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Ziemssen T, Groth M, Ettle B, Bopp T. Neutralizing antibody titers over 12 months after SARS-CoV-2 mRNA vaccine booster in patients with relapsing multiple sclerosis continuously treated with ofatumumab. Hum Vaccin Immunother 2024; 20:2316422. [PMID: 38346223 PMCID: PMC10863382 DOI: 10.1080/21645515.2024.2316422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024] Open
Abstract
Booster vaccinations against SARS-CoV-2 are recommended 6-12 months after the last dose or infection in elderly and high-risk groups. The present analysis aims to evaluate whether an interval shorter than 12 months is required in multiple sclerosis patients receiving ofatumumab. Neutralizing antibody status over 1 year in patients receiving booster vaccination in the non-interventional, multicenter KYRIOS study under continued ofatumumab treatment was analyzed. Fifteen patients were included. At the time of the first booster vaccination, ten patients were seropositive for neutralizing antibodies, four patients were seronegative, and for one patient, no baseline levels were available. All patients who were seropositive at baseline showed >2-fold increase in neutralizing antibody titers after the first booster and two patients (20%) showed a >10-fold increase. Among seronegative patients, three (75%) had a >10-fold increase in neutralizing antibody titers. Seropositivity was maintained in almost all patients until month 12. One initially seronegative patient had less than 2-fold increase in neutralizing antibody titers after the booster vaccination and can be considered a non-responder. Most patients with continued ofatumumab treatment are able to maintain permanent seropositivity and therefore presumably constant protection against severe courses of COVID-19 if repeated booster vaccinations are applied.
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Affiliation(s)
- Tjalf Ziemssen
- Department of Neurology, Center of Clinical Neuroscience, Carl Gustav Carus University Clinic, University Hospital of Dresden, Technische Universität Dresden, Dresden, Germany
| | - Marie Groth
- Medical Franchise Neuroscience, Novartis Pharma GmbH, Nuremberg, Germany
| | - Benjamin Ettle
- Medical Franchise Neuroscience, Novartis Pharma GmbH, Nuremberg, Germany
| | - Tobias Bopp
- Institute for Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Marrie RA, Lancia S, Cutter GR, Fox RJ, Salter A. Access to Care and Health-Related Quality of Life in Multiple Sclerosis. Neurol Clin Pract 2024; 14:e200338. [PMID: 39185096 PMCID: PMC11341006 DOI: 10.1212/cpj.0000000000200338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/12/2024] [Indexed: 08/27/2024]
Abstract
Background and Objectives Despite their high health care use, it is unclear whether the health care needs of people with MS are being met and what their priorities are. We assessed priorities for access to, and affordability of care, by people living with MS in the United States. We also tested the association between perceived inadequate access to care and health-related quality of life (HRQoL). Methods In Fall 2022, we conducted a cross-sectional survey of participants in the North American Research Committee on Multiple Sclerosis Registry about access to care and HRQoL (Health Utilities Index Mark III). We used multivariable polytomous logistic regression to test sociodemographic and clinical factors associated with access to care. We used multivariable linear regression analysis to test the association between access to care and HRQoL. Results We included 4,914 respondents in the analysis, of whom 3,974 (80.9%) were women, with a mean (SD) age 64.4 (9.9) years. The providers who were most reported as needed but inaccessible were complementary providers (35.5%), followed by allied health providers (24.2%), occupational therapists (22.7%), and mental health providers (20.7%). Over 80% of participants reported that it was important or very important to be able to get an appointment with their primary MS health care provider when needed, to have sufficient time in their appointments to explain their concerns, to see their neurologist if their status changed, and that their health care providers communicated to coordinate their care. Participants who reported needing to see the provider but not having access or seeing the provider but would like to see them more often had lower HRQOL (ranging from -0.059 to -0.176) than participants who saw the provider as much as needed. Discussion Gaps in access to care persist for people with MS in the United States and substantially affect HRQoL. Improving access to care for people with MS should be a health system priority.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
| | - Samantha Lancia
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
| | - Gary R Cutter
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
| | - Robert J Fox
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
| | - Amber Salter
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
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Rahmani M, Pakkhesal S, Baharomid S, Karimi H, Mosaddeghi-Heris R, Talebi M, Aghaei N, Rahimi-Mamaghani A, Sanaie S, Naseri A. Shining a Light on Selenium: a Meta-analysis of Supplementation in Multiple Sclerosis. Biol Trace Elem Res 2024; 202:4375-4386. [PMID: 38155333 DOI: 10.1007/s12011-023-04026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease of the central nervous system. Selenium is a trace element with significant antioxidant activity. This study aimed to seek evidence concerning selenium supplementation in MS. A systematic search was performed on PubMed, Web of Science, Scopus, and Embase databases to identify the studies assessing the consumption rate, efficacy, and safety of selenium and selenium-containing supplementations in MS patients. The meta-analysis was performed using the Comprehensive Meta-Analysis and the risk of bias was evaluated using the Joanna Briggs Institute's critical appraisal tools. A total of 9 studies were included, which consisted of six studies regarding the rate of selenium supplement consumption in MS patients, with a total sample size of 2381 patients. Based on the quantitative synthesis, 14.3% (95% CI, 12.8-16.0%; I2, 3.58%) of MS patients had current selenium supplements usage, and 11.3% (95% CI, 7.6-16.6%; I2, 81.40%) of patients had used selenium supplements previously. Although there is no evidence regarding supplementation with selenium alone, three RCT studies reported the safety of selenium-containing supplementation use in MS with improved inflammation and oxidative stress conditions. The findings of this study show that over 10% of patients with MS used selenium supplements, with no clinical significance supporting the benefits. There is a lack of evidence regarding the safety and efficacy of selenium supplements in MS patients. Due to the limited number of included studies and the lack of comprehensive and specific studies regarding selenium supplements in MS, the results must be interpreted with caution, and future clinical trials are required.
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Affiliation(s)
- Mehrab Rahmani
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Pakkhesal
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saman Baharomid
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanie Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mosaddeghi-Heris
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Talebi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negar Aghaei
- Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran
| | - Alireza Rahimi-Mamaghani
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.
- Faculty of Medicine, Aging Research Institute, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, East Azerbaijan, Iran.
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
- Tabriz USERN Office, Universal Scientific Education and Research Network (USERN), Tabriz, Iran.
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Wolf AB, Corboy JR. Escalation to Anti-CD20 Treatment for Multiple Sclerosis Following Natalizumab-Associated Progressive Multifocal Leukoencephalopathy. Neurol Clin Pract 2024; 14:e200330. [PMID: 38919933 PMCID: PMC11194788 DOI: 10.1212/cpj.0000000000200330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/04/2024] [Indexed: 06/27/2024]
Abstract
Objectives Disease-modifying therapy (DMT) for multiple sclerosis (MS) after natalizumab-associated progressive multifocal leukoencephalopathy (PML) is controversial due to concern for recurrent PML. We describe DMT utilization for over a decade in a patient with MS who survived PML. Methods Case report. Results A 36-year-old woman was diagnosed with MS in 2002 and treated with interferon beta-1a until 2006, when she transitioned to natalizumab due to relapses. She presented in 2012 with 2 months of progressive cognitive and gait concerns and was diagnosed with PML by positive CSF JC virus testing with concordant clinical and MRI findings. She was treated with plasma exchange and then corticosteroids for PML immune reconstitution inflammatory syndrome before starting glatiramer acetate for DMT. She transitioned to dimethyl fumarate in 2013 after MS activity on MRI with negative CSF JC virus testing. Owing to worsening footdrop consistent with progression, she transitioned to ocrelizumab in 2017 and then to ofatumumab in 2020 due to logistics of medication administration. There has been no clinicoradiographic or CSF evidence of recurrent PML. Discussion DMT selection is challenging for patients with MS who survive PML. We used an escalation approach extending to ocrelizumab and ofatumumab due to MS progression. Anti-CD20 DMTs are a high-efficacy option post-PML. Classification of Evidence This provides Class IV evidence. It is a single observational study without controls.
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Affiliation(s)
- Andrew B Wolf
- Department of Neurology and Rocky Mountain Multiple Sclerosis Center, University of Colorado School of Medicine, Aurora
| | - John R Corboy
- Department of Neurology and Rocky Mountain Multiple Sclerosis Center, University of Colorado School of Medicine, Aurora
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Wasem J, Heer Y, Karamasioti E, Muros-Le Rouzic E, Marcelli G, Di Maio D, Braune S, Kobelt G, Dillon P. Cost and Quality of Life of Disability Progression in Multiple Sclerosis Beyond EDSS: Impact of Cognition, Fatigue, and Limb Impairment. PHARMACOECONOMICS - OPEN 2024; 8:665-678. [PMID: 38949748 DOI: 10.1007/s41669-024-00501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Understanding the socioeconomic burden of multiple sclerosis (MS) is essential to inform policymakers and payers. Real-world studies have associated increasing costs and worsening quality of life (QoL) with disability progression. This study aims to further evaluate the impact of cognition, fatigue, upper and lower limb function (ULF, LLF) impairments, and disease progression per Expanded Disability Status Scale (EDSS) level, on costs and QoL. METHODS This was a cross-sectional cohort study including 20,988 patients from the German NeuroTransData MS registry from 2009 to 2019. QoL analyses were based on EQ-5D-5L. Cost analyses included indirect/direct medical and non-medical costs. Eight subgroups, ranging from 439 to 1812 patients were created based on presence of measures for disease progression (EDSS), cognition (Symbol Digit Modalities Test [SDMT]), fatigue (Modified Fatigue Impact 5-Item Scale [MFIS-5]), ULF (Nine-Hole Peg Test [9HPT]), and LLF (Timed 25-Foot Walk [T25FW]). Multivariable linear regression assessed the independent effect of each test's score on QoL and costs, while adjusting for EDSS and 12 other confounders. RESULTS Lower QoL was associated with decreasing cognition (p < 0.001), worsening ULF (p = 0.025), and increasing fatigue (p < 0.0001); however, the negative impact of LLF worsening on QoL was not statistically significant (p = 0.54). Higher costs were associated with decreasing cognition (p < 0.001), worsening of ULF (p = 0.0058) and LLF (p = 0.049), and increasing fatigue (p < 0.0001). Each 1-scale-step worsening function of SDMT, MFIS-5, 9HPT, and T25FW scores resulted in €170, €790, €330, and €520 higher costs, respectively. Modeling disability progression based on SDMT, MFIS-5, 9HPT, and T25FW scores as an interaction with EDSS strata found associations with lower QoL and higher costs at variable EDSS ranges. CONCLUSIONS Disease progression in MS measured by 9HPT, SDMT, and MFIS-5 had a significant negative impact on QoL and broad socioeconomic costs independent of EDSS. T25FW had a significant negative association with costs. Cognition, fatigue, ULF, and LLF have stronger impact on costs and QoL in patients with higher EDSS scores. Additional determinants of MS disability status, including SDMT, MFIS-5, 9HPT, and T25FW, should be considered for assessing cost effectiveness of novel therapeutics for MS.
