
- Department of Clinical and Experimental Medicine (DMSC), University of Florence, Florence, Italy
| | - Roberta Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Alice Mariottini
- Department of Neurosciences, Drugs and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Daria Bortolotti
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Valentina Gentili
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Elena Bonechi
- Department of Clinical and Experimental Medicine (DMSC), University of Florence, Florence, Italy
| | - Alessandra Aldinucci
- Department of Neurosciences, Drugs and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Alberto Carnasciali
- Department of Clinical and Experimental Medicine (DMSC), University of Florence, Florence, Italy
| | - Benedetta Peruzzi
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), Careggi University Hospital, Florence, Italy
| | - Anna Maria Repice
- Department of Neurosciences, Drugs and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drugs and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department Neurology II, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Clara Ballerini
- Department of Clinical and Experimental Medicine (DMSC), University of Florence, Florence, Italy
- *Correspondence: Clara Ballerini
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Farina A, Falso S, Cornacchini S, Spagni G, Monte G, Mariottini A, Massacesi L, Barilaro A, Evoli A, Damato V. Safety and tolerability of SARS-Cov2 vaccination in patients with myasthenia gravis: a multicenter experience. Eur J Neurol 2022; 29:2505-2510. [PMID: 35390184 PMCID: PMC9111609 DOI: 10.1111/ene.15348] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, Myasthenia gravis (MG) patients have been identified as subjects at high-risk of developing severe COVID-19, and thus were offered vaccination with priority. The lack of direct data on the safety and tolerability of SARS-CoV-2 vaccines in MG have contributed to vaccine hesitancy. To address this issue, the safety and tolerability of SARS-CoV-2 vaccines was assessed in a large cohort of MG patients from two referral centers. METHODS Patients with confirmed MG diagnosis, consecutively seen between October and December 2021 in two MG centers were enrolled. Demographics, clinical characteristics, and information regarding SARS-CoV-2 infection/vaccination were extracted from medical reports and/or collected throughout telephonic or in person interviews. RESULTS Ninety-eight (94.2%) out of 104 patients included were administered at least 2 vaccine doses 4 weeks before the interview or earlier, and, among them, 63/98 (64.2%) have already received the "booster" dose. The most frequently used vaccines were BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna. Overall, only minor side effects were reported, most commonly local pain and fever. MG worsening after vaccination was observed in 8/104 (7.7%) cases. The frequency of worsening among MuSK-MG cases (3/9 [33.3%]) was significantly higher compared to other serological subgroups. Spontaneous symptoms regression was observed in 6/8 cases. Twelve/104 (11.5%) patients had SARS-CoV-2 infection and none of the SARS-CoV-2 infected MG patients worsened after vaccination. CONCLUSION Our data support the safety and tolerability of mRNA-COVID-19 vaccines, which should be strongly recommended in MG patients who could be at higher risk of complications if exposed to SARS-CoV-2 infection.
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Affiliation(s)
- Antonio Farina
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Silvia Falso
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Cornacchini
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Gregorio Spagni
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario Gemelli, IRCCS, Rome, Italy
| | - Gabriele Monte
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alice Mariottini
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy.,Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy.,Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | | | - Amelia Evoli
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario Gemelli, IRCCS, Rome, Italy
| | - Valentina Damato
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy.,Department of Neurology 2, Careggi University Hospital, Florence, Italy
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15
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Azzolini F, Farina A, Gastaldi M, Barilaro A, Scotti V, Falchetti G, Fainardi E, Moretti M, Massacesi L. Leptomeningeal Gadolinium Enhancement in Autoimmune GFAP-Astrocytopathy. Neurology 2022; 98:720-722. [PMID: 35277442 DOI: 10.1212/wnl.0000000000200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] Open
Affiliation(s)
- Federica Azzolini
- Department of Neuroscience Drugs and Child Health - University of Florence, Florence, Italy
| | - Antonio Farina
- Department of Neuroscience Drugs and Child Health - University of Florence, Florence, Italy
| | - Matteo Gastaldi
- Neuroimmunology laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Valentina Scotti
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | - Giorgia Falchetti
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Department of Experimental and Clinical Biomedical Sciences - University of Florence, Florence, Italy.,Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Marco Moretti
- Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neuroscience Drugs and Child Health - University of Florence, Florence, Italy
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16
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Mariottini A, Bertozzi A, Marchi L, Di Cristinzi M, Mechi C, Barilaro A, Massacesi L, Repice AM. Effect of disease-modifying treatments on antibody-mediated response to anti-COVID19 vaccination in people with multiple sclerosis. J Neurol 2022; 269:2840-2847. [PMID: 35239006 PMCID: PMC8891428 DOI: 10.1007/s00415-022-11003-3] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 11/10/2022]
Abstract
Background Few data are available so far on the antibody-mediated immune response to anti-SARS-Cov2 vaccination in people with multiple sclerosis (pwMS) treated with disease-modifying treatments (DMTs), therefore this issue was explored in a real-life cohort of pwMS. Materials and methods Retrospective monocentric study on anti-spike protein antibody response in pwMS who had received vaccination for Sars-Cov2. Adverse events following vaccination were also recorded. Results One hundred and twenty pwMS were included: 83 females (69%); median age at vaccination 42 years (range 21–73); 112/120 patients (93%) were receiving DMTs at vaccination. Anti-spike protein IgG antibodies were detectable in 102/120 (85%) cases overall, being the proportion lower in pwMS receiving anti-CD20 antibodies (14/31, 45%) compared to non-depletive treatments (77/78, 99%), p < 0.0001. Median anti-spike titre was lower in anti-CD20 antibodies and fingolimod-treated pwMS compared to those receiving other DMTs, and it correlated with anti-CD20 treatment duration (R − 0.93, p < 0.0001) and with age at vaccination in pwMS not receiving depletive treatments (R − 0.25, p = 0.028). Baseline CD19+ cell count (where available) was higher in the responder group than in non-responders, p < 0.0001. Two symptomatic COVID-19 infections were diagnosed over a median follow-up of 5 months (range 2–7); adverse events were aligned with the published literature. Conclusion Antibody response to anti-COVID-19 vaccines was detected in most of the pwMS analysed, but frequency of responders was reduced in those receiving CD20 depleting therapies compared to other DMTs-treated pwMS. Investigations on cell-mediated immune response are needed to assess whether a protective immune response is elicited also in non-antibody responders.
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Affiliation(s)
- Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy.,Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Andrea Bertozzi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Leonardo Marchi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Maria Di Cristinzi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Claudia Mechi
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy.,Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Anna Maria Repice
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy.
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Mariottini A, Marchi L, Innocenti C, Di Cristinzi M, Pasca M, Filippini S, Barilaro A, Mechi C, Fani A, Mazzanti B, Biagioli T, Materozzi F, Saccardi R, Massacesi L, Repice AM. Intermediate-Intensity Autologous Hematopoietic Stem Cell Transplantation Reduces Serum Neurofilament Light Chains and Brain Atrophy in Aggressive Multiple Sclerosis. Front Neurol 2022; 13:820256. [PMID: 35280289 PMCID: PMC8907141 DOI: 10.3389/fneur.2022.820256] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAutologous haematopoietic stem cell transplantation (AHSCT) is highly effective in reducing new inflammatory activity in aggressive multiple sclerosis (MS). A remarkable decrease of serum neurofilament light chains (sNfL) concentration, a marker of axonal damage, was reported in MS following high-intensity regimen AHSCT, but hints for potential neurotoxicity had emerged. sNfL and brain atrophy were therefore analysed in a cohort of patients with aggressive MS treated with intermediate-intensity AHSCT, exploring whether sNfL might be a reliable marker of disability progression independent from new inflammation (i.e. relapses and/or new/gadolinium-enhancing MRI focal lesions).MethodssNfL concentrations were measured using SIMOA methodology in peripheral blood from relapsing-remitting (RR-) or secondary-progressive (SP-) MS patients undergoing AHSCT (MS AHSCT), collected before transplant and at months 6 and 24 following the procedure. sNfL measured at a single timepoint in SP-MS patients not treated with AHSCT without recent inflammatory activity (SP-MS CTRL) and healthy subjects (HD) were used as controls. The rate of brain volume loss (AR-BVL) was also evaluated by MRI in MS AHSCT cases.ResultsThirty-eight MS AHSCT (28 RR-MS; 10 SP-MS), 22 SP-MS CTRL and 19 HD were included. Baseline median sNfL concentrations were remarkably higher in the MS AHSCT than in the SP-MS CTRL and HD groups (p = 0.005 and <0.0001, respectively), and levels correlated with recent inflammatory activity. After a marginal (not significant) median increase observed at month 6, at month 24 following AHSCT sNfL concentrations decreased compared to baseline by median 42.8 pg/mL (range 2.4–217.3; p = 0.039), reducing by at least 50% in 13 cases, and did not differ from SP-MS CTRL (p = 0.110) but were still higher than in HD (p < 0.0001). Post-AHSCT AR-BVL normalised in 55% of RR-MS and in 30% of SP-MS. The effectiveness and safety of AHSCT were aligned with the literature.ConclusionsNfL concentrations correlated with recent inflammatory activity and were massively and persistently reduced by intermediate-intensity AHSCT. Association with response to treatment assessed by clinical or MRI outcomes was not observed, suggesting a good sensitivity of sNfL for recent inflammatory activity but low sensitivity in detecting ongoing axonal damage independent from new focal inflammation.
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Affiliation(s)
- Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Leonardo Marchi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Chiara Innocenti
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Maria Di Cristinzi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Matteo Pasca
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Stefano Filippini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Claudia Mechi
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
| | - Arianna Fani
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Benedetta Mazzanti
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Tiziana Biagioli
- General Laboratory, Careggi University Hospital, Florence, Italy
| | - Francesca Materozzi
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Riccardo Saccardi
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
- *Correspondence: Luca Massacesi
| | - Anna Maria Repice
- Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy
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18
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Mariottini A, Bulgarini G, Forci B, Innocenti C, Mealli F, Mattei A, Ceccarelli C, Repice AM, Barilaro A, Mechi C, Saccardi R, Massacesi L. Autologous hematopoietic stem cell transplantation vs low-dose immunosuppression in secondary-progressive multiple sclerosis. Eur J Neurol 2022; 29:1708-1718. [PMID: 35146841 PMCID: PMC9306891 DOI: 10.1111/ene.15280] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Effectiveness of autologous haematopoietic stem cell transplantation (AHSCT) in relapsing–remitting multiple sclerosis (MS) is well known, but in secondary–progressive (SP)‐MS it is still controversial. Therefore, AHSCT activity was evaluated in SP‐MS using low‐dose immunosuppression with cyclophosphamide (Cy) as a comparative treatment. Methods In this retrospective monocentric 1:2 matched study, SP‐MS patients were treated with intermediate‐intensity AHSCT (cases) or intravenous pulses of Cy (controls) at a single academic centre in Florence. Controls were selected according to baseline characteristics adopting cardinality matching after trimming on the estimated propensity score. Kaplan–Meier and Cox analyses were used to estimate survival free from relapses (R‐FS), survival free from disability progression (P‐FS), and no evidence of disease activity 2 (NEDA‐2). Results A total of 93 SP‐MS patients were included: 31 AHSCT, 62 Cy. Mean follow‐up was 99 months in the AHSCT group and 91 months in the Cy group. R‐FS was higher in AHSCT compared to Cy patients: at Year 5, 100% versus 52%, respectively (p < 0.0001). P‐FS did not differ between the groups (at Year 5: 70% in AHSCT and 81% in Cy, p = 0.572), nor did NEDA‐2 (p = 0.379). A sensitivity analysis including only the 31 “best‐matched” controls confirmed these results. Three neoplasms (2 Cy, 1 AHSCT) and two fatalities (2 Cy) occurred. Conclusions This study provides Class III evidence, in SP‐MS, on the superior effectiveness of AHSCT compared to Cy on relapse activity, without differences on disability accrual. Although the suppression of relapses was observed in the AHSCT group only, AHSCT did not show advantages over Cy on disability, suggesting that in SP‐MS disability progression becomes based more on noninflammatory neurodegeneration than on inflammation.
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Affiliation(s)
- Alice Mariottini
- Department of Neurosciences Drug and Child Health, University of Florence, Florence, Italy.,Department of Neurology, Tuscan Region MS Referral Centre, Careggi University Hospital, Florence, Italy
| | - Giovanni Bulgarini
- Department of Neurosciences Drug and Child Health, University of Florence, Florence, Italy
| | - Benedetta Forci
- Department of Neurosciences Drug and Child Health, University of Florence, Florence, Italy
| | - Chiara Innocenti
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Fabrizia Mealli
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti", University of Florence, Florence, Italy.,Florence Centre for Data Science, Florence, Italy
| | - Alessandra Mattei
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti", University of Florence, Florence, Italy.,Florence Centre for Data Science, Florence, Italy
| | - Chiara Ceccarelli
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti", University of Florence, Florence, Italy
| | - Anna Maria Repice
- Department of Neurology, Tuscan Region MS Referral Centre, Careggi University Hospital, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology, Tuscan Region MS Referral Centre, Careggi University Hospital, Florence, Italy
| | - Claudia Mechi
- Department of Neurology, Tuscan Region MS Referral Centre, Careggi University Hospital, Florence, Italy
| | - Riccardo Saccardi
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences Drug and Child Health, University of Florence, Florence, Italy.,Department of Neurology, Tuscan Region MS Referral Centre, Careggi University Hospital, Florence, Italy
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Contento M, Bertaccini B, Biggi M, Magliani M, Failli Y, Rosati E, Massacesi L, Paganini M. Response: Brightening the crystal ball: A constructive reappraisal of the postwithdrawal seizure relapse prediction model. Epilepsia 2021; 62:3148-3149. [PMID: 34633079 DOI: 10.1111/epi.17095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Margherita Contento
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Bruno Bertaccini
- Department of Statistics, Informatics, and Application "G. Parenti,", University of Florence, Florence, Italy
| | - Martina Biggi
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Matteo Magliani
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Ylenia Failli
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Eleonora Rosati
- Department Neurology 2, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy.,Department Neurology 2, Careggi University Hospital, Florence, Italy
| | - Marco Paganini
- Department Neurology 2, Careggi University Hospital, Florence, Italy
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20
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Azzolini F, Farina A, Barilaro A, Moretti M, Massacesi L. An emerging spectrum of autoimmune astrocythopathy: Beyond anti-GFAP antibodies. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117816] [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: 11/26/2022]
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Farina A, Mariottini A, Azzolini F, Mechi C, Repice AM, Barilaro A, Massacesi L. Clinical and paraclinical findings in a case series of MOGAD: Exploring the presence of perivenular brain white matter lesions. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118202] [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]
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22
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Tassorelli C, Silani V, Padovani A, Barone P, Calabresi P, Girlanda P, Lopiano L, Massacesi L, Monaco S, Onofrj M, Tedeschi G, Berardelli A. The contribution of the Italian residents in neurology to the COVID-19 crisis: admirable generosity but neurological training remains their priority. Neurol Sci 2021; 42:4425-4431. [PMID: 34374866 PMCID: PMC8353936 DOI: 10.1007/s10072-021-05346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has severely impacted the Italian healthcare system, underscoring a dramatic shortage of specialized doctors in many disciplines. The situation affected the activity of the residents in neurology, who were also offered the possibility of being formally hired before their training completion. Aims (1) To showcase examples of clinical and research activity of residents in neurology during the COVID-19 pandemic in Italy and (2) to illustrate the point of view of Italian residents in neurology about the possibility of being hired before the completion of their residency program. Results Real-life reports from several areas in Lombardia—one of the Italian regions more affected by COVID-19—show that residents in neurology gave an outstanding demonstration of generosity, collaboration, reliability, and adaptation to the changing environment, while continuing their clinical training and research activities. A very small minority of the residents participated in the dedicated selections for being hired before completion of their training program. The large majority of them prioritized their training over the option of earlier employment. Conclusions Italian residents in neurology generously contributed to the healthcare management of the COVID-19 pandemic in many ways, while remaining determined to pursue their training. Neurology is a rapidly evolving clinical field due to continuous diagnostic and therapeutic progress. Stakeholders need to listen to the strong message conveyed by our residents in neurology and endeavor to provide them with the most adequate training, to ensure high quality of care and excellence in research in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05346-4.
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Affiliation(s)
- Cristina Tassorelli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy. .,IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Vincenzo Silani
- Department of Neurology-Stroke Unit and Laboratory Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Pathophysiology and Transplantation "Dino Ferrari Center", University of Milan, Milan, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paolo Calabresi
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Girlanda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences "G. D'Annunzio", University of Chieti, Chieti, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed Institute, Pozzilli, IS, Italy
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Contento M, Bertaccini B, Biggi M, Magliani M, Failli Y, Rosati E, Massacesi L, Paganini M. Prediction of seizure recurrence risk following discontinuation of antiepileptic drugs. Epilepsia 2021; 62:2159-2170. [PMID: 34250596 PMCID: PMC8457060 DOI: 10.1111/epi.16993] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Discontinuation of antiepileptic drugs (AEDs) in seizure-free patients is an important goal because of possible long-term side effects and the social stigma burden of epilepsy. The purpose of this work was to assess seizure recurrence risk after suspension of AEDs, to evaluate predictors for recurrence, and to investigate the recovery of seizure control after relapse. In addition, the accuracy of a previously published prediction model of seizure recurrence risk was estimated. METHODS Seizure-free patients with epilepsy who had discontinued AEDs were retrospectively enrolled. The frequency of seizure relapses after AED withdrawal as well as prognosis after recurrence were assessed and the predictive role of baseline clinical-demographic variables was evaluated. The aforementioned prediction model was also validated and its accuracy assessed at different seizure-relapse probability levels. RESULTS The enrolled patients (n = 133) had been followed for a median of 3 years (range 0.8-33 years) after AED discontinuation; 60 (45%) of them relapsed. Previous febrile seizures in childhood (hazard ratio [HR] 3.927; 95% confidence interval [CI] 1.403-10.988), a seizure-free period on therapy of less than 2 years (HR 2.313; 95% CI 1.193-4.486), and persistent motor deficits (HR 4.568; 95% CI 1.412-14.772) were the clinical features associated with relapse risk in univariate analysis. Among these variables, only a seizure-free period on therapy of less than 2 years was associated with seizure recurrence in multivariate analysis (HR 2.365; 95% CI 1.178-4.7444). Pharmacological control of epilepsy was restored in 82.4% of the patients who relapsed. In this population, the aforementioned prediction model showed an unsatisfactory accuracy. SIGNIFICANCE A period of freedom from seizure on therapy of less than 2 years was the main predictor of seizure recurrence. The accuracy of the previously described prediction tool was low in this cohort, thus suggesting its cautious use in real-world clinical practice.
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Affiliation(s)
- Margherita Contento
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Bruno Bertaccini
- Department of Statistics Informatics and Application "G.Parenti", University of Florence, Florence, Italy
| | - Martina Biggi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Matteo Magliani
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Ylenia Failli
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Eleonora Rosati
- Department Neurology 2, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy.,Department Neurology 2, Careggi University Hospital, Florence, Italy
| | - Marco Paganini
- Department Neurology 2, Careggi University Hospital, Florence, Italy
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24
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Amoriello R, Chernigovskaya M, Greiff V, Carnasciali A, Massacesi L, Barilaro A, Repice AM, Biagioli T, Aldinucci A, Muraro PA, Laplaud DA, Lossius A, Ballerini C. TCR repertoire diversity in Multiple Sclerosis: High-dimensional bioinformatics analysis of sequences from brain, cerebrospinal fluid and peripheral blood. EBioMedicine 2021; 68:103429. [PMID: 34127432 PMCID: PMC8245901 DOI: 10.1016/j.ebiom.2021.103429] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND T cells play a key role in the pathogenesis of multiple sclerosis (MS), a chronic, inflammatory, demyelinating disease of the central nervous system (CNS). Although several studies recently investigated the T-cell receptor (TCR) repertoire in cerebrospinal fluid (CSF) of MS patients by high-throughput sequencing (HTS), a deep analysis on repertoire similarities and differences among compartments is still missing. METHODS We performed comprehensive bioinformatics on high-dimensional TCR Vβ sequencing data from published and unpublished MS and healthy donors (HD) studies. We evaluated repertoire polarization, clone distribution, shared CDR3 amino acid sequences (CDR3s-a.a.) across repertoires, clone overlap with public databases, and TCR similarity architecture. FINDINGS CSF repertoires showed a significantly higher public clones percentage and sequence similarity compared to peripheral blood (PB). On the other hand, we failed to reject the null hypothesis that the repertoire polarization is the same between CSF and PB. One Primary-Progressive MS (PPMS) CSF repertoire differed from the others in terms of TCR similarity architecture. Cluster analysis splits MS from HD. INTERPRETATION In MS patients, the presence of a physiological barrier, the blood-brain barrier, does not impact clone prevalence and distribution, but impacts public clones, indicating CSF as a more private site. We reported a high Vβ sequence similarity in the CSF-TCR architecture in one PPMS. If confirmed it may be an interesting insight into MS progressive inflammatory mechanisms. The clustering of MS repertoires from HD suggests that disease shapes the TCR Vβ clonal profile. FUNDING This study was partly financially supported by the Italian Multiple Sclerosis Foundation (FISM), that contributed to Ballerini-DB data collection (grant #2015 R02).
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Affiliation(s)
- Roberta Amoriello
- Dipartimento di Medicina Sperimentale e Clinica (DMSC), Laboratory of Neuroimmunology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | | | - Victor Greiff
- Department of Immunology, University of Oslo, Oslo, Norway
| | - Alberto Carnasciali
- Dipartimento di Medicina Sperimentale e Clinica (DMSC), Laboratory of Neuroimmunology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Luca Massacesi
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Italy
| | - Alessandro Barilaro
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Italy
| | - Anna M Repice
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Italy
| | - Tiziana Biagioli
- Laboratorio Generale, Careggi University Hospital, Florence, Italy
| | | | - Paolo A Muraro
- Wolfson Neuroscience Laboratory, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - David A Laplaud
- CRTI-Inserm U1064, CIC0004 and Service de Neurologie, CHU de Nantes, Hôpital Nord Laënnec, Nantes, France
| | - Andreas Lossius
- Institute of Clinical Medicine, University of Oslo, Postboks 1105, Blindern 0317 Oslo, Norway.
| | - Clara Ballerini
- Dipartimento di Medicina Sperimentale e Clinica (DMSC), Laboratory of Neuroimmunology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
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25
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Boffa G, Massacesi L, Inglese M, Mariottini A, Capobianco M, Moiola L, Amato MP, Cottone S, Gualandi F, De Gobbi M, Greco R, Scimè R, Frau J, Zimatore GB, Bertolotto A, Comi G, Uccelli A, Signori A, Angelucci E, Innocenti C, Ciceri F, Repice AM, Sormani MP, Saccardi R, Mancardi G. Long-term Clinical Outcomes of Hematopoietic Stem Cell Transplantation in Multiple Sclerosis. Neurology 2021; 96:e1215-e1226. [PMID: 33472915 DOI: 10.1212/wnl.0000000000011461] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether autologous hematopoietic stem cell transplantation (aHSCT) is able to induce durable disease remission in people with multiple sclerosis (MS), we analyzed the long-term outcomes after transplantation in a large cohort of patients with MS. METHODS To be included, a minimum dataset (consisting of age, MS phenotype, Expanded Disability Status Scale [EDSS] score at baseline, information on transplantation technology, and at least 1 follow-up visit after transplantation) was required. RESULTS Two hundred ten patients were included (relapsing-remitting [RR] MS 122 [58%]). Median baseline EDSS score was 6 (1-9); mean follow-up was 6.2 (±5.0) years. Among patients with RRMS, disability worsening-free survival (95% confidence interval [CI]) was 85.5% (76.9%-94.1%) at 5 years and 71.3% (57.8%-84.8%) at 10 years. In patients with progressive MS, disability worsening-free survival was 71.0% (59.4%-82.6%) and 57.2% (41.8%-72.7%) at 5 and 10 years, respectively. In patients with RRMS, EDSS significantly reduced after aHSCT (p = 0.001; mean EDSS change per year -0.09 [95% CI -0.15% to -0.04%]). In patients with RRMS, the use of the BCNU+Etoposide+Ara-C+Melphalan (BEAM) + anti-thymocyte globulin (ATG) conditioning protocol was independently associated with a reduced risk of no evidence of disease activity 3 failure (hazard ratio 0.27 [95% CI 0.14-0.50], p < 0.001). Three patients died within 100 days from aHSCT (1.4%); no deaths occurred in patients transplanted after 2007. CONCLUSIONS aHSCT prevents disability worsening in the majority of patients and induces durable improvement in disability in patients with RRMS. The BEAM + ATG conditioning protocol is associated with a more pronounced suppression of clinical relapses and MRI inflammatory activity. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for people with MS, aHSCT induces durable disease remission in most patients.