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Affiliation(s)
- Jürgen Wasem
- Faculty of Economics, University of Duisburg-Essen, Essen, Germany
| | - Yanic Heer
- PricewaterhouseCoopers (PwC), Zurich, Switzerland
| | | | | | | | | | | | - Gisela Kobelt
- EHE International, St Moritz, Switzerland
- European Health Economics, Mulhouse, France
| | - Paul Dillon
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Gross RH, Corboy J. De-escalation and Discontinuation of Disease-Modifying Therapies in Multiple Sclerosis. Curr Neurol Neurosci Rep 2024; 24:341-353. [PMID: 38995483 DOI: 10.1007/s11910-024-01355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE OF REVIEW Long-term use of multiple sclerosis (MS) disease-modifying therapies (DMTs) is standard practice to prevent accumulation of disability. Immunosenescence and other age-related changes lead to an altered risk-benefit ratio for older patients on DMTs. This article reviews recent research on the topic of de-escalation and discontinuation of MS DMTs. RECENT FINDINGS Observational and interventional studies have shed light on what happens to patients who de-escalate or discontinue DMTs and the factors, such as age, treatment type, and presence of recent disease activity, that influence outcomes. Though many questions remain, recent findings have been valuable for the development of an evidence-based approach to making de-escalation and discontinuation decisions in MS.
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Affiliation(s)
- Robert H Gross
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17thAvenue, Mail Stop F727, Aurora, CO, 80045, USA.
- Department of Neurology, Rocky Mountain Regional Veterans Administration Medical Center, Aurora, CO, USA.
| | - John Corboy
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17thAvenue, Mail Stop F727, Aurora, CO, 80045, USA
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Oertel FC, Zimmermann HG, Motamedi S, Bereuter C, Manthey LM, Ashtari F, Kafieh R, Dehghani A, Pourazizi M, Pandit L, D'Cunha A, Aktas O, Albrecht P, Ringelstein M, Martinez-Lapiscina EH, Sanchez Dalmau BF, Villoslada P, Asgari N, Marignier R, Cobo-Calvo A, Leocani L, Pisa M, Radaelli M, Palace J, Roca-Fernandez A, Leite MIS, Sharma S, De Seze J, Senger T, Yeaman MR, Smith TJ, Cook LJ, Brandt AU, Paul F. Retinal Changes in Double-Antibody Seronegative Neuromyelitis Optica Spectrum Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200273. [PMID: 38941573 PMCID: PMC11214151 DOI: 10.1212/nxi.0000000000200273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/29/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVES To systematically describe the clinical picture of double-antibody seronegative neuromyelitis optica spectrum disorders (DN-NMOSD) with specific emphasis on retinal involvement. METHODS Cross-sectional data of 25 people with DN-NMOSD (48 eyes) with and without a history of optic neuritis (ON) were included in this study along with data from 25 people with aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (AQP4-NMOSD, 46 eyes) and from 25 healthy controls (HCs, 49 eyes) for comparison. All groups were matched for age and sex and included from the collaborative retrospective study of retinal optical coherence tomography (OCT) in neuromyelitis optica (CROCTINO). Participants underwent OCT with central postprocessing and local neurologic examination and antibody testing. Retinal neurodegeneration was quantified as peripapillary retinal nerve fiber layer thickness (pRNFL) and combined ganglion cell and inner plexiform layer thickness (GCIPL). RESULTS This DN-NMOSD cohort had a history of [median (inter-quartile range)] 6 (5; 9) attacks within their 5 ± 4 years since onset. Myelitis and ON were the most common attack types. In DN-NMOSD eyes after ON, pRNFL (p < 0.001) and GCIPL (p = 0.023) were thinner compared with eyes of HCs. Even after only one ON episode, DN-NMOSD eyes already had considerable neuroaxonal loss compared with HCs. In DN-NMOSD eyes without a history of ON, pRNFL (p = 0.027) and GCIPL (p = 0.022) were also reduced compared with eyes of HCs. However, there was no difference in pRNFL and GCIPL between DN-NMOSD and AQP4-NMOSD for the whole group and for subsets with a history of ON and without a history of ON-as well as between variances of retinal layer thicknesses. DISCUSSION DN-NMOSD is characterized by severe retinal damage after ON and attack-independent retinal neurodegeneration. Most of the damage occurs during the first ON episode, which highlights the need for better diagnostic markers in DN-NMOSD to facilitate an earlier diagnosis as well as for effective and early treatments. In this study, people with DN-NMOSD presented with homogeneous clinical and imaging findings potentially suggesting a common retinal pathology in these patients.
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Affiliation(s)
- Frederike C Oertel
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Hanna G Zimmermann
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Seyedamirhosein Motamedi
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Charlotte Bereuter
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Luca Magdalena Manthey
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Fereshteh Ashtari
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Rahele Kafieh
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alireza Dehghani
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Mohsen Pourazizi
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Lekha Pandit
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Anitha D'Cunha
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Orhan Aktas
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Philipp Albrecht
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marius Ringelstein
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Elena H Martinez-Lapiscina
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Bernardo F Sanchez Dalmau
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Pablo Villoslada
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Nasrin Asgari
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Romain Marignier
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alvaro Cobo-Calvo
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Letizia Leocani
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marco Pisa
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Marta Radaelli
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Jacqueline Palace
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Adriana Roca-Fernandez
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Maria Isabel S Leite
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Srilakshmi Sharma
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Jerome De Seze
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Thomas Senger
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Michael R Yeaman
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Terry J Smith
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Lawrence J Cook
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Alexander U Brandt
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
| | - Friedemann Paul
- From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah
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Ponzio M, Podda J, Pignattelli E, Verri A, Persechino B, Vitturi BK, Bandiera P, Manacorda T, Inglese M, Durando P, Battaglia MA. Work Difficulties in People with Multiple Sclerosis. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:606-617. [PMID: 37921967 DOI: 10.1007/s10926-023-10149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE This study identifies potential predictors of unemployment and describes specific work difficulties and their determinants in a subgroup of employed people with multiple sclerosis (PwMS). The specific work difficulties were evaluated using a validated tool that measures the impact of respondents' symptoms and of workplace features. METHODS A cross-sectional study was carried out in Italy during 2021-2022. The subjects included were adults (18-65 years) with a diagnosis of MS, currently employed or unemployed. Logistic regression models were used to determine the association between each potential determinant and employment status, while linear regression models were used to determine the association between determinants and specific work difficulties. RESULTS The main risk factors associated with a higher risk of being unemployed were being older, living in the South of Italy/islands, and having a higher disability level, while protective factors against unemployment were having a high level of education and 'stable' employment (an open-ended contract). Fatigue was found to be associated with all work difficulties analyzed; mood disorders emerged as the main predictors of mental health-related work difficulties; level of disability and comorbidity significantly impacted physical health-related ones, and a good quality of life was found to improve both workplace-related and mental health-related difficulties at work. CONCLUSION Identifying the most significant difficulties is a crucial step in the development of vocational rehabilitation interventions tailored to maximize the ability of PwMS to handle their job-related duties and demands.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
- Department of Research, Italian Multiple Sclerosis Foundation, via Operai 40, 16149, Genoa, Italy.
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Elena Pignattelli
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | | | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
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9
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Smith E, Langdon D. A systematic review to explore patients' MS knowledge and MS risk knowledge. Neurol Sci 2024; 45:4185-4195. [PMID: 38700598 PMCID: PMC11306520 DOI: 10.1007/s10072-024-07541-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/18/2024] [Indexed: 08/09/2024]
Abstract
Living with a chronic illness poses particular challenges, including maintaining current disease knowledge to optimise self-management and interaction with health professionals. People with Multiple Sclerosis (MS) are increasingly encouraged to participate in shared decision making. Making informed decisions is likely to rely on adequate knowledge about the condition and its associated risks. The aim of this systematic review is to explore patients' existing MS knowledge and MS risk knowledge, and how these relate to demographic and disease variables. A literature search was conducted using PsycINFO, PubMed and Cochrane Library. Eligible studies were published peer-reviewed reporting quantitative measures of MS knowledge and MS risk knowledge in adult MS patients. Eighteen studies met inclusion criteria comprising a total sample of 4,420 patients. A narrative synthesis was undertaken because studies employed various measures. Suboptimal levels of MS knowledge and MS risk knowledge were generally identified across studies. Greater self-reported adherence and a willingness to take medication were related to higher MS knowledge, while educational level was a significant predictor of both MS knowledge and MS risk knowledge. Associations with other demographic and disease-related variables were mixed for both knowledge domains. Direct comparison of results across studies were limited by methodological, sampling and contextual heterogeneity. The review's findings and implications for future research and clinical practice are considered from this perspective.
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Affiliation(s)
- Edward Smith
- Department of Psychology, Royal Holloway University of London, Egham, UK.
| | - Dawn Langdon
- Department of Psychology, Royal Holloway University of London, Egham, UK
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10
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Fuchs TA, Schoonheim MM, Zivadinov R, Dwyer MG, Colato E, Weinstock Z, Weinstock-Guttman B, Strijbis EM, Benedict RH. Cognitive progression independent of relapse in multiple sclerosis. Mult Scler 2024:13524585241256540. [PMID: 39193699 DOI: 10.1177/13524585241256540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
BACKGROUND Substantial physical-disability worsening in relapsing-remitting multiple sclerosis (RRMS) occurs outside of clinically recorded relapse. This phenomenon, termed progression independent of relapse activity (PIRA), is yet to be established for cognitive decline. METHODS Retrospective analysis of RRMS patients. Cognitive decline was defined using reliable-change-index cut-offs for each test (Symbol Digit Modalities Test, Brief Visuospatial Memory Test-Revised, California Verbal Learning Test-II). Decline was classified as PIRA if the following conditions were met: no relapse observed between assessments nor within 9 months of cognitive decline. RESULTS The study sample (n = 336) was 80.7% female with a mean (standard deviation (SD)) age, disease duration, and observation period of 43.1 (9.5), 10.8 (8.4), and 8.1 (3.1) years, respectively. A total of 169 (50.3%) subjects were cognitively impaired at baseline relative to age-, sex-, and education-matched HCs. Within subjects who experienced cognitive decline (n = 167), 89% experienced cognitive PIRA. A total of 141 (68.1%) cognitive decline events were observed independent of EDSS worsening. Cognitive PIRA was more likely to be observed with increased assessments (p < 0.001) and lower assessment density (p < 0.001), accounting for baseline clinical factors. CONCLUSION These results establish the concept of cognitive PIRA and further our understanding of progressive cognitive decline in RRMS.
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Affiliation(s)
- Tom A Fuchs
- MS Center Amsterdam, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Menno M Schoonheim
- MS Center Amsterdam, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Robert Zivadinov
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Center for Biomedical Imaging at Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Michael G Dwyer
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Elisa Colato
- MS Center Amsterdam, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Zachary Weinstock
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Eva Mm Strijbis
- MS Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, The Netherlands
| | - Ralph Hb Benedict
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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11
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Ziccardi S, Guandalini M, Fuchs TA, Calabrese M, Benedict RH. The time to include cognition in the multiple sclerosis concept of progression independent from relapse activity is now. Mult Scler 2024:13524585241264476. [PMID: 39193704 DOI: 10.1177/13524585241264476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Progression independent of relapse activity (PIRA) has been recently proposed in multiple sclerosis (MS) as a model identifying a continuous silent progression of disability without the manifestation of new clinical and magnetic resonance imaging (MRI) events that contribute to MS worsening. Despite evidence suggesting that clinical MS manifestations often affect cognitive functioning and the importance of neuropsychological monitoring over time, attention to silent cognitive progression is lacking, and the PIRA concept does not include a measure of cognitive function. In this personal viewpoint, we highlight the need to include cognition in the PIRA model to have a more comprehensive understanding of clinical progression in patients with MS.