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Affiliation(s)
- Giacomo Boffa
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Luca Massacesi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Matilde Inglese
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy.
| | - Alice Mariottini
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Marco Capobianco
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Lucia Moiola
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Maria Pia Amato
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Salvatore Cottone
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Francesca Gualandi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Marco De Gobbi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Raffaella Greco
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Rosanna Scimè
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Jessica Frau
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Giovanni Bosco Zimatore
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Antonio Bertolotto
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Giancarlo Comi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Antonio Uccelli
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Alessio Signori
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Emanuele Angelucci
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Chiara Innocenti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Fabio Ciceri
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Anna Maria Repice
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Maria Pia Sormani
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Riccardo Saccardi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
| | - Gianluigi Mancardi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., M.I., A.U., G.M.) and Biostatistics Unit (A.S., M.P.S.), University of Genoa; San Martino Hospital (G.B.), Genoa; Department of Neurosciences Drugs (L. Massacesi, A.M., A.M.R.), Child Health and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), and Cell Therapy and Transfusion Medicine Unit (C.I., R. Saccardi), Careggi University Hospital, Florence; Ospedale Policlinico San Martino (M.I., A.U., G.M.), IRCCS, Genoa; Department of Neurology (M.C., A.B.), San Luigi Gonzaga Hospital, Orbassano; Department of Neurology (L. Moiola, G.C.) and Department of Haematology and Bone Marrow Transplant (R.G., F.C.), Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan; Department NEUROFARBA (M.P.A.), Section Neurological Sciences, University of Florence IRCCS Fondazione Don Carlo Gnocchi; Department of Neurology (S.C.) and Department of Haematology (R. Scimè), Villa Sofia Hospital, Palermo; Department of Haematology and Bone Marrow Transplant Unit (F.G., E.A.), Policlinico San Martino IRCCS, Genoa; Department of Clinical and Biological Sciences (M.D.G.), Haematopoietic Stem Cell Transplant Unit, University of Turin, San Luigi Gonzaga Hospital, Orbassano; Multiple Sclerosis Center (J.F.), Department of Medical Sciences and Public Health University of Cagliari; Binaghi Hospital (J.F.), Cagliari; Department of Neurology (G.B.Z.), Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, BA; and IRCCS Scientific Clinical Institutes Maugeri (G.M.), Pavia-Genoa Nervi, Italy
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Signori A, Boffa G, Bovis F, Mariottini A, Repice A, Inglese M, Amato MP, Mancardi G, Massacesi L, Saccardi R, Sormani MP. Prevalence of disability improvement as a potential outcome for multiple sclerosis trials. Mult Scler 2020; 27:706-711. [PMID: 32589486 DOI: 10.1177/1352458520936236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The concept of improvement of disability recently emerged as a new target in multiple sclerosis (MS) studies since the approval of new potent drugs and for testing drugs for neuroprotection and repair. OBJECTIVE To propose a simple estimator for assessing and comparing the prevalence of improvement over time between groups. METHODS The prevalence of a transient condition takes into account the incidence and the duration of such condition. We propose here the application of a modified Kaplan-Meier estimator to evaluate and compare between groups the prevalence of improvement over time in a cohort of 121 patients treated with autologous hematopoietic stem cell transplantation. RESULTS The prevalence of improvement after 5 years from transplant was 50.3% (95%CI: [38.0-63.0]) in relapsing-remitting patients and 6.5% (95%CI: [0-17.8]) in secondary-progressive patients (p < 0.001). Such a difference wouldn't be evident considering the traditional cumulative probability of improvement at 5 years (55.5% in relapsing-remitting vs 33.4% in secondary-progressive patients, p = 0.10). CONCLUSION This study shows the relevance of a new estimator of prevalence of improvement in MS. This estimator gives simple information on whether a drug can induce a durable improvement in disability and can be considered a potential outcome for trials assessing drugs for neuroprotection or repair.
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Affiliation(s)
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Alice Mariottini
- Department of Neurology 2, Careggi University Hospital, Florence, Italy/Department of Neurosciences, University of Florence, Florence, Italy
| | - Annamaria Repice
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of Neurosciences, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Gianluigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genova, Genova, Italy
| | - Luca Massacesi
- Department of Neurology 2, Careggi University Hospital, Florence, Italy/Department of Neurosciences, University of Florence, Florence, Italy
| | - Riccardo Saccardi
- Department of Cell Therapy and Transfusional Medicine, Careggi University Hospital, Florence, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
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27
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Steingo B, Al Malik Y, Bass AD, Berkovich R, Carraro M, Fernández Ó, Ionete C, Massacesi L, Meuth SG, Mitsikostas DD, Pardo G, Simm RF, Traboulsee A, Choudhry Z, Daizadeh N, Compston DAS. Long-term efficacy and safety of alemtuzumab in patients with RRMS: 12-year follow-up of CAMMS223. J Neurol 2020; 267:3343-3353. [PMID: 32583052 PMCID: PMC7578137 DOI: 10.1007/s00415-020-09983-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the phase 2 CAMMS223 trial (NCT00050778), alemtuzumab significantly improved clinical and MRI outcomes versus subcutaneous interferon beta-1a over 3 years in treatment-naive patients with relapsing-remitting MS. Here, we assess efficacy and safety of alemtuzumab over 12 years in CAMMS223 patients who enrolled in the CAMMS03409 extension (NCT00930553), with available follow-up through the subsequent TOPAZ extension (NCT02255656). METHODS In CAMMS223, patients received 2 alemtuzumab courses (12 mg/day; baseline: 5 days; 12 months later: 3 days); 22% received a third course. In the open-label, nonrandomized extensions, patients could receive as-needed additional alemtuzumab or other disease-modifying therapies. RESULTS Of 108 alemtuzumab-treated patients in CAMMS223, 60 entered the CAMMS03409 extension; 33% received a total of 2 alemtuzumab courses, and 73% received no more than 3 courses through Year 12. Over 12 years, annualized relapse rate was 0.09, 71% of patients had stable or improved Expanded Disability Status Scale scores, and 69% were free of 6-month confirmed disability worsening. In Year 12, 73% of patients were free of MRI disease activity. Cumulatively throughout the extensions (Years 7-12), 34% of patients had no evidence of disease activity. Adverse event (AE) incidence declined through Year 12. Infusion-associated reactions peaked at first course and declined thereafter. Cumulative thyroid AE incidence was 50%; one immune thrombocytopenia event occurred, and there were no autoimmune nephropathy cases. CONCLUSIONS Alemtuzumab efficacy was maintained over 12 years in CAMMS223 patients, with 73% receiving no more than three courses. The safety profile in this cohort was consistent with other alemtuzumab clinical trials.
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Affiliation(s)
| | - Yaser Al Malik
- King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ann D Bass
- Neurology Center of San Antonio, San Antonio, TX, USA
| | - Regina Berkovich
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Synergy Healthcare Medical Associates, Los Angeles, CA, USA
| | | | - Óscar Fernández
- Fundación IMABIS, Hospital Universitario Carlos Haya, Málaga, Spain
| | - Carolina Ionete
- University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Luca Massacesi
- Department of Neurosciences, Drugs and Child Health, University of Florence, Florence, Italy
| | - Sven G Meuth
- Clinic of Neurology with Institute of Translational Neurology, University Clinic Münster, Münster, Germany
| | - Dimos D Mitsikostas
- First Neurology Department, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriel Pardo
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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28
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Berardelli A, Silani V, Barone P, Calabresi P, Girlanda P, Lopiano L, Massacesi L, Monaco S, Onofrj M, Tassorelli C, Tedeschi G. Neurology and the COVID-19 emergency. Neurol Sci 2020; 41:1343-1344. [PMID: 32430622 PMCID: PMC7235546 DOI: 10.1007/s10072-020-04465-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alfredo Berardelli
- Italian College of Professors of Neurology, Rome, Italy. .,Department of Human Neurosciences and IRCCS Neuromed Institute, Sapienza University of Rome, Rome, Italy.
| | - Vincenzo Silani
- Italian College of Professors of Neurology, Rome, Italy.,Department of Neurology-Stroke Unit and Laboratory Neuroscience, Istituto Auxologico Italiano, IRCCS, Department of Pathophysiology and Transplantation "Dino Ferrari Center", University of Milan, Milan, Italy
| | - Paolo Barone
- Italian College of Professors of Neurology, Rome, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paolo Calabresi
- Italian College of Professors of Neurology, Rome, Italy.,Department of Neuroscience, Università Cattolica Sacro Cuore, Rome, Italy
| | - Paolo Girlanda
- Italian College of Professors of Neurology, Rome, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Leonardo Lopiano
- Italian College of Professors of Neurology, Rome, Italy.,Department of Neuroscience, University of Torino, Turin, Italy
| | - Luca Massacesi
- Italian College of Professors of Neurology, Rome, Italy.,Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Salvatore Monaco
- Italian College of Professors of Neurology, Rome, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Onofrj
- Italian College of Professors of Neurology, Rome, Italy.,Department of Neuroscience, Imaging and Clinical Sciences "G. D'Annunzio", University of Chieti, Chieti, Italy
| | - Cristina Tassorelli
- Italian College of Professors of Neurology, Rome, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, IRCCS Mondino Foundation, Pavia, Italy
| | - Gioacchino Tedeschi
- Italian College of Professors of Neurology, Rome, Italy.,Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
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29
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Piccini B, Ulivelli M, Amato MP, Bartalini S, Falcini M, Giannini M, Magnani E, Massacesi L, Repice AM, Vascotto M, Grosso S. Association of celiac disease in patients with multiple sclerosis in Tuscany. Rev Esp Enferm Dig 2020; 112:474-476. [PMID: 32379467 DOI: 10.17235/reed.2020.6123/2018] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED Background and study purpose: to describe the comorbidity of celiac disease among a large cohort of multiple sclerosis patients in Tuscany. METHODS the association of celiac disease among multiple sclerosis adult patients (n=2050) was retrospectively evaluated. RESULTS 13 patients were diagnosed with celiac disease, the female:male ratio was 3.3:1 and the median age at diagnosis was 34.2 years (SD 13). Seventy-seven per cent of subjects complained about gastrointestinal symptoms. IgA anti- transglutaminase was positive in 85 % of cases and there was 70 % of villous atrophy. CONCLUSIONS the frequency of celiac disease among multiple sclerosis patients examined was lower than in the general population, 0.6 % vs 1 %)(p = 0.65).
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Affiliation(s)
| | | | - Maria Pia Amato
- Department of NEUROFARBA, Section Neurosciences, University of Florence
| | - Sabina Bartalini
- Neurology and Neurophysiopathology, University Hospital Santa Maria alle Scotte
| | | | - Marta Giannini
- Department of NEUROFARBA, Section Neurosciences, University of Florence
| | - Eliana Magnani
- Division Neurology 2, Careggi University Hospital, University of Florence
| | - Luca Massacesi
- Department of Neurosciences, Careggi Univ Hospital, University of Florence
| | - Anna Maria Repice
- Division Neurology 2, Careggi University Hospital, University of Florence
| | - Marina Vascotto
- Clinical Pediatrics, Department of Pediatrics, University Hospital Santa Maria alle Scotte
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Pediatrics , University of Siena
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30
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Amoriello R, Greiff V, Aldinucci A, Bonechi E, Carnasciali A, Peruzzi B, Repice AM, Mariottini A, Saccardi R, Mazzanti B, Massacesi L, Ballerini C. The TCR Repertoire Reconstitution in Multiple Sclerosis: Comparing One-Shot and Continuous Immunosuppressive Therapies. Front Immunol 2020; 11:559. [PMID: 32328061 PMCID: PMC7160336 DOI: 10.3389/fimmu.2020.00559] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/11/2020] [Indexed: 11/13/2022] Open
Abstract
Natalizumab (NTZ) and autologous hematopoietic stem cell transplantation (AHSCT) are two successful treatments for relapsing-remitting multiple sclerosis (RRMS), an autoimmune T-cell-driven disorder affecting the central nervous system that is characterized by relapses interspersed with periods of complete or partial recovery. Both RRMS treatments have been documented to impact T-cell subpopulations and the T-cell receptor (TCR) repertoire in terms of clone frequency, but, so far, the link between T-cell naive and memory populations, autoimmunity, and treatment outcome has not yet been established hindering insight into the post-treatment TCR landscape of MS patients. To address this important knowledge gap, we tracked peripheral T-cell subpopulations (naïve and memory CD4+ and CD8+) across 15 RRMS patients before and after two years of continuous treatment (NTZ) and a single treatment course (AHSCT) by high-throughput TCRß sequencing. We found that the two MS treatments left treatment-specific multidimensional traces in patient TCRß repertoire dynamics with respect to clonal expansion, clonal diversity and repertoire architecture. Comparing MS TCR sequences with published datasets suggested that the majority of public TCRs belonged to virus-associated sequences. In summary, applying multi-dimensional computational immunology to a TCRß dataset of treated MS patients, we show that qualitative changes of TCRß repertoires encode treatment-specific information that may be relevant for future clinical trials monitoring and personalized MS follow-up, diagnosis and treatment regimes. Natalizumab (NTZ) and autologous hematopoietic stem cell transplantation (AHSCT) are two successful treatments for relapsing-remitting multiple sclerosis (RRMS), an autoimmune T-cell-driven disorder affecting the central nervous system that is characterized by relapses interspersed with periods of complete or partial recovery. Both RRMS treatments have been documented to impact T-cell subpopulations and the T-cell receptor (TCR) repertoire in terms of clone frequency, but, so far, the link between T-cell naive and memory populations, autoimmunity, and treatment outcome has not yet been established hindering insight into the posttreatment TCR landscape of MS patients. To address this important knowledge gap, we tracked peripheral T-cell subpopulations (naive and memory CD4+ and CD8+) across 15 RRMS patients before and after 2 years of continuous treatment (NTZ) and a single treatment course (AHSCT) by high-throughput TCRβ sequencing. We found that the two MS treatments left treatment-specific multidimensional traces in patient TCRβ repertoire dynamics with respect to clonal expansion, clonal diversity, and repertoire architecture. Comparing MS TCR sequences with published datasets suggested that the majority of public TCRs belonged to virus-associated sequences. In summary, applying multidimensional computational immunology to a TCRβ dataset of treated MS patients, we show that qualitative changes of TCRβ repertoires encode treatment-specific information that may be relevant for future clinical trials monitoring and personalized MS follow-up, diagnosis, and treatment regimens.
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Affiliation(s)
- Roberta Amoriello
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy
| | - Victor Greiff
- Department of Immunology, University of Oslo, Oslo, Norway
| | - Alessandra Aldinucci
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy
| | - Elena Bonechi
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy
| | - Alberto Carnasciali
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy
| | - Benedetta Peruzzi
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Careggi University Hospital, Florence, Italy
| | - Anna Maria Repice
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy
| | - Alice Mariottini
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy
| | - Riccardo Saccardi
- SODc Terapie Cellulari e Medicina Trasfusionale, Careggi University Hospital, Florence, Italy
| | - Benedetta Mazzanti
- Dipartimento di Medicina Sperimentale e Clinica (DMSC), University of Florence, Florence, Italy
| | - Luca Massacesi
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy
| | - Clara Ballerini
- Dipartimento di Medicina Sperimentale e Clinica (DMSC), University of Florence, Florence, Italy
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31
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Mariottini A, Filippini S, Innocenti C, Forci B, Mechi C, Barilaro A, Fani A, Carlucci G, Saccardi R, Massacesi L, Repice AM. Impact of autologous haematopoietic stem cell transplantation on disability and brain atrophy in secondary progressive multiple sclerosis. Mult Scler 2020; 27:61-70. [DOI: 10.1177/1352458520902392] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Autologous haematopoietic stem cell transplantation (aHSCT) is a valuable option in aggressive relapsing–remitting multiple sclerosis (MS), but its efficacy in secondary progressive (SP)-MS is still controversial. Objective: Assessing efficacy of aHSCT in SP-MS by clinical-radiological outcomes. Methods: Open-label monocentric retrospective study enrolling consecutive SP-MS patients treated with BEAM-aHSCT in the period 1999–2016. Results: In total, 26 SP-MS patients with moderate–severe disability were included. Progression-free survival (PFS) at years 5 and 10 after aHSCT were, respectively, 42% and 30%. Out of 16 patients who worsened, only 6 patients (23% overall) maintained continuous disability accrual (CDA), whereas 10 patients stabilized following one single-step Expanded Disability Status Scale (EDSS) worsening. CDA-free survival was 74% at 5–10 years. No relapses or magnetic resonance imaging (MRI) activity were reported, thus no evidence of disease activity (NEDA)-3 corresponded to PFS. Annualized rate of brain atrophy (AR-BVL) normalized after 1 year in 55% of the cases analysed (12/22). Conclusion: BEAM-aHSCT halted CDA and normalized AR-BVL in most of the treated patients, inducing long-term remission of inflammatory activity at a median follow-up of 99 months (range 27–222). These data suggest that CDA might still be mainly driven by inflammation in a subgroup of SP-MS and could therefore be reversed by treatments. CDA should be analysed independently from any isolated disability worsening.
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Affiliation(s)
- Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy/Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
| | - Stefano Filippini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy/Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
| | - Chiara Innocenti
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Benedetta Forci
- Department of Neurosciences Drug and Child Health, University of Florence, Florence, Italy
| | - Claudia Mechi
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
| | - Arianna Fani
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Giovanna Carlucci
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy/Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
| | - Riccardo Saccardi
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy/Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
| | - Anna Maria Repice
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
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32
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Gastaldi M, Mariotto S, Giannoccaro MP, Iorio R, Zoccarato M, Nosadini M, Benedetti L, Casagrande S, Di Filippo M, Valeriani M, Ricci S, Bova S, Arbasino C, Mauri M, Versino M, Vigevano F, Papetti L, Romoli M, Lapucci C, Massa F, Sartori S, Zuliani L, Barilaro A, De Gaspari P, Spagni G, Evoli A, Liguori R, Ferrari S, Marchioni E, Giometto B, Massacesi L, Franciotta D. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study. Eur J Neurol 2020; 27:633-643. [PMID: 31814224 DOI: 10.1111/ene.14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroup of Ab-negative-AE. METHODS This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). RESULTS Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P = 0.045), responded more frequently to treatments (92.3% vs. 65.6%, P < 0.001) and received second-line therapies more often (33.3% vs. 10.8%, P = 0.01). Delays in first-line therapy initiation were associated with poor response (P = 0.022; odds ratio 1.02; confidence interval 1.00-1.04). CONCLUSIONS In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgroup only, implying possible Ab-positive-AE underestimation. Notwithstanding this limitation, our findings suggest that Ab-negative-AE and Ab-positive-AE patients share similar oncological profiles, warranting appropriate tumor screening. Ab-negative-AE patients risk worse responses due to delayed and less aggressive treatments.
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Affiliation(s)
- M Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - S Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M P Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Iorio
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - M Zoccarato
- Ospedale S. Antonio, AULSS Euganea, Padua, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - M Nosadini
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Benedetti
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Casagrande
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - M Di Filippo
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
| | - M Valeriani
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - S Ricci
- Ospedale 'Città-di-Castello-e-Branca', Italy
| | - S Bova
- Pediatric Neurology Unit, ASST Fatebenefratelli Sacco, Children Hospital Vittore Buzzi, Milan, Italy
| | | | - M Mauri
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - M Versino
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - F Vigevano
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - L Papetti
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - M Romoli
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.,Neurology Unit, Rimini "Infermi" Hospital - AUSL Romagna, Rimini, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - F Massa
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Sartori
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Zuliani
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Neurology Department, Ospedale S. Bortolo, Vicenza, Italy
| | - A Barilaro
- Careggi University Hospital, Florence, Italy
| | - P De Gaspari
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - G Spagni
- Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - A Evoli
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - S Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - E Marchioni
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - L Massacesi
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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Pasca M, Picchioni A, Mazzeo S, Terenzi F, Prestipino E, Fratangelo R, Repice AM, Carlucci G, Massacesi L, Barilaro A. A case of recurrent progressive multifocal leukoencephalopathy after human stem cell transplant, with detection of John Cunningham virus and human herpesvirus 6 on cerebrospinal fluid, treated with Mirtazapine, Olanzapine and Foscarnet. Intractable Rare Dis Res 2019; 8:275-278. [PMID: 31890456 PMCID: PMC6929596 DOI: 10.5582/irdr.2019.01107] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We reported the case of a John Cunningham virus (JCV) and human herpesvirus 6 (HHV-6) mediated progressive multifocal leukoencephalopathy (PML) after human stem cell transplant, reactivated 6 months later in absence of immunosuppressive therapy, successfully treated with anti-5HT2A receptors agents and antiviral therapy. Few cases of JCV and HHV-6 coinfection associated PML are described in literature and the role of HHV-6 in the pathogenesis and prognosis of PML is not completely clear. Our case suggests that, in a possible PML, the research of HHV-6 and JCV should be always performed on cerebrospinal fluid (CSF) and on blood samples and in case of detection of HHV-6 DNA a chromosomally integrated human herpesvirus 6(ciHHV-6) should be excluded. Furthermore we recommend to start an appropriate therapy with antiviral and anti-5HT2A receptors agents in case of possible PML due to JCV and HHV-6 coinfection.