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Affiliation(s)
- Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tom A Fuchs
- MS Center Amsterdam, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ralph Hb Benedict
- Departments of Neurology and Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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12
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Reece J, Yu M, Bevens W, Simpson-Yap S, Davenport R, Jelinek G, Neate S. Sociodemographic, Health, and Lifestyle-Related Characteristics Associated With the Commencement and Completion of a Web-Based Lifestyle Educational Program for People With Multiple Sclerosis: Randomized Controlled Trial. J Med Internet Res 2024; 26:e58253. [PMID: 39197163 DOI: 10.2196/58253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/10/2024] [Accepted: 07/02/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Digital health interventions increase access to multiple sclerosis (MS)-related knowledge for people living with MS; however, our understanding of factors associated with engagement in web-based learning is limited. OBJECTIVE This study aims to examine associations between participant sociodemographic, health, and lifestyle-related characteristics and the commencement and completion of the Multiple Sclerosis Online Course (MSOC) in a randomized controlled trial (RCT). METHODS An intervention course was developed based on the Overcoming MS Program-an evidence-based lifestyle modification program for MS, and a standard care course was developed based on international MS website information. An RCT was conducted to compare the effectiveness of the intervention course versus the standard care course in improving health outcomes in people living with MS. Participant data were collected from a baseline survey. Associations between baseline participant characteristics and MSOC commencement and completion, respectively, were assessed using multivariate log-binomial regression. RESULTS Overall, 1893 participants enrolled in the RCT, and 45.27% (n=857) completed the baseline survey: 23.5% (n=444) in the intervention course and 21.8% (n=413) in the standard care course. Of these 857 participants, 631 (73.6%) commenced the standard care course or intervention course, and 49.1% (218/444) and 54.2% (224/413) completed the intervention course and standard care course, respectively. University education, partnered relationship status, and higher mental and physical quality of life were associated with 19%, 12%, 20%, and 22% higher rates of course commencement, respectively. Clinically significant fatigue was associated with a 10% reduction in the likelihood of commencement. Strongest associations with intervention course completion included middle and older adulthood, male sex, fatigue, and preexisting adherence to a diet program, with 96%, 27%, 24%, and 19% higher rates of completion observed, respectively, whereas higher self-efficacy was associated with up to 35% lower intervention course completion. Associations with standard care course completion included practicing meditation (20% higher completion), whereas employment was associated with 22% lower completion. CONCLUSIONS Sociodemographic and clinical factors, as well as lifestyle-related factors, were important factors in MSOC commencement and completion. These data may help guide the design and enhancement of digital health interventions tailored for people living with MS. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001605886; https://tinyurl.com/2vyve9p9. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12883-023-03298-0.
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Affiliation(s)
- Jeanette Reece
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Maggie Yu
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - William Bevens
- Institute for Clinical and Translational Science, University of California, Irvine, CA, United States
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Rebekah Davenport
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - George Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sandra Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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13
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Chisari CG, Amato MP, Di Sapio A, Foschi M, Iaffaldano P, Inglese M, Fermo SL, Lugaresi A, Lus G, Mascoli N, Montepietra S, Pesci I, Quatrale R, Salemi G, Torri Clerici V, Totaro R, Valentino P, Filippi M, Patti F. Active and non-active secondary progressive multiple sclerosis patients exhibit similar disability progression: results of an Italian MS registry study (ASPERA). J Neurol 2024:10.1007/s00415-024-12621-9. [PMID: 39190108 DOI: 10.1007/s00415-024-12621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/28/2024]
Abstract
'Active' and 'non-active' secondary progressive MS (SPMS) have distinct pathophysiological mechanisms and clinical characteristics, but there is still no consensus regarding the frequency of these MS forms in the real-world setting. We aimed to evaluate the frequency of 'active' and 'non-active' SPMS in a large cohort of Italian MS patients and the differences in terms of clinical and MRI characteristics and disease progression. This multicenter study collected data about MS patients who have transitioned to the SP form in the period between 1st January 2014 and 31st December 2019 and followed by the MS centers contributing to the Italian MS Registry. Patients were divided into 'active SPMS' and 'non-active SPMS', based on both reported MRI data and relapse activity in the year before conversion to SPMS. Out of 68,621, 8,316 (12.1%) patients were diagnosed with SPMS. Out of them, 872 (10.5%) were classified into patients with either 'active' or 'non-active' SPMS. A total of 237 were classified into patients with 'active SPMS' (27.2%) and 635 as 'non-active SPMS' (72.8%). 'Non-active SPMS' patients were older, with a longer disease duration compared to those with 'active SPMS'. The percentages of patients showing progression independent of relapse activity (PIRA) at 24 months were similar between 'active' and 'non-active' SPMS patients (67 [27.4%] vs 188 [29.6%]; p = 0.60). In the 'active' group, 36 (15.2%) patients showed relapse-associated worsening (RAW). Comparison of the survival curves to EDSS 6 and 7 according to disease activity did not show significant differences (p = 0.68 and p = 0.71). 'Active' and 'non-active' SPMS patients had a similar risk of achieving disability milestones, suggesting that progression is primarily attributed to PIRA and only to a small extent to disease activity.
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Affiliation(s)
- Clara Grazia Chisari
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Multiple Sclerosis Center, University of Catania, Catania, Italy
- Multiple Sclerosis Unit; Neurology Clinic, Policlinico "G. Rodolico- San Marco", Catania, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Alessia Di Sapio
- Department of Neurology, Regional Referral Multiple Sclerosis Center, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Matteo Foschi
- Department of Neuroscience, Multiple Sclerosis Center, S. Maria delle Croci Hospital of Ravenna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Salvatore Lo Fermo
- Multiple Sclerosis Unit; Neurology Clinic, Policlinico "G. Rodolico- San Marco", Catania, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nerina Mascoli
- Neurology Unit, Department of Medicine, S. Anna Hospital, Como, Italy
| | - Sara Montepietra
- MS Centre, SMN Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Unità Sanitaria Locale, Ospedale Di Vaio, Fidenza, Parma, Italy
| | - Rocco Quatrale
- Dipartimento Di Scienze Neurologiche, UOC Di Neurologia, Ospedale Dell'Angelo AULSS 3 Serenissima, Venice Mestre, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Valentina Torri Clerici
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, San Salvatore Hospital, L'Aquila, Italy
| | - Paola Valentino
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Multiple Sclerosis Center, University of Catania, Catania, Italy.
- Multiple Sclerosis Unit; Neurology Clinic, Policlinico "G. Rodolico- San Marco", Catania, Italy.
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14
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G Ravindran KK, Della Monica C, Atzori G, Lambert D, Hassanin H, Revell V, Dijk DJ. Reliable Contactless Monitoring of Heart Rate, Breathing Rate, and Breathing Disturbance During Sleep in Aging: Digital Health Technology Evaluation Study. JMIR Mhealth Uhealth 2024; 12:e53643. [PMID: 39190477 DOI: 10.2196/53643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/13/2024] [Accepted: 06/25/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Longitudinal monitoring of vital signs provides a method for identifying changes to general health in an individual, particularly in older adults. The nocturnal sleep period provides a convenient opportunity to assess vital signs. Contactless technologies that can be embedded into the bedroom environment are unintrusive and burdenless and have the potential to enable seamless monitoring of vital signs. To realize this potential, these technologies need to be evaluated against gold standard measures and in relevant populations. OBJECTIVE We aimed to evaluate the accuracy of heart rate and breathing rate measurements of 3 contactless technologies (2 undermattress trackers, Withings Sleep Analyzer [WSA] and Emfit QS [Emfit]; and a bedside radar, Somnofy) in a sleep laboratory environment and assess their potential to capture vital signs in a real-world setting. METHODS Data were collected from 35 community-dwelling older adults aged between 65 and 83 (mean 70.8, SD 4.9) years (men: n=21, 60%) during a 1-night clinical polysomnography (PSG) test in a sleep laboratory, preceded by 7 to 14 days of data collection at home. Several of the participants (20/35, 57%) had health conditions, including type 2 diabetes, hypertension, obesity, and arthritis, and 49% (17) had moderate to severe sleep apnea, while 29% (n=10) had periodic leg movement disorder. The undermattress trackers provided estimates of both heart rate and breathing rate, while the bedside radar provided only the breathing rate. The accuracy of the heart rate and breathing rate estimated by the devices was compared with PSG electrocardiogram-derived heart rate (beats per minute) and respiratory inductance plethysmography thorax-derived breathing rate (cycles per minute), respectively. We also evaluated breathing disturbance indexes of snoring and the apnea-hypopnea index, available from the WSA. RESULTS All 3 contactless technologies provided acceptable accuracy in estimating heart rate (mean absolute error <2.12 beats per minute and mean absolute percentage error <5%) and breathing rate (mean absolute error ≤1.6 cycles per minute and mean absolute percentage error <12%) at 1-minute resolution. All 3 contactless technologies were able to capture changes in heart rate and breathing rate across the sleep period. The WSA snoring and breathing disturbance estimates were also accurate compared with PSG estimates (WSA snore: r2=0.76; P<.001; WSA apnea-hypopnea index: r2=0.59; P<.001). CONCLUSIONS Contactless technologies offer an unintrusive alternative to conventional wearable technologies for reliable monitoring of heart rate, breathing rate, and sleep apnea in community-dwelling older adults at scale. They enable the assessment of night-to-night variation in these vital signs, which may allow the identification of acute changes in health, and longitudinal monitoring, which may provide insight into health trajectories. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3390/clockssleep6010010.
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Affiliation(s)
- Kiran K G Ravindran
- Surrey Sleep Research Centre, Guildford, United Kingdom
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London, United Kingdom, and the University of Surrey, Guildford, London, United Kingdom
| | - Ciro Della Monica
- Surrey Sleep Research Centre, Guildford, United Kingdom
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London, United Kingdom, and the University of Surrey, Guildford, London, United Kingdom
| | - Giuseppe Atzori
- Surrey Sleep Research Centre, Guildford, United Kingdom
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London, United Kingdom, and the University of Surrey, Guildford, London, United Kingdom
| | - Damion Lambert
- Surrey Sleep Research Centre, Guildford, United Kingdom
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London, United Kingdom, and the University of Surrey, Guildford, London, United Kingdom
| | - Hana Hassanin
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London, United Kingdom, and the University of Surrey, Guildford, London, United Kingdom
- Surrey Clinical Research Facility, University of Surrey, Guildford, United Kingdom
- NIHR Royal Surrey Clinical Research Facility, Guildford, United Kingdom
| | - Victoria Revell
- Surrey Sleep Research Centre, Guildford, United Kingdom
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London, United Kingdom, and the University of Surrey, Guildford, London, United Kingdom
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, Guildford, United Kingdom
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London, United Kingdom, and the University of Surrey, Guildford, London, United Kingdom
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15
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Intarakhao P, Laipasu T, Jitprapaikulsan J, Apiraksattayakul N, Kosiyakul P, Siritho S, Prayoonwiwat N, Ongphichetmetha T. Rituximab in secondary progressive multiple sclerosis: a meta-analysis. Ann Clin Transl Neurol 2024. [PMID: 39186371 DOI: 10.1002/acn3.52186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/29/2024] [Accepted: 08/03/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy of rituximab (RTX) in stabilizing disability progression in secondary progressive multiple sclerosis (SPMS). METHODS A systematic review was conducted, encompassing studies from inception to April 2023, utilizing the MEDLINE and EMBASE databases. Inclusion criteria comprised studies with a minimum of 3 SPMS patients receiving intravenous RTX in at least one infusion, with a follow-up duration of at least 6 months. Primary outcome measures included changes in Expanded Disability Status Scale (EDSS) scores. Mean differences in pre- and post-RTX EDSS scores were analyzed using a random-effects model. Meta-regression examined age at RTX initiation, pre-RTX EDSS scores, disease duration, and outcome reported time as variables. Secondary outcomes assessed changes in the annualized relapse rate (ARR). RESULTS Thirteen studies, involving 604 SPMS patients, met the inclusion criteria. Following a mean follow-up of 2 years, the mean difference in EDSS scores (ΔEDSS = EDSSpre-RTX - EDSSpost-RTX) was -0.21 (95% CI -0.51 to 0.08, p = 0.16), indicating no significant variation. Multivariable meta-regression identified significant associations between EDSS score mean difference and pre-RTX EDSS scores, disease duration at RTX initiation, and outcome reported time. However, age at RTX initiation showed no significant association. Pre- and post-RTX ARR data were available for 245 out of 604 SPMS patients across seven studies, revealing a mean difference in ARR (ΔARR = ARRpre-RTX - ARRpost-RTX) of 0.74 (95% CI 0.19-1.29, p = 0.008). INTERPRETATION RTX demonstrates efficacy in reducing relapse frequency and exhibits potential in stabilizing disability progression over a 2-year follow-up, particularly among individuals with shorter disease duration.
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Affiliation(s)
- Pasin Intarakhao
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Taksaporn Laipasu
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jiraporn Jitprapaikulsan
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Natnasak Apiraksattayakul
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Punchika Kosiyakul
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Bumrungrad International Hospital, Bangkok, Thailand
| | - Naraporn Prayoonwiwat
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tatchaporn Ongphichetmetha
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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16
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Olejnik P, Roszkowska Z, Adamus S, Kasarełło K. Multiple sclerosis: a narrative overview of current pharmacotherapies and emerging treatment prospects. Pharmacol Rep 2024:10.1007/s43440-024-00642-0. [PMID: 39177889 DOI: 10.1007/s43440-024-00642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 08/24/2024]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease characterized by pathological processes of demyelination, subsequent axonal loss, and neurodegeneration within the central nervous system. Despite the availability of numerous disease-modifying therapies that effectively manage this condition, there is an emerging need to identify novel therapeutic targets, particularly for progressive forms of MS. Based on contemporary insights into disease pathophysiology, ongoing efforts are directed toward developing innovative treatment modalities. Primarily, monoclonal antibodies have been extensively investigated for their efficacy in influencing specific pathological pathways not yet targeted. Emerging approaches emphasizing cellular mechanisms, such as chimeric antigen receptor T cell therapy targeting immunological cells, are attracting increasing interest. The evolving understanding of microglia and the involvement of ferroptotic mechanisms in MS pathogenesis presents further avenues for targeted therapies. Moreover, innovative treatment strategies extend beyond conventional approaches to encompass interventions that target alterations in microbiota composition and dietary modifications. These adjunctive therapies hold promise as complementary methods for the holistic management of MS. This narrative review aims to summarize current therapies and outline potential treatment methods for individuals with MS.
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Affiliation(s)
- Piotr Olejnik
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Roszkowska
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Sylwia Adamus
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
- Biomedical Physics Division, Faculty of Physics, University of Warsaw, Warsaw, Poland
| | - Kaja Kasarełło
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.
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17
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Nyári A, Kokas Z, Szamosi S, Fricska-Nagy Z, Kincses ZT, Füvesi J, Biernacki T, Klivényi P, Bencsik K, Sandi D. Fatigue and depression influence the prevalence of anxiety in patients with multiple sclerosis. Neurol Sci 2024:10.1007/s10072-024-07737-9. [PMID: 39174771 DOI: 10.1007/s10072-024-07737-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND There is scarce information in Middle-Eastern Europe regarding the prevalence of anxiety in patients with multiple sclerosis (pwMS) and its association with different clinical-demographic factors. OBJECTIVE We aimed to determine the prevalence of anxiety in Hungarian MS patients and to analyze associated factors. MATERIALS AND METHODS We evaluated 260 PwMS with the STAI-5 anxiety questionnaire. Fatigue (FIS), depression (BDI-II) and cognition (BICAMS) were also measured. Patients underwent standard neurological evaluations to evaluate Expanded Disability Status Scale (EDSS), and also measured the fine motor skills of the hand with the 9-hole peg test (9HPT), and the walking distance with the 25-foot walking test (T25FW). RESULTS We identified 23.1% (N = 60) of the patients with anxiety (only state, trait or both forms concurrently). According to our two univariate, multivariable logistic regression analysis, fatigue and depression are strongly associated with both state and trait anxiety. In the absence of fatigue, the odds of trait anxiety are 82% lower (OR: 0.18; 95% CI: 0.06-0.53; p = 0.002), while in the case of pwMS without depression, the odds are reduced by 81% (OR: 0.19; CI95%= 0.07-0.51, p = 0.001). This association with fatigue (OR: 0.33; CI95%= 0.13-0.85, p = 0.021) and depression (OR: 0.14; CI95%=0.06-0.35; p < 0.001) can also be statistically verified on state anxiety. Importantly, a significant association with state anxiety was found in SPSM patients as well (OR: 34.94; CI95%=2.55-479.61; p = 0.008). CONCLUSIONS Anxiety was strongly associated with fatigue, depression, and secondary progressive disease form. These results emphasize the burden of psychiatric morbidity in pwMS.
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Affiliation(s)
- Aliz Nyári
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsófia Kokas
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Szabolcs Szamosi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Radiology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Biernacki
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine and Clinical Center, University of Szeged, Szeged, Hungary.
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18
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Mazziotti V, Crescenzo F, Turano E, Guandalini M, Bertolazzo M, Ziccardi S, Virla F, Camera V, Marastoni D, Tamanti A, Calabrese M. The contribution of tumor necrosis factor to multiple sclerosis: a possible role in progression independent of relapse? J Neuroinflammation 2024; 21:209. [PMID: 39169320 PMCID: PMC11340196 DOI: 10.1186/s12974-024-03193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024] Open
Abstract
Tumor necrosis factor (TNF) is a pleiotropic cytokine regulating many physiological and pathological immune-mediated processes. Specifically, it has been recognized as an essential pro-inflammatory cytokine implicated in multiple sclerosis (MS) pathogenesis and progression. MS is a chronic immune-mediated disease of the central nervous system, characterized by multifocal acute and chronic inflammatory demyelination in white and grey matter, along with neuroaxonal loss. A recent concept in the field of MS research is disability resulting from Progression Independent of Relapse Activity (PIRA). PIRA recognizes that disability accumulation since the early phase of the disease can occur independently of relapse activity overcoming the traditional dualistic view of MS as either a relapsing-inflammatory or a progressive-neurodegenerative disease. Several studies have demonstrated an upregulation in TNF expression in both acute and chronic active MS brain lesions. Additionally, elevated TNF levels have been observed in the serum and cerebrospinal fluid of MS patients. TNF appears to play a significant role in maintaining chronic intrathecal inflammation, promoting axonal damage neurodegeneration, and consequently contributing to disease progression and disability accumulation. In summary, this review highlights the current understanding of TNF and its receptors in MS progression, specifically focusing on the relatively unexplored PIRA condition. Further research in this area holds promise for potential therapeutic interventions targeting TNF to mitigate disability in MS patients.
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Affiliation(s)
- Valentina Mazziotti
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Francesco Crescenzo
- Neurology Unit - Multiple Sclerosis Center, Scaligera Local Unit of Health and Social Services 9, Mater Salutis Hospital, 37045, Legnago, Verona, Italy
| | - Ermanna Turano
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Maddalena Guandalini
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Maddalena Bertolazzo
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Stefano Ziccardi
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Federica Virla
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Valentina Camera
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Damiano Marastoni
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Agnese Tamanti
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B Unit - Multiple Sclerosis Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy.
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19
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Fitzjerrells RL, Ollberding NJ, Mangalam AK. Looking at the full picture, using topic modeling to observe microbiome communities associated with disease. GUT MICROBES REPORTS 2024; 1:1-11. [PMID: 39183943 PMCID: PMC11340690 DOI: 10.1080/29933935.2024.2378067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/24/2024] [Accepted: 07/01/2024] [Indexed: 08/27/2024]
Abstract
The microbiome, a complex micro-ecosystem, helps the host with various vital physiological processes. Alterations of the microbiome (dysbiosis) have been linked with several diseases, and generally, differential abundance testing between the healthy and patient groups is performed to identify important bacteria. However, providing a singular species of bacteria to an individual as treatment has not been as successful as fecal microbiota transplant therapy, where the entire microbiome of a healthy individual is transferred. These observations suggest that a combination of bacteria might be crucial for the beneficial effects. Here we provide the framework to utilize topic modeling, an unsupervised machine learning approach, to identify a community of bacteria related to health or disease. Specifically, we used our previously published gut microbiome data of patients with multiple sclerosis (MS), a neurodegenerative disease linked to a dysbiotic gut microbiome. We identified communities of bacteria associated with MS, including genera previously discovered, but also others that would have been overlooked by differential abundance testing. This method can be a useful tool for analyzing the microbiome, and it should be considered along with the commonly utilized differential abundance tests to better understand the role of the gut microbiome in health and disease.
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Affiliation(s)
- Rachel L. Fitzjerrells
- Interdisciplinary Graduate Program in Informatics, University of Iowa, Iowa City, IA, 52242, USA
- College of Dentistry, University of Iowa, Iowa City, IA, 52242, USA
| | - Nicholas J. Ollberding
- Division of Biostatistics and Epidemiology; Cincinnati Children’s Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, 45267, USA
| | - Ashutosh K. Mangalam
- Interdisciplinary Graduate Program in Informatics, University of Iowa, Iowa City, IA, 52242, USA
- College of Dentistry, University of Iowa, Iowa City, IA, 52242, USA
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
- Iowa City VA Health Care System, 601 US-6 W, Iowa City, IA 52246, USA
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20
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Klehmet J, Bopp T. [Ofatumumab in the treatment of multiple sclerosis - A summary of preclinical and clinical data]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024. [PMID: 39159670 DOI: 10.1055/a-2365-0966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
BACKGROUND B-cell targeted therapies are highly effective in multiple sclerosis (MS). Most of these therapies are administered intravenously at long intervals. Ofatumumab, an anti-CD20 antibody that is administered subcutaneously at low doses on a monthly basis due to its high affinity to the target structure, became available for the treatment of MS in 2021. METHODS An overview of practice-relevant immunological and clinical data on ofatumumab is provided. RESULTS The high affinity of ofatumumab to the target structure allows low dose and low volume administration, with the release and absorption profile after subcutaneous application allowing for high concentrations in the lymph nodes and gradual depletion of B-cells. Rapid onset of action is achieved as well as B-cell repletion within a few months in case of discontinuation of therapy. Long-term data show stable IgG levels over up to four years and high efficacy with respect to relapse rate, progression, and cognition. According to current study data, the effect compared to teriflunomide is greater the earlier therapy is initiated. Ofatumumab has a specific B-cell depletion pattern. CD20 expressing B-cell progenitor cells in the bone marrow are preserved and therefore also the inducibility and differentiation of plasma cells. The formation of a humoral immunological memory is therefore possible. Four-year study data showed no abnormalities in the rate of severe infections or malignancies. CONCLUSIONS Ofatumumab is an innovative B-cell targeted therapy. It is highly effective with a good safety and tolerability profile, well controllable and maintains immunocompetence against pathogens.