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Affiliation(s)
- Matteo Pasca
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Address correspondence to:Dr. Matteo Pasca, Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Largo Brambilla, 3 - 50134 Florence, Italy. E-mail:
| | - Antonella Picchioni
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Salvatore Mazzeo
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Federica Terenzi
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Elio Prestipino
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Roberto Fratangelo
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Anna Maria Repice
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Neurological Division II Careggi University Hospital, Florence, Italy
| | - Giovanna Carlucci
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Neurological Division II Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Neurological Division II Careggi University Hospital, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Neurological Division II Careggi University Hospital, Florence, Italy
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Maggi P, Absinta M, Sati P, Perrotta G, Massacesi L, Dachy B, Pot C, Meuli R, Reich DS, Filippi M, Pasquier RD, Théaudin M. The "central vein sign" in patients with diagnostic "red flags" for multiple sclerosis: A prospective multicenter 3T study. Mult Scler 2019; 26:421-432. [PMID: 31536435 DOI: 10.1177/1352458519876031] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective. OBJECTIVES To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases. METHODS In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory "red flags" (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed. RESULTS Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value. CONCLUSION The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
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Affiliation(s)
- Pietro Maggi
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland/ Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA/ Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Gaetano Perrotta
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Luca Massacesi
- Department of Neuroscience, Psychology, Drug and Child Health (NEUROFARBA), University of Florence, Florence, Italy/ Multiple Sclerosis Center, Department of Neurology 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Bernard Dachy
- Department of Neurology, Hopital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Pot
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Massimo Filippi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Renaud Du Pasquier
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Théaudin
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
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Zamboni P, Tesio L, Galimberti S, Massacesi L, Salvi F, D'Alessandro R, Cenni P, Galeotti R, Papini D, D'Amico R, Simi S, Valsecchi MG, Filippini G. Efficacy and Safety of Extracranial Vein Angioplasty in Multiple Sclerosis: A Randomized Clinical Trial. JAMA Neurol 2019; 75:35-43. [PMID: 29150995 PMCID: PMC5833494 DOI: 10.1001/jamaneurol.2017.3825] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Question What is the efficacy of venous percutaneous transluminal angioplasty (PTA) for chronic cerebrospinal venous insufficiency in patients with multiple sclerosis? Findings In the Brave Dreams trial, which included 115 patients with relapsing-remitting multiple sclerosis, venous PTA did not increase the proportion of patients who improved functionally nor did it reduce the mean number of new combined brain lesions on magnetic resonance imaging at 12 months. However, there was a tendency for more patients to become free of new lesions after venous PTA mainly because of a reduction in new lesions appearing 6 to 12 months after randomization. Meaning Venous PTA cannot be recommended for patients with relapsing-remitting multiple sclerosis. Importance Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by restricted venous outflow from the brain and spinal cord. Whether this condition is associated with multiple sclerosis (MS) and whether venous percutaneous transluminal angioplasty (PTA) is beneficial in persons with MS and CCSVI is controversial. Objective To determine the efficacy and safety of venous PTA in patients with MS and CCSVI. Design, Setting, and Participants We analyzed 177 patients with relapsing-remitting MS; 62 were ineligible, including 47 (26.6%) who did not have CCSVI on color Doppler ultrasonography screening. A total of 115 patients were recruited in the study timeframe. All patients underwent a randomized, double-blind, sham-controlled, parallel-group trial in 6 MS centers in Italy. The trial began in August 2012 and concluded in March 2016; data were analyzed from April 2016 to September 2016. The analysis was intention to treat. Interventions Patients were randomly allocated (2:1) to either venous PTA or catheter venography without venous angioplasty (sham). Main Outcomes and Measures Two primary end points were assessed at 12 months: (1) a composite functional measure (ie, walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity) and (2) a measure of new combined brain lesions on magnetic resonance imaging, including the proportion of lesion-free patients. Combined lesions included T1 gadolinium-enhancing lesions plus new or enlarged T2 lesions. Results Of the included 115 patients with relapsing-remitting MS, 76 were allocated to the PTA group (45 female [59%]; mean [SD] age, 40.0 [10.3] years) and 39 to the sham group (29 female [74%]; mean [SD] age, 37.5 [10.6] years); 112 (97.4%) completed follow-up. No serious adverse events occurred. Flow restoration was achieved in 38 of 71 patients (54%) in the PTA group. The functional composite measure did not differ between the PTA and sham groups (41.7% vs 48.7%; odds ratio, 0.75; 95% CI, 0.34-1.68; P = .49). The mean (SD) number of combined lesions on magnetic resonance imaging at 6 to 12 months were 0.47 (1.19) in the PTA group vs 1.27 (2.65) in the sham group (mean ratio, 0.37; 95% CI, 0.15-0.91; P = .03: adjusted P = .09) and were 1.40 (4.21) in the PTA group vs 1.95 (3.73) in the sham group at 0 to 12 months (mean ratio, 0.72; 95% CI, 0.32-1.63; P = .45; adjusted P = .45). At follow-up after 6 to 12 months, 58 of 70 patients (83%) in the PTA group and 22 of 33 (67%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 2.64; 95% CI, 1.11-6.28; P = .03; adjusted P = .09). At 0 to 12 months, 46 of 73 patients (63.0%) in the PTA group and 18 of 37 (49%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 1.80; 95% CI, 0.81-4.01; P = .15; adjusted P = .30). Conclusion and Relevance Venous PTA has proven to be a safe but largely ineffective technique; the treatment cannot be recommended in patients with MS. Trial Registration clinicaltrials.gov Identifier: NCT01371760
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Affiliation(s)
- Paolo Zamboni
- Translational Surgery and Vascular Diseases Centre, University of Ferrara Hospital, Ferrara, Italy
| | - Luigi Tesio
- Department of Biomedical Sciences for Health, Chair of Physical and Rehabilitation Medicine, University of Milan, Milan, Italy.,Italian Auxologico Institute, Milan, Italy
| | - Stefania Galimberti
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Luca Massacesi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Fabrizio Salvi
- Institute of the Neurological Science, Bellaria Hospital, Bologna, Italy
| | | | | | | | - Donato Papini
- Regional Agency for Health and Social Care, Regione Emilia-Romagna, Italy
| | - Roberto D'Amico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Simi
- MS Cochrane Group. Institute of Clinical Physiology, Pisa, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Graziella Filippini
- Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy
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Mariottini A, Innocenti C, Forci B, Magnani E, Mechi C, Barilaro A, Nistri R, Fani A, Saccardi R, Massacesi L, Repice AM. Safety and efficacy of autologous hematopoietic stem‐cell transplantation following natalizumab discontinuation in aggressive multiple sclerosis. Eur J Neurol 2018; 26:624-630. [DOI: 10.1111/ene.13866] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 11/06/2018] [Indexed: 12/29/2022]
Affiliation(s)
- A. Mariottini
- Department of Neurosciences Drug and Child Health University of Florence Florence
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence
| | - C. Innocenti
- Cell Therapy and Transfusion Medicine Unit Careggi University Hospital Florence Italy
| | - B. Forci
- Department of Neurosciences Drug and Child Health University of Florence Florence
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence
| | - E. Magnani
- Department of Neurosciences Drug and Child Health University of Florence Florence
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence
| | - C. Mechi
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence
| | - A. Barilaro
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence
| | - R. Nistri
- Department of Neurosciences Drug and Child Health University of Florence Florence
| | - A. Fani
- Cell Therapy and Transfusion Medicine Unit Careggi University Hospital Florence Italy
| | - R. Saccardi
- Cell Therapy and Transfusion Medicine Unit Careggi University Hospital Florence Italy
| | - L. Massacesi
- Department of Neurosciences Drug and Child Health University of Florence Florence
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence
| | - A. M. Repice
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre Careggi University Hospital Florence
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D'Amore A, Tessa A, Casali C, Dotti MT, Filla A, Silvestri G, Antenora A, Astrea G, Barghigiani M, Battini R, Battisti C, Bruno I, Cereda C, Dato C, Di Iorio G, Donadio V, Felicori M, Fini N, Fiorillo C, Gallone S, Gemignani F, Gigli GL, Graziano C, Guerrini R, Gurrieri F, Kariminejad A, Lieto M, Marques LourenḈo C, Malandrini A, Mandich P, Marcotulli C, Mari F, Massacesi L, Melone MAB, Mignarri A, Milone R, Musumeci O, Pegoraro E, Perna A, Petrucci A, Pini A, Pochiero F, Pons MR, Ricca I, Rossi S, Seri M, Stanzial F, Tinelli F, Toscano A, Valente M, Federico A, Rubegni A, Santorelli FM. Next Generation Molecular Diagnosis of Hereditary Spastic Paraplegias: An Italian Cross-Sectional Study. Front Neurol 2018; 9:981. [PMID: 30564185 PMCID: PMC6289125 DOI: 10.3389/fneur.2018.00981] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022] Open
Abstract
Hereditary spastic paraplegia (HSP) refers to a group of genetically heterogeneous neurodegenerative motor neuron disorders characterized by progressive age-dependent loss of corticospinal motor tract function, lower limb spasticity, and weakness. Recent clinical use of next generation sequencing (NGS) methodologies suggests that they facilitate the diagnostic approach to HSP, but the power of NGS as a first-tier diagnostic procedure is unclear. The larger-than-expected genetic heterogeneity-there are over 80 potential disease-associated genes-and frequent overlap with other clinical conditions affecting the motor system make a molecular diagnosis in HSP cumbersome and time consuming. In a single-center, cross-sectional study, spanning 4 years, 239 subjects with a clinical diagnosis of HSP underwent molecular screening of a large set of genes, using two different customized NGS panels. The latest version of our targeted sequencing panel (SpastiSure3.0) comprises 118 genes known to be associated with HSP. Using an in-house validated bioinformatics pipeline and several in silico tools to predict mutation pathogenicity, we obtained a positive diagnostic yield of 29% (70/239), whereas variants of unknown significance (VUS) were found in 86 patients (36%), and 83 cases remained unsolved. This study is among the largest screenings of consecutive HSP index cases enrolled in real-life clinical-diagnostic settings. Its results corroborate NGS as a modern, first-step procedure for molecular diagnosis of HSP. It also disclosed a significant number of new mutations in ultra-rare genes, expanding the clinical spectrum, and genetic landscape of HSP, at least in Italy.