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Affiliation(s)
- Juliane Klehmet
- Klinik für Neurologie, Zentrum für Multiple Sklerose, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Tobias Bopp
- Institut für Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
- Forschungszentrum für Immuntherapie (FZI), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
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21
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Sak M, Chariker JH, Park JW, Rouchka EC. Gene expression and alternative splicing analysis in a large-scale Multiple Sclerosis study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.16.24312099. [PMID: 39185521 PMCID: PMC11343266 DOI: 10.1101/2024.08.16.24312099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background Multiple Sclerosis (MS) is an autoimmune neurodegenerative disease affecting approximately 3 million people globally. Despite rigorous research on MS, aspects of its development and progression remain unclear. Understanding molecular mechanisms underlying MS is crucial to providing insights into disease pathways, identifying potential biomarkers for early diagnosis, and revealing novel therapeutic targets for improved patient outcomes. Methods We utilized publicly available RNA-seq data (GSE138614) from post-mortem white matter tissues of five donors without any neurological disorder and ten MS patient donors. This data was interrogated for differential gene expression, alternative splicing and single nucleotide variants as well as for functional enrichments in the resulting datasets. Results A comparison of non-MS white matter (WM) to MS samples yielded differentially expressed genes involved in adaptive immune response, cell communication, and developmental processes. Genes with expression changes positively correlated with tissue inflammation were enriched in the immune system and receptor interaction pathways. Negatively correlated genes were enriched in neurogenesis, nervous system development, and metabolic pathways. Alternatively spliced transcripts between WM and MS lesions included genes that play roles in neurogenesis, myelination, and oligodendrocyte differentiation, such as brain enriched myelin associated protein ( BCAS1 ), discs large MAGUK scaffold protein 1 ( DLG1 ), KH domain containing RNA binding ( QKI ), and myelin basic protein ( MBP ). Our approach to comparing normal appearing WM (NAWM) and active lesion (AL) from one donor and NAWM and chronic active (CA) tissues from two donors, showed that different IgH and IgK gene subfamilies were differentially expressed. We also identified pathways involved in white matter injury repair and remyelination in these tissues. Differentially spliced genes between these lesions were involved in axon and dendrite structure stability. We also identified exon skipping events and spontaneous single nucleotide polymorphisms in membrane associated ring-CH-type finger 1 ( MARCHF1 ), UDP glycosyltransferase 8 ( UGT8 ), and other genes important in autoimmunity and neurodegeneration. Conclusion Overall, we identified unique genes, pathways, and novel splicing events affecting disease progression that can be further investigated as potential novel drug targets for MS treatment.
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22
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Zahoor I, Pan G, Cerghet M, Elbayoumi T, Mao-Draayer Y, Giri S, Palaniyandi SS. Current understanding of cardiovascular autonomic dysfunction in multiple sclerosis. Heliyon 2024; 10:e35753. [PMID: 39170118 PMCID: PMC11337049 DOI: 10.1016/j.heliyon.2024.e35753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024] Open
Abstract
Autoimmune diseases, including multiple sclerosis (MS), are proven to increase the likelihood of developing cardiovascular disease (CVD) due to a robust systemic immune response and inflammation. MS can lead to cardiovascular abnormalities that are related to autonomic nervous system dysfunction by causing inflammatory lesions surrounding tracts of the autonomic nervous system in the brain and spinal cord. CVD in MS patients can affect an already damaged brain, thus worsening the disease course by causing brain atrophy and white matter disease. Currently, the true prevalence of cardiovascular dysfunction and associated death rates in patients with MS are mostly unknown and inconsistent. Treating vascular risk factors is recommended to improve the management of this disease. This review provides an updated summary of CVD prevalence in patients with MS, emphasizing the need for more preclinical studies using animal models to understand the pathogenesis of MS better. However, no distinct studies exist that explore the temporal effects and etiopathogenesis of immune/inflammatory cells on cardiac damage and dysfunction associated with MS, particularly in the cardiac myocardium. To this end, a thorough investigation into the clinical presentation and underlying mechanisms of CVD must be conducted in patients with MS and preclinical animal models. Additionally, clinicians should monitor for cardiovascular complications while prescribing medications to MS patients, as some MS drugs cause severe CVD.
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Affiliation(s)
- Insha Zahoor
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Guodong Pan
- Division of Hypertension and Vascular Research, Department of Internal Medicine, Henry Ford Health, Detroit, MI, USA
| | - Mirela Cerghet
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Tamer Elbayoumi
- Department of Pharmaceutical Sciences, College of Pharmacy, Midwestern University, Glendale, AZ, USA
| | - Yang Mao-Draayer
- Multiple Sclerosis Center of Excellence, Autoimmunity Center of Excellence, Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Shailendra Giri
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Suresh Selvaraj Palaniyandi
- Division of Hypertension and Vascular Research, Department of Internal Medicine, Henry Ford Health, Detroit, MI, USA
- Department of Physiology, Wayne State University, Detroit, MI, USA
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23
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Bernhardt AM, Oeller M, Friedrich I, Kocakavuk E, Nachman E, Peikert K, Roderigo M, Rossmann A, Schröter T, Wilhelm LO, Prell T, van Riesen C, Nieweler J, Katzdobler S, Weiler M, Jacobi H, Warnecke T, Claus I, Palleis C, Breimann S, Falkenburger B, Brandt M, Hermann A, Rumpf JJ, Claßen J, Höglinger G, Gandor F, Levin J, Giese A, Janzen A, Oertel WH. Risk willingness in multiple system atrophy and Parkinson's disease understanding patient preferences. NPJ Parkinsons Dis 2024; 10:158. [PMID: 39147806 PMCID: PMC11327309 DOI: 10.1038/s41531-024-00764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 07/29/2024] [Indexed: 08/17/2024] Open
Abstract
Disease-modifying therapeutics in the α-synucleinopathies multiple system atrophy (MSA) and Parkinson's Disease (PD) are in early phases of clinical testing. Involving patients' preferences including therapy-associated risk willingness in initial stages of therapy development has been increasingly pursued in regulatory approval processes. In our study with 49 MSA and 38 PD patients, therapy-associated risk willingness was quantified using validated standard gamble scenarios for varying severities of potential drug or surgical side effects. Demonstrating a non-gaussian distribution, risk willingness varied markedly within, and between groups. MSA patients accepted a median 1% risk [interquartile range: 0.001-25%] of sudden death for a 99% [interquartile range: 99.999-75%] chance of cure, while PD patients reported a median 0.055% risk [interquartile range: 0.001-5%]. Contrary to our hypothesis, a considerable proportion of MSA patients, despite their substantially impaired quality of life, were not willing to accept increased therapy-associated risks. Satisfaction with life situation, emotional, and nonmotor disease burden were associated with MSA patients' risk willingness in contrast to PD patients, for whom age, and disease duration were associated factors. An individual approach towards MSA and PD patients is crucial as direct inference from disease (stage) to therapy-associated risk willingness is not feasible. Such studies may be considered by regulatory agencies in their approval processes assisting with the weighting of safety aspects in a patient-centric manner. A systematic quantitative assessment of patients' risk willingness and associated features may assist physicians in conducting individual consultations with patients who have MSA or PD by facilitating communication of risks and benefits of a treatment option.
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Affiliation(s)
- Alexander Maximilian Bernhardt
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Marc Oeller
- Department for Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany.
| | - Isabel Friedrich
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Emre Kocakavuk
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Eliana Nachman
- VIB Center for Brain & Disease Research, Leuven, Belgium
- KU Leuven Department of Neurosciences, Leuven Brain Institute, Mission Lucidity, Leuven, Belgium
| | - Kevin Peikert
- Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, Rostock, Germany
- United Neuroscience Campus Lund-Rostock (UNC), Rostock, Germany
| | - Malte Roderigo
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Andreas Rossmann
- Department of Cardiology, Augustinum Klinik München, München, Germany
| | - Tabea Schröter
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany
- Department of Geriatrics, Halle University Hospital, Halle, Germany
| | - Christoph van Riesen
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Johanna Nieweler
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Sabrina Katzdobler
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Heike Jacobi
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Warnecke
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Stephan Breimann
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Bioinformatics, Wissenschaftszentrum Weihenstephan, Technical University of Munich, Freising, Germany
- Metabolic Biochemistry, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Björn Falkenburger
- Department of Neurology, TU Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Dresden, Germany
| | - Moritz Brandt
- Department of Neurology, TU Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Dresden, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Jost-Julian Rumpf
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Joseph Claßen
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Günter Höglinger
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Florin Gandor
- Movement Disorders Clinic, Beelitz-Heilstätten, Germany
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- MODAG GmbH, Wendelsheim, Germany
| | - Armin Giese
- MODAG GmbH, Wendelsheim, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Annette Janzen
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Wolfgang Hermann Oertel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Institute for Neurogenomics, Helmholtz Center for Environment and Health, München, Germany
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24
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Chaves AR, Tremblay S, Pilutti L, Ploughman M. Lowered ratio of corticospinal excitation to inhibition predicts greater disability, poorer motor and cognitive function in multiple sclerosis. Heliyon 2024; 10:e35834. [PMID: 39170378 PMCID: PMC11337054 DOI: 10.1016/j.heliyon.2024.e35834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024] Open
Abstract
Objective Investigate excitatory-inhibitory (E/I) (im)balance using transcranial magnetic stimulation (TMS) in individuals with Multiple Sclerosis (MS) and determine its validity as a neurophysiological biomarker of disability. Methods Participants with MS (n = 83) underwent TMS, cognitive, and motor function assessments. TMS-induced motor evoked potential amplitudes (excitability) and cortical silent periods (inhibition) were assessed bilaterally through recruitment curves. The E/I ratio was calculated as the ratio of excitation to inhibition. Results Participants with greater disability (Expanded Disability Status Scale, EDSS≥3) exhibited lower excitability and increased inhibition compared to those with lower disability (EDSS<3). This resulted in lower E/I ratios in the higher disability group. Individuals with higher disability presented with asymmetrical E/I ratios between brain hemispheres, a pattern not present in the group with lower disability. In regression analyses controlling for demographics, lowered TMS-probed E/I ratio predicted variance in disability (R2 = 0.37, p < 0.001), upper extremity function (R2 = 0.35, p < 0.001), walking speed (R2 = 0.22, p = 0.005), and cognitive performance (R2 = 0.25, p = 0.007). Receiver Operating Characteristic curve analysis confirmed 'excellent' discriminative ability of the E/I ratio in distinguishing high and low disability. Finally, excitation superiorly correlated with the E/I ratio than overall inhibition in both hemispheres (p ≤ 0.01). Conclusion The E/I ratio is a potential neurophysiological biomarker of disability level in MS, especially when assessed in the hemisphere corresponding to the weaker body side. Interventions aimed at increasing cortical excitation or reducing inhibition may restore E/I balance potentially stalling progression or improving function in MS.
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Affiliation(s)
- Arthur R. Chaves
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, ON, Canada
- Neuromodulation Research Clinic, The Royal's Institute of Mental Health Research, ON, Canada
- Département de Psychoéducation et de Psychologie, Université Du Québec en Outaouais, QC, Canada
| | - Sara Tremblay
- Neuromodulation Research Clinic, The Royal's Institute of Mental Health Research, ON, Canada
- Département de Psychoéducation et de Psychologie, Université Du Québec en Outaouais, QC, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, ON, Canada
- Department of Molecular and Cellular Medicine, University of Ottawa, ON, Canada
| | - Lara Pilutti
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, ON, Canada
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Nguyen PT, Makowiecki K, Lewis TS, Fortune AJ, Clutterbuck M, Reale LA, Taylor BV, Rodger J, Cullen CL, Young KM. Low intensity repetitive transcranial magnetic stimulation enhances remyelination by newborn and surviving oligodendrocytes in the cuprizone model of toxic demyelination. Cell Mol Life Sci 2024; 81:346. [PMID: 39134808 PMCID: PMC11335270 DOI: 10.1007/s00018-024-05391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/22/2024]
Abstract
In people with multiple sclerosis (MS), newborn and surviving oligodendrocytes (OLs) can contribute to remyelination, however, current therapies are unable to enhance or sustain endogenous repair. Low intensity repetitive transcranial magnetic stimulation (LI-rTMS), delivered as an intermittent theta burst stimulation (iTBS), increases the survival and maturation of newborn OLs in the healthy adult mouse cortex, but it is unclear whether LI-rTMS can promote remyelination. To examine this possibility, we fluorescently labelled oligodendrocyte progenitor cells (OPCs; Pdgfrα-CreER transgenic mice) or mature OLs (Plp-CreER transgenic mice) in the adult mouse brain and traced the fate of each cell population over time. Daily sessions of iTBS (600 pulses; 120 mT), delivered during cuprizone (CPZ) feeding, did not alter new or pre-existing OL survival but increased the number of myelin internodes elaborated by new OLs in the primary motor cortex (M1). This resulted in each new M1 OL producing ~ 471 µm more myelin. When LI-rTMS was delivered after CPZ withdrawal (during remyelination), it significantly increased the length of the internodes elaborated by new M1 and callosal OLs, increased the number of surviving OLs that supported internodes in the corpus callosum (CC), and increased the proportion of axons that were myelinated. The ability of LI-rTMS to modify cortical neuronal activity and the behaviour of new and surviving OLs, suggests that it may be a suitable adjunct intervention to enhance remyelination in people with MS.
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Affiliation(s)
- Phuong Tram Nguyen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Kalina Makowiecki
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Thomas S Lewis
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Alastair J Fortune
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Mackenzie Clutterbuck
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Laura A Reale
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Carlie L Cullen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Mater Research Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Kaylene M Young
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
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Janssen A, Shah K, Keep M, Shaw T. Community perspectives on the use of electronic health data to support reflective practice by health professionals. BMC Med Inform Decis Mak 2024; 24:226. [PMID: 39135009 PMCID: PMC11318226 DOI: 10.1186/s12911-024-02626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/31/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Electronic health records and other clinical information systems have crucial roles in health service delivery and are often utilised for patient care as well as health promotion and research. Government agencies and healthcare bodies are gradually shifting the focus on how these data systems can be harnessed for secondary uses such as reflective practice, professional learning and continuing professional development. Whilst there has been a presence in research around the attitudes of health professionals in employing clinical information systems to support their reflective practice, there has been very little research into consumer attitudes towards these data systems and how they would like to interact with such structures. The study described in this article aimed to address this gap in the literature by exploring community perspectives on the secondary use of Electronic Health Data for health professional learning and practice reflection. METHODS A qualitative methodology was used, with data being collected via semi-structured interviews. Interviews were conducted via phone and audio recordings, before being transcribed into text for analysis. Reflective thematic analysis was undertaken to analyse the data. RESULTS Fifteen Australians consented to participate in an interview. Analysis of interview data generated five themes: (1) Knowledge about health professional registration and professional learning; (2) Secondary uses of Electronic Health Data; (3) Factors that enable the use of Electronic Health Data for health professional learning; (4) Challenges using Electronic Health Data for health professional learning and (5) Expectations around consent to use Electronic Health Data for health professional learning. CONCLUSIONS Australians are generally supportive of health professionals using Electronic Health Data to support reflective practice and learning but identify several challenges for data being used in this way.
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Affiliation(s)
- Anna Janssen
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Kavisha Shah
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Melanie Keep
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
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Adamson B, Lindsay KG, Almasri L, Koppele Duffy M, Kirkpatrick S, Hernandez ME. Evaluating the Impact of Seated Pilates on Functional Outcomes Among Those With Mild, Moderate, and Severe Multiple Sclerosis Impairment: A Pilot Feasibility Trial. Adapt Phys Activ Q 2024:1-29. [PMID: 39122240 DOI: 10.1123/apaq.2023-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 08/12/2024] Open
Abstract
This pilot study assessed the feasibility and functional benefits of a twice-weekly, 12-week, virtual, seated, group-based Pilates program in persons with mild to severe multiple sclerosis (MS). Participants were randomized into either a Pilates-only group or a Pilates group, which also incorporated hip and shoulder-cuff activation exercises. Process, management, and scientific-feasibility metrics were analyzed descriptively. Functional outcomes, physical activity, and MS-related outcomes (impact, fatigue, and quality of life) were measured pre- and postintervention and analyzed using mixed-effects models, analysis of variance, and cluster analysis. Twenty-two participants completed baseline testing. Sixteen completed the intervention and postintervention testing. Collapsed across groups, analyses demonstrated improvements in the Timed 25-Foot Walk (36%), Timed Up-and-Go (13%), and the Berg Balance Scale (10%, statistically significant). Neither between-groups differences nor physical activity or MS outcome changes were significant. Participants reported high satisfaction. Findings suggest that virtual, seated Pilates is feasible and may confer balance benefits to individuals with MS.
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Affiliation(s)
- Brynn Adamson
- Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- William J. Hybl Sports Medicine and Performance Center, Colorado Springs, CO, USA
| | - Keston G Lindsay
- William J. Hybl Sports Medicine and Performance Center, Colorado Springs, CO, USA
- Human Physiology and Nutrition, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Layla Almasri
- Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- William J. Hybl Sports Medicine and Performance Center, Colorado Springs, CO, USA
| | | | | | - Manuel E Hernandez
- Biomedical and Translational Sciences, Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
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Petracca M, Petsas N, Sellitto G, Ruotolo I, Livi C, Bonanno V, Felicetti F, Ianniello A, Ruggieri S, Borriello G, Pozzilli C. Telerehabilitation and onsite rehabilitation effectively improve quality of life, fatigue, balance, and cognition in people with multiple sclerosis: an interventional study. Front Neurol 2024; 15:1394867. [PMID: 39175758 PMCID: PMC11338795 DOI: 10.3389/fneur.2024.1394867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024] Open
Abstract
Background Telerehabilitation (TR) offers a valuable opportunity to improve access to care and has shown results comparable to onsite rehabilitation (SR) across different conditions. The present study aimed to explore the efficacy of TR and SR in improving clinically meaningful outcomes in people with multiple sclerosis (pwMS). Materials and methods Subjects enrolled in the study were assigned to one of two treatment arms: a 6-week TR intervention or a 6-week onsite rehabilitation (SR) intervention. Pre-and post-intervention evaluation included assessment of global wellbeing using the Multiple Sclerosis Quality of Life-54 scale (QoL), fatigue using the Fatigue Severity Status scale (FSS), cognitive status using the Symbol Digit Modalities Test (SDMT), and balance dysfunction using the Berg Balance Scale (BBS). Group-level and single-subject improvements were considered as outcome measures, with QoL as the primary endpoint. To determine significant group changes over time for the entire pwMS cohort, a paired t-test was applied to the overall QoL score, focusing on both physical and mental composites. An independent sample t-test was used to assess differences in baseline and follow-up performance, as well as changes over time between the intervention groups (TR and SR). This same analysis was repeated for the other clinical domains (FSS, BBS, and SDMT). The minimal clinically important difference (MCID) according to treatment group (TR vs. SR) was explored using logistic regression. Additionally, a multiple linear regression model was applied to evaluate the impact of baseline clinical-demographic features on the observed post-intervention modifications. Results A total of 51 subjects completed the study (37 women, mean age 46.3 ± 9.8, median Expanded Disability Status Scale 3.5, min. 2, max. 6.5). The entire sample benefited from the rehabilitation treatment, with significant improvements observed at both the group and individual levels across all measured domains for both intervention groups (TR vs. SR). Quality of life improved significantly (p = 0.005), as did fatigue and balance (both p < 0.001), and cognition (p = 0.003). Conclusions Both SR and TR approaches effectively improved the perception of fatigue, cognitive performance, balance, and quality of life in a population of MS patients with moderate disability.
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Affiliation(s)
- Maria Petracca
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Nikolaos Petsas
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giovanni Sellitto
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Multiple Sclerosis Center, Sant'Andrea Hospital, Rome, Italy
| | - Ilaria Ruotolo
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Multiple Sclerosis Center, Sant'Andrea Hospital, Rome, Italy
| | - Chiara Livi
- Multiple Sclerosis Center, Sant'Andrea Hospital, Rome, Italy
| | - Valeria Bonanno
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Multiple Sclerosis Center, Sant'Andrea Hospital, Rome, Italy
| | | | - Antonio Ianniello
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giovanna Borriello
- Neurology Unit, Multiple Sclerosis Center, Fatebenefratelli San Pietro Hospital, Rome, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Multiple Sclerosis Center, Sant'Andrea Hospital, Rome, Italy
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Righetti F, Rubiu G, Penso M, Moccia S, Carerj ML, Pepi M, Pontone G, Caiani EG. Deep learning approaches for the detection of scar presence from cine cardiac magnetic resonance adding derived parametric images. Med Biol Eng Comput 2024:10.1007/s11517-024-03175-z. [PMID: 39105884 DOI: 10.1007/s11517-024-03175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
This work proposes a convolutional neural network (CNN) that utilizes different combinations of parametric images computed from cine cardiac magnetic resonance (CMR) images, to classify each slice for possible myocardial scar tissue presence. The CNN performance comparison in respect to expert interpretation of CMR with late gadolinium enhancement (LGE) images, used as ground truth (GT), was conducted on 206 patients (158 scar, 48 control) from Centro Cardiologico Monzino (Milan, Italy) at both slice- and patient-levels. Left ventricle dynamic features were extracted in non-enhanced cine images using parametric images based on both Fourier and monogenic signal analyses. The CNN, fed with cine images and Fourier-based parametric images, achieved an area under the ROC curve of 0.86 (accuracy 0.79, F1 0.81, sensitivity 0.9, specificity 0.65, and negative (NPV) and positive (PPV) predictive values 0.83 and 0.77, respectively), for individual slice classification. Remarkably, it exhibited 1.0 prediction accuracy (F1 0.98, sensitivity 1.0, specificity 0.9, NPV 1.0, and PPV 0.97) in patient classification as a control or pathologic. The proposed approach represents a first step towards scar detection in contrast-free CMR images. Patient-level results suggest its preliminary potential as a screening tool to guide decisions regarding LGE-CMR prescription, particularly in cases where indication is uncertain.
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Affiliation(s)
- Francesca Righetti
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy
| | - Giulia Rubiu
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy
| | - Marco Penso
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy
| | - Sara Moccia
- Department of Innovative Technologies in Medicine and Dentistry, Università degli Studi "G. d'Annunzio" Chieti, Pescara, Italy
| | - Maria L Carerj
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Messina, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Enrico G Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, P.zza L. da Vinci 32, 20133, Milan, Italy.
- Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy.