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Affiliation(s)
- Angelica D'Amore
- Molecular Medicine, Pisa, Italy.,Department of Biology, University of Pisa, Pisa, Italy
| | | | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Federico II University, Naples, Italy
| | - Gabriella Silvestri
- IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonella Antenora
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Federico II University, Naples, Italy
| | | | | | | | - Carla Battisti
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Irene Bruno
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Cristina Cereda
- Genomic and Post-Genomic Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Clemente Dato
- Second Division of Neurology, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Di Iorio
- Second Division of Neurology, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna-UOC Clinica Neurologica, Bologna, Italy
| | - Monica Felicori
- Istituto delle Scienze Neurologiche di Bologna-UOC Neuropsichiatria Infantile, Bologna, Italy
| | - Nicola Fini
- Department of Neurosciences, Sant'Agostino-Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Chiara Fiorillo
- Pediatric Neurology and Neuromuscular Disorders, University of Genoa and Istituto Giannina Gaslini, Genova, Italy
| | - Salvatore Gallone
- Neurology I, Department of Neuroscience and Mental Health, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Gian Luigi Gigli
- Neurology Clinic, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Claudio Graziano
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit, Children's Hospital A. Meyer, University of Firenze, Florence, Italy
| | - Fiorella Gurrieri
- Institute of Genomic Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Ariana Kariminejad
- Clinical Genetics, Kariminejad-Najmabadi Pathology & Genetics Research Center, Tehran, Iran
| | - Maria Lieto
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Federico II University, Naples, Italy
| | - Charles Marques LourenḈo
- Neurogenetics Division, Clinics Hospital of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alessandro Malandrini
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Medical Genetics, University of Genoa, Genoa, Italy.,Medical Genetics Unit, Department of Diagnosis, Pathology and Treatments of High Technological Complexity, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Christian Marcotulli
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Francesco Mari
- Pediatric Neurology Unit, Children's Hospital A. Meyer, University of Firenze, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Maria A B Melone
- Second Division of Neurology, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Luigi Vanvitelli, Naples, Italy
| | - Andrea Mignarri
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Roberta Milone
- Child Neuropsychiatry, ULSS 7 Pedemontana, Vicenza, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Alessia Perna
- IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | | | - Antonella Pini
- Istituto delle Scienze Neurologiche di Bologna-UOC Neuropsichiatria Infantile, Bologna, Italy
| | - Francesca Pochiero
- Metabolic and Muscular Unit, Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Maria Roser Pons
- First Department of Pediatrics, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece
| | | | - Salvatore Rossi
- IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Marco Seri
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Franco Stanzial
- Clinical Genetics Service and South Tyrol Coordination Center for Rare Diseases, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
| | | | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mariarosaria Valente
- Neurology Clinic, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
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Cadavid D, Balcer L, Galetta S, Aktas O, Ziemssen T, Vanopdenbosch LJ, Leocani L, Freedman MS, Plant GT, Preiningerova JL, Ziemssen F, Massacesi L, Chai Y, Xu L. Predictors of response to opicinumab in acute optic neuritis. Ann Clin Transl Neurol 2018; 5:1154-1162. [PMID: 30349850 PMCID: PMC6186935 DOI: 10.1002/acn3.620] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 01/03/2023] Open
Abstract
Objective The objective of this study was to evaluate prespecified and post hoc analyses in RENEW subgroups to identify participants more likely to benefit from opicinumab. Methods RENEW assessed the efficacy/safety of opicinumab versus placebo in participants with a first unilateral acute optic neuritis (AON) episode. Difference in visual evoked potential (VEP) latency of the affected eye at 24 weeks versus the fellow eye at baseline was the primary endpoint. Interactions between the primary endpoint and prespecified baseline variables (including age, timing of treatment initiation, and visual impairment) using the median as cut-off were evaluated in the per protocol population using analysis of covariance (ANCOVA); subgroups based on preexisting brain T2 lesion volume were also analyzed. Interactions between the primary endpoint and retinal ganglion cell layer/inner plexiform layer (RGCL/IPL) and retinal nerve fiber layer (RNFL) thickness were assessed post hoc as was weight gain by treatment. Results Treatment benefit of opicinumab (n = 33) over placebo (n = 36) on the primary endpoint was greatest in participants older than the median age at baseline (≥33 years); the difference versus placebo for baseline age ≥33 years was -14.17 msec [P = 0.01] versus -0.89 msec for baseline age <33 years, [P = 0.87]). Post hoc analysis showed that VEP latency recovery was significantly associated with less RGCL/IPL thinning (P = 0.0164), occurring early on. Interpretation Age was the strongest prespecified baseline characteristic associated with a treatment effect of opicinumab. A strong association between VEP latency recovery at week 24 and early RGCL/IPL preservation was observed.
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Affiliation(s)
| | - Laura Balcer
- Departments of Neurology, Population Health, and Ophthalmology New York University School of Medicine New York New York
| | - Steven Galetta
- Departments of Neurology, Population Health, and Ophthalmology New York University School of Medicine New York New York
| | - Orhan Aktas
- Department of Neurology Medical Faculty Heinrich-Heine-Universität Düsseldorf Düsseldorf Germany
| | - Tjalf Ziemssen
- MS Center Dresden Center of Clinical Neuroscience University Hospital Carl Gustav Carus Dresden University of Technology Dresden Germany
| | | | | | - Mark S Freedman
- University of Ottawa and the Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Gordon T Plant
- Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery London United Kingdom
| | | | - Focke Ziemssen
- Center for Ophthalmology Eberhard Karls University of Tuebingen Tuebingen Germany
| | - Luca Massacesi
- Department of Neurosciences, Drugs and Child's Health University of Florence Florence Italy
| | - Yi Chai
- Biogen Cambridge Massachusetts
| | - Lei Xu
- Biogen Cambridge Massachusetts
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Zamboni P, Tesio L, Galimberti S, Massacesi L, Salvi F, D'Alessandro R. Efficacy and Safety of Extracranial Vein Angioplasty in Multiple Sclerosis: A Randomized Clinical Trial. J Vasc Surg Venous Lymphat Disord 2018. [DOI: 10.1016/j.jvsv.2018.03.007] [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: 10/17/2022]
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Maggi P, Absinta M, Grammatico M, Vuolo L, Emmi G, Carlucci G, Spagni G, Barilaro A, Repice AM, Emmi L, Prisco D, Martinelli V, Scotti R, Sadeghi N, Perrotta G, Sati P, Dachy B, Reich DS, Filippi M, Massacesi L. Central vein sign differentiates Multiple Sclerosis from central nervous system inflammatory vasculopathies. Ann Neurol 2018; 83:283-294. [PMID: 29328521 PMCID: PMC5901412 DOI: 10.1002/ana.25146] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 12/12/2022]
Abstract
Objectives In multiple sclerosis (MS), magnetic resonance imaging (MRI) is a sensitive tool for detecting white matter lesions, but its diagnostic specificity is still suboptimal; ambiguous cases are frequent in clinical practice. Detection of perivenular lesions in the brain (the “central vein sign”) improves the pathological specificity of MS diagnosis, but comprehensive evaluation of this MRI biomarker in MS‐mimicking inflammatory and/or autoimmune diseases, such as central nervous system (CNS) inflammatory vasculopathies, is lacking. In a multicenter study, we assessed the frequency of perivenular lesions in MS versus systemic autoimmune diseases with CNS involvement and primary angiitis of the CNS (PACNS). Methods In 31 patients with inflammatory CNS vasculopathies and 52 with relapsing–remitting MS, 3‐dimensional T2*‐weighted and T2–fluid‐attenuated inversion recovery images were obtained during a single MRI acquisition after gadolinium injection. For each lesion, the central vein sign was evaluated according to consensus guidelines. For each patient, lesion count, volume, and brain location, as well as fulfillment of dissemination in space MRI criteria, were assessed. Results MS showed higher frequency of perivenular lesions (median = 88%) than did inflammatory CNS vasculopathies (14%), without overlap between groups or differences between 3T and 1.5T MRI. Among inflammatory vasculopathies, Behçet disease showed the highest median frequency of perivenular lesions (34%), followed by PACNS (14%), antiphospholipid syndromes (12%), Sjögren syndrome (11%), and systemic lupus erythematosus (0%). When a threshold of 50% perivenular lesions was applied, central vein sign discriminated MS from inflammatory vasculopathies with a diagnostic accuracy of 100%. Interpretation The central vein sign differentiates inflammatory CNS vasculopathies from MS at standard clinical magnetic field strengths. Ann Neurol 2018;83:283–294
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Affiliation(s)
- Pietro Maggi
- Department of Neurology, Université Libre de Bruxelles, Brussels, Belgium.,Department of Neurology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.,Department of Neurology, Vita-Salute San Raffaele University, Milan, Italy.,Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Grammatico
- Department of Neuroscience, Drug and Child Health, University of Florence, Florence, Italy
| | - Luisa Vuolo
- Department of Neuroscience, Drug and Child Health, University of Florence, Florence, Italy
| | - Giacomo Emmi
- Internal Interdisciplinary Medicine, Center for Rare Cardiovascular and Immunological Diseases Lupus Clinic, Careggi University Hospital, University of Florence, Florence, Italy
| | - Giovanna Carlucci
- Multiple Sclerosis Center, Department of Neurology 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Gregorio Spagni
- Department of Neuroscience, Drug and Child Health, University of Florence, Florence, Italy
| | - Alessandro Barilaro
- Multiple Sclerosis Center, Department of Neurology 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Anna Maria Repice
- Multiple Sclerosis Center, Department of Neurology 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Lorenzo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Roberta Scotti
- Department of Radiology, Vita-Salute San Raffaele University, Milan, Italy
| | - Niloufar Sadeghi
- Department of Radiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gaetano Perrotta
- Department of Neurology, Université Libre de Bruxelles, Brussels, Belgium
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Bernard Dachy
- Department of Neurology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Massimo Filippi
- Department of Neurology, Vita-Salute San Raffaele University, Milan, Italy.,Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Massacesi
- Department of Neuroscience, Drug and Child Health, University of Florence, Florence, Italy.,Multiple Sclerosis Center, Department of Neurology 2, Careggi University Hospital, University of Florence, Florence, Italy
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Muraro PA, Pasquini M, Atkins HL, Bowen JD, Farge D, Fassas A, Freedman MS, Georges GE, Gualandi F, Hamerschlak N, Havrdova E, Kimiskidis VK, Kozak T, Mancardi GL, Massacesi L, Moraes DA, Nash RA, Pavletic S, Ouyang J, Rovira M, Saiz A, Simoes B, Trnený M, Zhu L, Badoglio M, Zhong X, Sormani MP, Saccardi R. Long-term Outcomes After Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis. JAMA Neurol 2017; 74:459-469. [PMID: 28241268 DOI: 10.1001/jamaneurol.2016.5867] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Autologous hematopoietic stem cell transplantation (AHSCT) may be effective in aggressive forms of multiple sclerosis (MS) that fail to respond to standard therapies. Objective To evaluate the long-term outcomes in patients who underwent AHSCT for the treatment of MS in a large multicenter cohort. Design, Setting, and Participants Data were obtained in a multicenter, observational, retrospective cohort study. Eligibility criteria were receipt of AHSCT for the treatment of MS between January 1995 and December 2006 and the availability of a prespecified minimum data set comprising the disease subtype at baseline; the Expanded Disability Status Scale (EDSS) score at baseline; information on the administered conditioning regimen and graft manipulation; and at least 1 follow-up visit or report after transplant. The last patient visit was on July 1, 2012. To avoid bias, all eligible patients were included in the analysis regardless of their duration of follow-up. Data analysis was conducted from September 1, 2014 to April 27, 2015. Exposures Demographic, disease-related, and treatment-related exposures were considered variables of interest, including age, disease subtype, baseline EDSS score, number of previous disease-modifying treatments, and intensity of the conditioning regimen. Main Outcomes and Measures The primary outcomes were MS progression-free survival and overall survival. The probabilities of progression-free survival and overall survival were calculated using Kaplan-Meier survival curves and multivariable Cox proportional hazards regression analysis models. Results Valid data were obtained from 25 centers in 13 countries for 281 evaluable patients, with median follow-up of 6.6 years (range, 0.2-16 years). Seventy-eight percent (218 of 281) of patients had progressive forms of MS. The median EDSS score before mobilization of peripheral blood stem cells was 6.5 (range, 1.5-9). Eight deaths (2.8%; 95% CI, 1.0%-4.9%) were reported within 100 days of transplant and were considered transplant-related mortality. The 5-year probability of progression-free survival as assessed by the EDSS score was 46% (95% CI, 42%-54%), and overall survival was 93% (95% CI, 89%-96%) at 5 years. Factors associated with neurological progression after transplant were older age (hazard ratio [HR], 1.03; 95% CI, 1.00-1.05), progressive vs relapsing form of MS (HR, 2.33; 95% CI, 1.27-4.28), and more than 2 previous disease-modifying therapies (HR, 1.65; 95% CI, 1.10-2.47). Higher baseline EDSS score was associated with worse overall survival (HR, 2.03; 95% CI, 1.40-2.95). Conclusions and Relevance In this observational study of patients with MS treated with AHSCT, almost half of them remained free from neurological progression for 5 years after transplant. Younger age, relapsing form of MS, fewer prior immunotherapies, and lower baseline EDSS score were factors associated with better outcomes. The results support the rationale for further randomized clinical trials of AHSCT for the treatment of MS.