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Ozakbas S, Kaya E, Aslan T, Ozdogar AT, Baba C. Comparative analysis of cognitive and physical characteristics in late-onset, adult-onset and early-onset multiple sclerosis patients. Mult Scler Relat Disord 2024; 90:105810. [PMID: 39180837 DOI: 10.1016/j.msard.2024.105810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/27/2024] [Accepted: 08/05/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Late-onset multiple sclerosis (LOMS or L; MS) and early-onset MS (EOMS or E) are less common, and their prognosis can be different. To characterize the demographic and clinical features, and clinical outcomes of LOMS and EOMS patients, comparing them to adult-onset MS (AOMS or A) patients. METHODS The study was conducted as a secondary analysis of a prospective study. The participants were divided into three groups according to age of MS onset: early onset (<18 years of age), adult-onset (20-40 years of age), and late-onset (>55 years of age). Demographic variables, oligoclonal bands, IgG index, and Expanded Disability Status Scale (EDSS) score in admission, first year, second year and current EDSS were evaluated. The Timed 25-Foot Walk Test (T25FW), Timed Up and Go (TUG), Multiple Sclerosis Walking Scale-12, Single Leg Standing Test, Activity-Specific Balance Confidence Scale, Nine-Hole Peg Test, Epworth Sleepiness Scale and Restless Legs Syndrome Severity Scale were performed. Appropriate statistical analysis was made. RESULTS A total of 658 pwMS was included in the study and divided into three groups: EOMS (n = 117), AOMS (n = 499), and LOMS (n = 42). Statistically significant differences were determined between groups in terms of age [L (mean:59.86±5.45 years-y-)> A (36.87±9.12 y)> E(26.56±8.85 y), p < 0.001], education level, current EDSS score (L > E, p < 0.001), EDSS score in first admission, EDSS score in the first year, EDSS score in the second year (L > A > E, p < 0.001), reached an EDSS score 6 (E > L p = 0.001, E > A p = 0.015), disease duration (E > A, E > L, mean E = 11.66±9.7 y, A = 7.99±7.4 y, L = 6.31±4.67 y) time switching second-line treatment to the third line (E > L p < 0.001, A > L p = 0.002, mean E = 171.73±83.29 months-m-, A = 136.13±65.75 m, L = 65.85±45.96 m), number of relapses (A > E > L, median E = 4.0, A = 3.0, L = 2.0), distribution of MS type and oligoclonal band types. Significant differences were found in T25FW and TUG. Post-hoc analysis showed that participants in the LOMS group have longer T25FW (mean L = 7.8 ± 6.11, A = 6.25±5.09, E = 5.72±3.13, p = 0.011) and TUG (mean L = 11.01±5.53, A = 9.57±8.04, E = 8.38±5.51, p = 0.007) times than the AOMS and EOMS groups. CONCLUSION Our result revealed that individuals with LOMS face elevated disability levels and a heightened propensity to transition from first-line treatments to more advanced therapeutic interventions. LOMS have worse lower extremity functional status than AOMS and EOMS patient. Clinical evaluations and treatment choices require more attention in LOMS. However, according to the low number of LOMS in our cohort, these results were considered cautious, and more wide and multi-center studies must be designed.
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Affiliation(s)
- Serkan Ozakbas
- Izmir University of Economics, Medical Point Hospital Izmir, Turkey
| | - Ergi Kaya
- Dokuz Eylul University, Faculty of Medicine, Department of Neurology, Izmir, Turkey
| | - Taha Aslan
- Dokuz Eylul University, Faculty of Medicine, Department of Neurology, Izmir, Turkey
| | - Asiye Tuba Ozdogar
- Van Yüzüncü Yıl University, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Van, Turkey.
| | - Cavid Baba
- Dokuz Eylül University, Graduate School of Health Sciences, Izmir, Turkey
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Mick G, Douek P. Clinical Benefits and Safety of Medical Cannabis Products: A Narrative Review on Natural Extracts. Pain Ther 2024:10.1007/s40122-024-00643-0. [PMID: 39096481 DOI: 10.1007/s40122-024-00643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024] Open
Abstract
Interest in medical cannabis and cannabis-based medicinal products (CBMPs) has increased greatly in recent years. Two cannabinoids are of principal importance; delta-9-tetrahydrocannabinol (∆9-THC), the primary psychoactive component, and also cannabidiol (CBD), considered non-intoxicating. Each has distinct mechanisms of action and different therapeutic potentials. CBMPs differ in their ∆9-THC and CBD components; predominantly ∆9-THC, balanced formulations with equivalent ∆9-THC and CBD elements, and CBD-predominant products. In this narrative review, we evaluate the published evidence for the clinical benefits of CBMPs and overall benefits in well-being. We also review the overall safety profile and discuss the potential for dependence with CBMPs. Evidence can be drawn from a wide range of randomized and other controlled studies and from observational real-world studies. Most data from observational registry studies are supportive of ∆9-THC-based products (∆9-THC-predominant or balanced CBMPs) in the management of chronic neuropathic pain. Balanced products are also effective in reducing spasticity in multiple sclerosis. Most CBMPs show benefit in providing symptomatic benefits in reducing anxiety, nausea, and in improving sleep, but the place of specific products is more subtle, and choice guided by specific circumstances. Symptomatic improvements are accompanied by improved quality of life and well-being. Safety data indicate that CBMPs are generally well tolerated in most patients without specific contraindications. The majority of adverse effects are non-serious, and transient; most are principally associated with ∆9-THC and are dose-dependent. In contrast to recreational cannabis use, there is little evidence from clinical studies that CBMPs have any potential for dependence.
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Affiliation(s)
- Gérard Mick
- Pain Center, Voiron Hospital, CHU Grenoble-Alpes-Voiron, Voiron, 38500, Grenoble, France.
- CETD, Hôpital Neurologique Pierre Wertheimer, CHU de Lyon-Hospices Civils de Lyon (HCL), 69500, Bron, France.
- Health Systemic Process (P2S) Laboratory, Research Unit 4129, Université Claude Bernard Lyon 1, 69008, Lyon, France.
- THEMAS Team, TIMC Laboratory, Université Grenoble Alpes, 38000, Grenoble, France.
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Paolicelli D, Borriello G, Clerici R, Colombo E, Croce D, D'Amico E, De Rossi N, Di Sapio A, Fenu G, Maimone D, Marfia GA, Moccia M, Perini P, Piscaglia MG, Razzolini L, Riccaboni M, Signoriello E, Agostoni G, Farina A, Mondino M, Berruto F, Tettamanti A, Donnaloja F, Tortorella C. Predicted Expenditure for Prescription Drugs for Multiple Sclerosis in the Italian Market Between 2023 and 2028: Results of the Oracle Project. Neurol Ther 2024:10.1007/s40120-024-00644-3. [PMID: 39093539 DOI: 10.1007/s40120-024-00644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic neurodegenerative disease that leads to impaired cognitive function and accumulation of disability, with significant socioeconomic burden. Serious unmet need in the context of managing MS has given rise to ongoing research efforts, leading to the launch of new drugs planned for the near future, and subsequent concerns about the sustainability of healthcare systems. This study assessed the changes in the Italian MS market and their impact on the expenditures of the Italian National Healthcare Service between 2023 and 2028. METHODS A horizon-scanning model was developed to estimate annual expenditure from 2023 to 2028. Annual expenditure for MS was calculated by combining the number of patients treated with each product (clinical inputs) and the yearly costs of therapy (economic inputs). Baseline inputs (2020-2022) were collected from IQVIA® real-world data, while input estimation for the 5-year forecast was integrated with analog analyses and the insights of clinicians and former payers. RESULTS The number of equivalent patients treated in 2028 in Italy was estimated at around 67,000, with an increase of 10% versus 2022. In terms of treatment pattern evolution, first-line treatments are expected to reduce their shares from 47% in 2022 to 27% in 2028, and Bruton tyrosine kinase inhibitors are expected to reach 23% of patient shares. Overall, expenditure for MS is estimated to decrease from €721 million in 2022 to €551 million in 2028, mainly due to losses of exclusivity and renegotiation of drug prices. CONCLUSION Despite the increase in the number of patients treated for MS and the launch of new molecules that will reach high market penetration, the model confirmed sustainability for the Italian National Healthcare Service.
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Affiliation(s)
- Damiano Paolicelli
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Giovanna Borriello
- Multiple Sclerosis Center, San Pietro Fatebenefratelli Hospital, Rome, Italy
- Department of Public Health, Federico II University, Naples, Italy
| | | | - Elena Colombo
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Davide Croce
- Centre for Health Economics, Social and Health Care Management, University Carlo Castanea - LIUC, Castellanza, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia - P.O. Montichiari, Montichiari, Italy
| | - Alessia Di Sapio
- Department of Neurology and CRESM (Regional Referral Multiple Sclerosis Centre), University Hospital San Luigi Gonzaga, Orbassano, Italy
| | - Giuseppe Fenu
- Department of Neurology, Brotzu Hospital, Cagliari, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania, Italy
| | - Girolama A Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Marcello Moccia
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital of Naples, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Paola Perini
- Department of Neurology, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Maria G Piscaglia
- Multiple Sclerosis Center, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | | | - Elisabetta Signoriello
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | | | | | | | - Carla Tortorella
- Department of Neurosciences, Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Rome, Italy
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Selmaj K, Hartung HP, Mycko MP, Selmaj I, Cross AH. MS treatment de-escalation: review and commentary. J Neurol 2024:10.1007/s00415-024-12584-x. [PMID: 39093335 DOI: 10.1007/s00415-024-12584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 08/04/2024]
Abstract
Almost all currently licensed disease-modifying therapies (DMTs) for MS treatment require prolonged if not lifelong administration. Yet, as people age, the immune system has increasingly reduced responsiveness, known as immunosenescence. Many MS DMTs reduce the responsiveness of the immune system, increasing the risks for infections and possibly cancers. As people with MS (pwMS) age, it is recognized that inflammatory MS activity declines. Several studies have addressed de-escalation of DMTs for relapsing MS under special circumstances. Here, we review evidence for de-escalating DMTs as a strategy that is particularly relevant to pwMS of older age. Treatment de-escalation can involve various strategies, such as extended or reduced dosing, switching from high-efficacy DMTs having higher risks to moderately effective DMTs with lesser risks, or treatment discontinuation. Studies have suggested that for natalizumab extended dosing maintained clinical efficacy while reducing the risk of PML. Extended interval dosing of ocrelizumab mitigated the decline of Ig levels. Retrospective and observational discontinuation studies demonstrate that age is an essential modifier of drug efficacy. Discontinuation of MS treatment in older patients has been associated with a stable disease course, while younger patients who discontinued treatment were more likely to experience new clinical activity. A recently completed 2-year randomized-controlled discontinuation study in 260 stable pwMS > 55 years found stable clinical multiple sclerosis with only a small increased risk of new MRI activity upon discontinuation. DMT de-escalation or discontinuation in MS patients older than 55 years may be non-inferior to continued treatment with immunosuppressive agents having higher health risks. However, despite several small studies, a definite conclusion about treatment de-escalation in older pwMS will require larger and longer studies. Ideally, comparison of de-escalation versus continuation versus discontinuation of DMTs should be done by prospective randomized-controlled trials enrolling sufficient numbers of subjects to allow comparisons for MS patients of both sexes within age groups, such as 55-59, 60-65, 66-69, etc. Optimally, such studies should be 3 years or longer and should incorporate testing for specific markers of immunosenescence (such as T-cell receptor excision circles) to account for differential aging of individuals.
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Affiliation(s)
- Krzysztof Selmaj
- Department of Neurology, University of Warmia & Mazury, Olsztyn, Poland.