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Affiliation(s)
- Paolo A Muraro
- Division of Brain Sciences, Imperial College London, London, England
| | - Marcelo Pasquini
- Center for International Blood and Marrow Transplant Research, Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Harold L Atkins
- Clinical Hematology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - James D Bowen
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, Washington
| | - Dominique Farge
- Internal Medicine, Autoimmune and Vascular Diseases Unit, Unité Fonctionnelle 04, Assistance Publique-Hôpitaux de Paris Saint-Louis Hospital, Institut National de la Santé et de la Récherche Médicale Unité Mixte de Recherche 1160, Paris, France
| | - Athanasios Fassas
- Department of Hematology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark S Freedman
- Division of Neurology, Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - George E Georges
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle
| | | | - Nelson Hamerschlak
- Bone Marrow Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eva Havrdova
- Department of Neurology, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Vassilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Tomas Kozak
- Department of Internal Medicine and Haematology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Giovanni L Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genova, Italy
| | - Luca Massacesi
- Department of Neurosciences, Careggi University Hospital, University of Florence, Firenze, Italy
| | - Daniela A Moraes
- Department of Clinical Medicine, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Steven Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jian Ouyang
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Montserrat Rovira
- Hematology Service, Hospital Clinic and Neurology Service, Universitat de Barcelona, Barcelona, Spain
| | - Albert Saiz
- Hospital Clinic and Institut d'Investigació August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Belinda Simoes
- Department of Clinical Medicine, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marek Trnený
- Department of Medicine, Charles University General Hospital, Prague, Czech Republic
| | - Lin Zhu
- Drum Tower Hospital of Nanjing Medical University, Nanjing, China
| | - Manuela Badoglio
- European Blood and Marrow Transplant Paris Office, Hôpital Saint Antoine, Paris, France
| | - Xiaobo Zhong
- Center for International Blood and Marrow Transplant Research, Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee
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Cadavid D, Balcer L, Galetta S, Aktas O, Ziemssen T, Vanopdenbosch L, Frederiksen J, Skeen M, Jaffe GJ, Butzkueven H, Ziemssen F, Massacesi L, Chai Y, Xu L, Freeman S. Safety and efficacy of opicinumab in acute optic neuritis (RENEW): a randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2017; 16:189-199. [PMID: 28229892 DOI: 10.1016/s1474-4422(16)30377-5] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND The human monoclonal antibody opicinumab (BIIB033, anti-LINGO-1) has shown remyelinating activity in preclinical studies. We therefore assessed the safety and tolerability, and efficacy of opicinumab given soon after a first acute optic neuritis episode. METHODS This randomised, double-blind, placebo-controlled, phase 2 study (RENEW) was done at 33 sites in Australia, Canada, and Europe in participants (aged 18-55 years) with a first unilateral acute optic neuritis episode within 28 days from study baseline. After treatment with high-dose methylprednisolone (1 g/day, intravenously, for 3-5 days), participants were assigned with a computer-generated sequence with permuted block randomisation (1:1) using a centralised interactive voice and web response system to receive 100 mg/kg opicinumab intravenously or placebo once every 4 weeks (six doses) and followed up to week 32. All study participants and all study staff, including the central readers, were masked to treatment assignment apart from the pharmacist responsible for preparing the study treatments and the pharmacy monitor at each site. The primary endpoint was remyelination at 24 weeks, measured as recovery of affected optic nerve conduction latency using full-field visual evoked potential (FF-VEP) versus the unaffected fellow eye at baseline. Analysis was by intention-to-treat (ITT); prespecified per-protocol (PP) analyses were also done. This study is registered with ClinicalTrials.gov, number NCT01721161. FINDINGS The study was done between Dec 21, 2012, and Oct 21, 2014. 82 participants were enrolled, and 41 in each group comprised the ITT population; 33 participants received opicinumab and 36 received placebo in the PP population. Adjusted mean treatment difference of opicinumab versus placebo was -3·5 ms (17·3 vs 20·8 [95% CI -10·6 to 3·7]; 17%; p=0·33) in the ITT population, and -7·6 ms in the PP population (14·7 vs 22·2 [-15·1 to 0·0]; 34%; p=0·050) at week 24 and -6·1 ms (15·1 vs 21·2 [-12·7 to 0·5]; 29%; p=0·071) in the ITT population and -9·1 ms (13·2 vs 22·4 [-16·1 to -2·1]; 41%; p=0·011) in the PP population at week 32. The overall incidence (34 [83%] of 41 in each group) and severity of adverse events (two [5%] of 41 severe adverse events with placebo vs three [7%] of 41 with opicinumab) were similar between groups and no significant effects on brain MRI measures were noted in either group (mean T2 lesion volume change, 0·05 mL [SD 0·21] for placebo vs 0·20 mL [0·52] with opicinumab; 27 [77%] of 35 participants with no change in gadolinium-enhancing [Gd+] lesion number with opicinumab vs 27 [79%] of 34 with placebo; mean 0·4 [SD 0·79 for the placebo group and 0·85 for the opicinumab group] new Gd+ lesions per participant in both groups). Treatment-related serious adverse events were reported in three (7%) of 41 participants in the opicinumab group (hypersensitivity [n=2], asymptomatic increase in transaminase concentrations [n=1]) and none of the participants in the placebo group. INTERPRETATION Remyelination did not differ significantly between the opicinumab and placebo groups in the ITT population at week 24. However, results from the prespecified PP population suggest that enhancing remyelination in the human CNS with opicinumab might be possible and warrant further clinical investigation. FUNDING Biogen.
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Affiliation(s)
| | - Laura Balcer
- Departments of Neurology, Population Health, and Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Steven Galetta
- Departments of Neurology, Population Health, and Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tjalf Ziemssen
- MS Centre Dresden, Centre of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Ludo Vanopdenbosch
- Department of Neurology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Jette Frederiksen
- Department of Neurology, Rigshospitalet-Glostrup and University of Copenhagen, Glostrup, Denmark
| | - Mark Skeen
- Department of Neurology, Duke University, Durham, NC, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Focke Ziemssen
- Center for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Luca Massacesi
- Department of Neurosciences, Drug Research, and Child's Health, University of Florence, Florence, Italy
| | | | - Lei Xu
- Biogen, Cambridge, MA, USA
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Amato MP, Derfuss T, Hemmer B, Liblau R, Montalban X, Soelberg Sørensen P, Miller DH, Alfredsson L, Aloisi F, Amato MP, Ascherio A, Baldin E, Bjørnevik K, Comabella M, Correale J, Cortese M, Derfuss T, D’Hooghe M, Ghezzi A, Gold J, Hellwig K, Hemmer B, Koch-Henricksen N, Langer Gould A, Liblau R, Linker R, Lolli F, Lucas R, Lünemann J, Magyari M, Massacesi L, Miller A, Miller DH, Montalban X, Monteyne P, Mowry E, Münz C, Nielsen NM, Olsson T, Oreja-Guevara C, Otero S, Pugliatti M, Reingold S, Riise T, Robertson N, Salvetti M, Sidhom Y, Smolders J, Soelberg Sørensen P, Sollid L, Steiner I, Stenager E, Sundstrom P, Taylor BV, Tremlett H, Trojano M, Uccelli A, Waubant E, Wekerle H. Environmental modifiable risk factors for multiple sclerosis: Report from the 2016 ECTRIMS focused workshop. Mult Scler 2017; 24:590-603. [DOI: 10.1177/1352458516686847] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative demyelinating disease of the central nervous system (CNS), most likely autoimmune in origin, usually beginning in early adulthood. The aetiology of the disease is not well understood; it is viewed currently as a multifactorial disease which results from complex interactions between genetic predisposition and environmental factors, of which a few are potentially modifiable. Improving our understanding of these factors can lead to new and more effective approaches to patient counselling and, possibly, prevention and management of the disease. The 2016 focused workshop of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) addressed the topic of environmental, modifiable risk factors for MS, gathering experts from around the world, to collate experimental and clinical research into environmental factors that have been associated with the disease onset and, in a few cases, disease activity and progression. A number of factors, including infections, vitamin D deficiency, diet and lifestyle factors, stress and comorbidities, were discussed. The meeting provided a forum to analyse available evidence, to identify inconsistencies and gaps in current knowledge and to suggest avenues for future research.
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Affiliation(s)
- Maria Pia Amato
- Department of NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Tobias Derfuss
- Departments of Neurology and Biomedicine, University Hospital Basel, Basel, Switzerland
| | | | - Roland Liblau
- Faculte de Medecine Purpan, Universite Toulouse III – Paul Sabatier, Toulouse, France
| | | | | | - David H Miller
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK*
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Sati P, Oh J, Constable RT, Evangelou N, Guttmann CRG, Henry RG, Klawiter EC, Mainero C, Massacesi L, McFarland H, Nelson F, Ontaneda D, Rauscher A, Rooney WD, Samaraweera APR, Shinohara RT, Sobel RA, Solomon AJ, Treaba CA, Wuerfel J, Zivadinov R, Sicotte NL, Pelletier D, Reich DS. The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative. Nat Rev Neurol 2016; 12:714-722. [DOI: 10.1038/nrneurol.2016.166] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Maggi P, Sati P, Massacesi L. Magnetic resonance imaging of experimental autoimmune encephalomyelitis in the common marmoset. J Neuroimmunol 2016; 304:86-92. [PMID: 27743612 DOI: 10.1016/j.jneuroim.2016.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 04/14/2016] [Accepted: 09/28/2016] [Indexed: 12/26/2022]
Abstract
Magnetic resonance imaging (MRI) is an invaluable tool for the diagnosis and monitoring of patients with multiple sclerosis (MS) as well as for the study of the disease pathophysiology. Because of its strong clinical, radiological and histopathological similarities with the human disease, experimental autoimmune encephalomyelitis (EAE) in the common marmoset has been studied more intensively over the past several years. Here, we review the current knowledge on MRI in the marmoset EAE, and we outline the physiopathological significance and translational values of these studies with respect to MS. Accumulating evidences suggest that the application of conventional, as well as non-conventional, MRI techniques in the marmoset EAE is a promising approach to elucidate the pathological processes underlying the development of inflammatory demyelinated lesions in the central nervous system, potentially improving the identification and development of new therapeutics.
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Affiliation(s)
- Pietro Maggi
- Department of Neurology, Hôpital Erasme-Université libre de Bruxelles, Belgium
| | - Pascal Sati
- Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Luca Massacesi
- Department of Neurosciences, Drug Research, and Child Health, University of Florence, Florence, Italy
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Maggi P, Mazzoni LN, Moretti M, Grammatico M, Chiti S, Massacesi L. SWI enhances vein detection using gadolinium in multiple sclerosis. Acta Radiol Open 2015; 4:2047981614560938. [PMID: 25815209 PMCID: PMC4372566 DOI: 10.1177/2047981614560938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/31/2014] [Indexed: 12/14/2022] Open
Abstract
Susceptibility weighted imaging (SWI) combined with the FLAIR sequence provides the ability to depict in vivo the perivenous location of inflammatory demyelinating lesions – one of the most specific pathologic features of multiple sclerosis (MS). In addition, in MS white matter (WM) lesions, gadolinium-based contrast media (CM) can increase vein signal loss on SWI. This report focuses on two cases of WM inflammatory lesions enhancing on SWI images after CM injection. In these lesions in fact the CM increased the contrast between the parenchyma and the central vein allowing as well, in one of the two cases, the detection of a vein not visible on the same SWI sequence acquired before CM injection.
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Affiliation(s)
- Pietro Maggi
- Department of Neurosciences, Drug Research, and Child's Health, University of Florence, Florence, Italy
| | | | - Marco Moretti
- Department of Neuroimaging, University of Florence, Florence, Italy
| | - Matteo Grammatico
- Department of Neurosciences, Drug Research, and Child's Health, University of Florence, Florence, Italy
| | - Stefano Chiti
- Medical Imaging Department, Careggi University Hospital, Florence Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug Research, and Child's Health, University of Florence, Florence, Italy
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Mancardi GL, Sormani MP, Gualandi F, Saiz A, Carreras E, Merelli E, Donelli A, Lugaresi A, Di Bartolomeo P, Rottoli MR, Rambaldi A, Amato MP, Massacesi L, Di Gioia M, Vuolo L, Currò D, Roccatagliata L, Filippi M, Aguglia U, Iacopino P, Farge D, Saccardi R. Autologous hematopoietic stem cell transplantation in multiple sclerosis: a phase II trial. Neurology 2015; 84:981-8. [PMID: 25672923 DOI: 10.1212/wnl.0000000000001329] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess in multiple sclerosis (MS) the effect of intense immunosuppression followed by autologous hematopoietic stem cells transplantation (AHSCT) vs mitoxantrone (MTX) on disease activity measured by MRI. METHODS We conducted a multicenter, phase II, randomized trial including patients with secondary progressive or relapsing-remitting MS, with a documented increase in the last year on the Expanded Disability Status Scale, in spite of conventional therapy, and presence of one or more gadolinium-enhancing (Gd+) areas. Patients were randomized to receive intense immunosuppression (mobilization with cyclophosphamide and filgrastim, conditioning with carmustine, cytosine-arabinoside, etoposide, melphalan, and anti-thymocyte globulin) followed by AHSCT or MTX 20 mg every month for 6 months. The primary endpoint was the cumulative number of new T2 lesions in the 4 years following randomization. Secondary endpoints were the cumulative number of Gd+ lesions, relapse rate, and disability progression. Safety and tolerability were also assessed. Twenty-one patients were randomized and 17 had postbaseline evaluable MRI scans. RESULTS AHSCT reduced by 79% the number of new T2 lesions as compared to MTX (rate ratio 0.21, p = 0.00016). It also reduced Gd+ lesions as well as the annualized relapse rate. No difference was found in the progression of disability. CONCLUSION Intense immunosuppression followed by AHSCT is significantly superior to MTX in reducing MRI activity in severe cases of MS. These results strongly support further phase III studies with primary clinical endpoints. The study was registered as EUDRACT No. 2007-000064-24.
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Affiliation(s)
- Giovanni L Mancardi
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France.
| | - Maria P Sormani
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Francesca Gualandi
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Albert Saiz
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Eric Carreras
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Elisa Merelli
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Amedea Donelli
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Alessandra Lugaresi
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Paolo Di Bartolomeo
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Maria R Rottoli
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Alessandro Rambaldi
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Maria P Amato
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Luca Massacesi
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Massimo Di Gioia
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Luisa Vuolo
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Daniela Currò
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Luca Roccatagliata
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Massimo Filippi
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Umberto Aguglia
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Pasquale Iacopino
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Dominique Farge
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
| | - Riccardo Saccardi
- From the MRI Center for Neurological Diseases (L.R.), Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (G.L.M., D.C.), and the Biostatistic Unit, Department of Health Sciences (M.P.S., L.R.), University of Genova; the Bone Marrow Transplantation Unit (F.G.), S. Martino Hospital, Genova, Italy; the Service of Neurology (A.S.) and the Hematology Department (E.C.), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic, University of Barcelona, Spain; the Department of Neurosciences (E.M.) and the Bone Marrow Transplantation Unit, Department of Hematology and Oncology (A.D.), University of Modena and Reggio Emilia; the MS Center, Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University Gabriele D'Annunzio, Chieti-Pescara; the Bone Marrow Transplant Center, Department of Hematology (P.D.B.), Spirito Santo Hospital, Pescara; the Multiple Sclerosis Unit Ospedale Papa Giovanni XXIII (M.R.R.), Bergamo; the Hematology and Bone Marrow Transplant Unit Azienda Ospedaliera Papa Giovanni XXIII (A.R.), Bergamo; Division Neurology 1 (M.P.A.) and Division Neurology 2, Drug and Child Health (L.M., L.V.), Department of Neurosciences, and Bone Marrow Transplantation Unit (M.D.G., R.S.), Careggi University Hospital, University of Firenze; the Neuroimaging Research Unit (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; the Department of Medical and Surgical Sciences (U.A.), Magna Graecia University of Catanzaro; the Advanced Cellular Therapy Center IRCCS "Istituto Tumori Giovanni Paolo II" Bari (P.I.), Italy; and the Internal Medicine and Vascular Disease Unit (D.F.), Assistance Publique Hospitaux de Paris (AP-HP) INSERM U 796, Paris 7 University, Saint-Louis Hospital, Paris, France
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Clausi V, Giannecchini S, Magnani E, Repice A, Mechi C, Martelli F, Azzi A, Massacesi L. Markers of JC virus infection in patients with multiple sclerosis under natalizumab therapy. Neurol Neuroimmunol Neuroinflamm 2015; 2:e58. [PMID: 25610882 PMCID: PMC4299884 DOI: 10.1212/nxi.0000000000000058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/01/2014] [Indexed: 12/02/2022]
Abstract
Objective: To evaluate the frequency of JC polyomavirus (JCPyV) infection and anti-JCPyV antibodies in patients with multiple sclerosis under natalizumab therapy. Methods: Presence of anti-JCPyV antibodies and JCPyV DNA was analyzed in 39 patients with relapsing-remitting multiple sclerosis undergoing natalizumab therapy. Anti-JCPyV antibodies were evaluated in serum by a 2-step virus-like particle-based ELISA assay (Stratify), and JCPyV DNA was evaluated in peripheral blood mononuclear cells, plasma, and urine by quantitative PCR. The anti-JCPyV antibodies were evaluated in serum samples collected at the same time or later than those collected for DNA analysis. Results: JCPyV DNA was detected in 59% of patients, and anti-JCPyV antibodies were present in 67%. JCPyV DNA occurred more often in blood than in urine. Anti-JCPyV antibodies were observed in 70% of the JCPyV-infected patients, and JCPyV DNA was detected in 50% of the patients without anti-JCPyV antibodies. When JCPyV DNA was investigated in blood and urine the frequency of infection was higher than previously described. Conclusion: Under these experimental conditions, with respect to the observed frequency of JCPyV infection, the sensitivity of the anti-JCPyV antibody assay was lower than expected.
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Affiliation(s)
- Valeria Clausi
- Department of Experimental and Clinical Medicine (V.C., S.G., F.M., A.A.) and Department of Neurosciences, Drugs and Child Health (E.M., L.M.), University of Florence; and Neurology 2 Division (A.R., C.M., L.M.), Careggi University Hospital, Florence, Italy
| | - Simone Giannecchini
- Department of Experimental and Clinical Medicine (V.C., S.G., F.M., A.A.) and Department of Neurosciences, Drugs and Child Health (E.M., L.M.), University of Florence; and Neurology 2 Division (A.R., C.M., L.M.), Careggi University Hospital, Florence, Italy
| | - Eliana Magnani
- Department of Experimental and Clinical Medicine (V.C., S.G., F.M., A.A.) and Department of Neurosciences, Drugs and Child Health (E.M., L.M.), University of Florence; and Neurology 2 Division (A.R., C.M., L.M.), Careggi University Hospital, Florence, Italy
| | - Anna Repice
- Department of Experimental and Clinical Medicine (V.C., S.G., F.M., A.A.) and Department of Neurosciences, Drugs and Child Health (E.M., L.M.), University of Florence; and Neurology 2 Division (A.R., C.M., L.M.), Careggi University Hospital, Florence, Italy
| | - Claudia Mechi
- Department of Experimental and Clinical Medicine (V.C., S.G., F.M., A.A.) and Department of Neurosciences, Drugs and Child Health (E.M., L.M.), University of Florence; and Neurology 2 Division (A.R., C.M., L.M.), Careggi University Hospital, Florence, Italy
| | - Francesco Martelli
- Department of Experimental and Clinical Medicine (V.C., S.G., F.M., A.A.) and Department of Neurosciences, Drugs and Child Health (E.M., L.M.), University of Florence; and Neurology 2 Division (A.R., C.M., L.M.), Careggi University Hospital, Florence, Italy
| | - Alberta Azzi
- Department of Experimental and Clinical Medicine (V.C., S.G., F.M., A.A.) and Department of Neurosciences, Drugs and Child Health (E.M., L.M.), University of Florence; and Neurology 2 Division (A.R., C.M., L.M.), Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Experimental and Clinical Medicine (V.C., S.G., F.M., A.A.) and Department of Neurosciences, Drugs and Child Health (E.M., L.M.), University of Florence; and Neurology 2 Division (A.R., C.M., L.M.), Careggi University Hospital, Florence, Italy
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Scarpino M, Lanzo G, Repice A, Magnani E, Carrai R, Amantini A, Massacesi L, Grippo A. 81. Motor evoked potential as a predictor of clinical response in multiple sclerosis patients treated with 4 aminopyridine. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.100] [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: 11/28/2022]
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Paganini M, Biggeri A, Romoli AM, Mechi C, Ghelli E, Berti V, Pradella S, Bucciantini S, Catelan D, Saccardi R, Lombardini L, Mascalchi M, Massacesi L, Porfirio B, Di Lorenzo N, Vannelli GB, Gallina P. Fetal striatal grafting slows motor and cognitive decline of Huntington's disease. J Neurol Neurosurg Psychiatry 2014; 85:974-81. [PMID: 24347577 PMCID: PMC4145428 DOI: 10.1136/jnnp-2013-306533] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the clinical effect of caudate-putaminal transplantation of fetal striatal tissue in Huntington's disease (HD). METHODS We carried out a follow-up study on 10 HD transplanted patients and 16 HD not-transplanted patients. All patients were evaluated with the Unified HD Rating Scale (UHDRS) whose change in motor, cognitive, behavioural and functional capacity total scores were considered as outcome measures. Grafted patients also received morphological and molecular neuroimaging. RESULTS Patients were followed-up from disease onset for a total of 309.3 person-years (minimum 5.3, median 11.2 years, maximum 21.6 years). UHDRS scores have been available since 2004 (median time of 5.7 years since onset, minimum zero, maximum 17.2 years). Median post-transplantation follow-up was 4.3 years, minimum 2.8, maximum 5.1 years. Adjusted post-transplantation motor score deterioration rate was reduced compared to the pretransplantation period, and to that of not-transplanted patients by 0.9 unit/years (95% CI 0.2 to 1.6). Cognitive score deterioration was reduced of 2.7 unit/years (95% CI 0.1 to 5.3). For grafted patients the 2-year post-transplantation [(18)F]fluorodeoxyglucose positron emission tomography (PET) showed striatal/cortical metabolic increase compared to the presurgical evaluation; 4-year post-transplantation PET values were slightly decreased, but remained higher than preoperatively. [(123)I]iodobenzamide single photon emission CT demonstrated an increase in striatal D2-receptor density during postgrafting follow-up. CONCLUSIONS Grafted patients experienced a milder clinical course with less pronounced motor/cognitive decline and associated brain metabolism improvement. Life-time follow-up may ultimately clarify whether transplantation permanently modifies the natural course of the disease, allowing longer sojourn time at less severe clinical stage, and improvement of overall survival.
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Affiliation(s)
- Marco Paganini
- Department of Neuroscience, University of Florence, Florence, Italy Careggi University Hospital, Florence, Italy
| | - Annibale Biggeri
- Department of Statistics, Informatics and Applications "G. Parenti", University of Florence, Florence, Italy Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | | | - Claudia Mechi
- Department of Neuroscience, University of Florence, Florence, Italy
| | - Elena Ghelli
- Department of Neuroscience, University of Florence, Florence, Italy
| | - Valentina Berti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Silvia Pradella
- Department of Neuroscience, University of Florence, Florence, Italy
| | | | - Dolores Catelan
- Department of Statistics, Informatics and Applications "G. Parenti", University of Florence, Florence, Italy Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | | | - Letizia Lombardini
- Careggi University Hospital, Florence, Italy Italian National Health Institute, National Transplantation Center, Rome, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Luca Massacesi
- Department of Neuroscience, University of Florence, Florence, Italy Careggi University Hospital, Florence, Italy
| | - Berardino Porfirio
- Careggi University Hospital, Florence, Italy Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Nicola Di Lorenzo
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | | | - Pasquale Gallina
- Careggi University Hospital, Florence, Italy Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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