- Center of Neurology, Lodz, Poland.
| | - Hans-Peter Hartung
- Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Palacky University, Olomouc, Czech Republic
- Brain and Mind Center, University of Sydney, Sydney, Australia
| | - Marcin P Mycko
- Department of Neurology, University of Warmia & Mazury, Olsztyn, Poland
| | | | - Anne H Cross
- Washington University School of Medicine, St. Louis, MO, USA
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Pouzol L, Sassi A, Tunis M, Zurbach A, Baumlin N, Gnerre C, Strasser DS, Marrie J, Vezzali E, Martinic MM. ACKR3 Antagonism Enhances the Repair of Demyelinated Lesions Through Both Immunomodulatory and Remyelinating Effects. Neurochem Res 2024; 49:2087-2104. [PMID: 38819698 PMCID: PMC11233362 DOI: 10.1007/s11064-024-04173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/16/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
Addressing inflammation, demyelination, and associated neurodegeneration in inflammatory demyelinating diseases like multiple sclerosis (MS) remains challenging. ACT-1004-1239, a first-in-class and potent ACKR3 antagonist, currently undergoing clinical development, showed promise in preclinical MS models, reducing neuroinflammation and demyelination. However, its effectiveness in treating established disease and impact on remyelination after the occurrence of demyelinated lesions remain unexplored. This study assessed the therapeutic effect of ACT-1004-1239 in two demyelinating disease models. In the proteolipid protein (PLP)-induced experimental autoimmune encephalomyelitis (EAE) model, ACT-1004-1239 administered upon the detection of the first signs of paralysis, resulted in a dose-dependent reduction in EAE disease severity, concomitant with diminished immune cell infiltrates in the CNS and reduced demyelination. Notably, efficacy correlated with elevated plasma concentrations of CXCL11 and CXCL12, two pharmacodynamic biomarkers of ACKR3 antagonism. Combining ACT-1004-1239 with siponimod, an approved immunomodulatory treatment for MS, synergistically reduced EAE severity. In the cuprizone-induced demyelination model, ACT-1004-1239 administered after 5 weeks of cuprizone exposure, significantly accelerated remyelination, already quantifiable one week after cuprizone withdrawal. Additionally, ACT-1004-1239 penetrated the CNS, elevating brain CXCL12 concentrations. These results demonstrate that ACKR3 antagonism significantly reduces the severity of experimental demyelinating diseases, even when treatment is initiated therapeutically, after the occurrence of lesions. It confirms the dual mode of action of ACT-1004-1239, exhibiting both immunomodulatory effects by reducing neuroinflammation and promyelinating effects by accelerating myelin repair. The results further strengthen the rationale for evaluating ACT-1004-1239 in clinical trials for patients with demyelinating diseases.
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Affiliation(s)
- Laetitia Pouzol
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland.
| | - Anna Sassi
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
| | - Mélanie Tunis
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
| | - Anaïs Zurbach
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
| | - Nadège Baumlin
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
| | - Carmela Gnerre
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
| | - Daniel S Strasser
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
| | - Julia Marrie
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
| | - Enrico Vezzali
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
| | - Marianne M Martinic
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil 4123, Basel-Landschaft, Switzerland
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Fakolade A, Jackson A, Cardwell KL, Finlayson M, O'Sullivan TL, Tomasone JR, Pilutti LA. DigiTRAC: Qualitative insights from knowledge users to inform the development of a Digital Toolkit for enhancing resilience among multiple sclerosis caregivers. Mult Scler Relat Disord 2024; 88:105736. [PMID: 38954857 DOI: 10.1016/j.msard.2024.105736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Resilience-promoting resources are critically needed to support positive caregiving experiences for multiple sclerosis (MS) caregivers. A digital toolkit offers a flexible way to access and use evidence-based resources that align with MS caregivers' interests and needs over time. OBJECTIVE We explored the perspectives of key knowledge users regarding content areas, features, and other considerations to inform an MS caregiver resilience digital toolkit. METHODS Twenty-two individuals completed a demographic survey as part of this study: 11 MS family caregivers, 7 representatives of organizations providing support services for people with MS and/or caregivers, and 4 clinicians. We conducted nine semi-structured individual interviews and two focus groups. Data were analyzed using content analysis. RESULTS Participants recommended that a digital toolkit should include content focused on promoting MS caregivers' understanding of the disease, its trajectory and available management options, and enhancing caregiving skills and caregivers' ability to initiate and maintain behaviours to promote their own well-being. Features that allow for tracking and documenting care recipients' and caregivers' experiences, customization of engagement, and connectivity with other sources of support were also recommended. Participants suggested a digital toolkit should be delivered through an app with web browser capabilities accessible on smartphones, tablets, or laptops. They also acknowledged the need to consider how users' previous technology experiences and issues related to accessibility, usability, privacy and security could influence toolkit usage. CONCLUSION These findings will guide future toolkit development and evaluation. More broadly, this study joins the chorus of voices calling for critical attention to the well-being of MS family caregivers.
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Affiliation(s)
- Afolasade Fakolade
- School of Rehabilitation Therapy, Louise D. Acton Building, 31 George Street, Queen's University, Kingston, ON, K7L 3N6, Canada; Providence Care Hospital, 752 King Street West, Kingston, ON, K7L 4 X 3, Canada.
| | - Alexandra Jackson
- School of Rehabilitation Therapy, Louise D. Acton Building, 31 George Street, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Katherine L Cardwell
- Interdisciplinary School of Health Sciences, 200 Lees Avenue, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Louise D. Acton Building, 31 George Street, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Tracey L O'Sullivan
- Interdisciplinary School of Health Sciences, 200 Lees Avenue, University of Ottawa, Ottawa, ON, K1N 6N5, Canada; LIFE Research Institute, Thompson Hall, 25 University Private, room 227, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, 200 Division Street, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, 200 Lees Avenue, University of Ottawa, Ottawa, ON, K1N 6N5, Canada; Brain and Mind Research Institute, Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road Ottawa, ON, K1H 8M5, Canada
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Arnett S, Chew SH, Leitner U, Hor JY, Paul F, Yeaman MR, Levy M, Weinshenker BG, Banwell BL, Fujihara K, Abboud H, Dujmovic Basuroski I, Arrambide G, Neubrand VE, Quan C, Melamed E, Palace J, Sun J, Asgari N, Broadley SA. Sex ratio and age of onset in AQP4 antibody-associated NMOSD: a review and meta-analysis. J Neurol 2024; 271:4794-4812. [PMID: 38958756 PMCID: PMC11319503 DOI: 10.1007/s00415-024-12452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Aquaporin-4 (AQP4) antibody-associated neuromyelitis optica spectrum disorder (NMOSD) is an antibody-mediated inflammatory disease of the central nervous system. We have undertaken a systematic review and meta-analysis to ascertain the sex ratio and mean age of onset for AQP4 antibody associated NMOSD. We have also explored factors that impact on these demographic data. METHODS A systematic search of databases was conducted according to the PRISMA guidelines. Articles reporting sex distribution and age of onset for AQP4 antibody-associated NMSOD were reviewed. An initially inclusive approach involving exploration with regression meta-analysis was followed by an analysis of just AQP4 antibody positive cases. RESULTS A total of 528 articles were screened to yield 89 articles covering 19,415 individuals from 88 population samples. The female:male sex ratio was significantly influenced by the proportion of AQP4 antibody positive cases in the samples studied (p < 0.001). For AQP4 antibody-positive cases the overall estimate of the sex ratio was 8.89 (95% CI 7.78-10.15). For paediatric populations the estimate was 5.68 (95% CI 4.01-8.03) and for late-onset cases, it was 5.48 (95% CI 4.10-7.33). The mean age of onset was significantly associated with the mean life expectancy of the population sampled (p < 0.001). The mean age of onset for AQP4 antibody-positive cases in long-lived populations was 41.7 years versus 33.3 years in the remainder. CONCLUSIONS The female:male sex ratio and the mean age of onset of AQP4 antibody-associated NMOSD are significantly higher than MS. The sex ratio increases with the proportion of cases that are positive for AQP4 antibodies and the mean age of onset increases with population life expectancy.
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Affiliation(s)
- Simon Arnett
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia.
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia.
| | - Sin Hong Chew
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Unnah Leitner
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Jyh Yung Hor
- Department of Neurology, Penang General Hospital, George Town, Penang, Malaysia
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael R Yeaman
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Department of Medicine, Divisions of Molecular Medicine & Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA, USA
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Brenda L Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University and Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Hesham Abboud
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Veronika E Neubrand
- Department of Cell Biology, Faculty of Sciences, University of Granada, Granada, Spain
| | - Chao Quan
- Department of Neurology, The National Centre for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Esther Melamed
- Dell Medical School, University of Texas, Austin, TX, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department Clinical Neurology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Jing Sun
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Institute of Integrated Intelligence and Systems, Nathan Campus, Griffith University, Nathan, QLD, Australia
- Rural Health Research Institute, Charles Sturt University, Bathurst, NSW, Australia
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark
- Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Simon A Broadley
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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Roos I, Sharmin S, Malpas C, Ozakbas S, Lechner-Scott J, Hodgkinson S, Alroughani R, Eichau Madueño S, Boz C, van der Walt A, Butzkueven H, Buzzard K, Skibina O, Foschi M, Grand'Maison F, John N, Grammond P, Terzi M, Prévost J, Barnett M, Laureys G, Van Hijfte L, Luis Sanchez-Menoyo J, Blanco Y, Oh J, McCombe P, Ramo Tello C, Soysal A, Prat A, Duquette P, Yamout BI, Khoury S, van Pesch V, Macdonell R, José Sá M, Slee M, Kuhle J, Maimone D, Spitaleri DLA, Willekens B, Asmi AA, Tallantyre E, Robertson NP, Coles A, L Brown JW, Kalincik T. Effectiveness of cladribine compared to fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting multiple sclerosis. Mult Scler 2024; 30:1163-1175. [PMID: 39087208 DOI: 10.1177/13524585241267211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND Comparisons between cladribine and other potent immunotherapies for multiple sclerosis (MS) are lacking. OBJECTIVES To compare the effectiveness of cladribine against fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting MS. METHODS Patients with relapsing-remitting MS treated with cladribine, fingolimod, natalizumab, ocrelizumab or alemtuzumab were identified in the global MSBase cohort and two additional UK centres. Patients were followed for ⩾6/12 and had ⩾3 in-person disability assessments. Patients were matched using propensity score. Four pairwise analyses compared annualised relapse rates (ARRs) and disability outcomes. RESULTS The eligible cohorts consisted of 853 (fingolimod), 464 (natalizumab), 1131 (ocrelizumab), 123 (alemtuzumab) or 493 (cladribine) patients. Cladribine was associated with a lower ARR than fingolimod (0.07 vs. 0.12, p = 0.006) and a higher ARR than natalizumab (0.10 vs. 0.06, p = 0.03), ocrelizumab (0.09 vs. 0.05, p = 0.008) and alemtuzumab (0.17 vs. 0.04, p < 0.001). Compared to cladribine, the risk of disability worsening did not differ in patients treated with fingolimod (hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.47-2.47) or alemtuzumab (HR 0.73, 95% CI 0.26-2.07), but was lower for patients treated with natalizumab (HR 0.35, 95% CI 0.13-0.94) and ocrelizumab (HR 0.45, 95% CI 0.26-0.78). There was no evidence for a difference in disability improvement. CONCLUSION Cladribine is an effective therapy that can be viewed as a step up in effectiveness from fingolimod, but is less effective than the most potent intravenous MS therapies.
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Affiliation(s)
- Izanne Roos
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Charles Malpas
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia/John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia
| | - Suzanne Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, NSW, Australia
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | | | - Cavit Boz
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Anneke van der Walt
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Katherine Buzzard
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Olga Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Matteo Foschi
- Department of Neuroscience, Multiple Sclerosis Center, S. Maria delle Croci Hospital of Ravenna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | | | - Nevin John
- Department of Neurology, Monash Health, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | | | - Murat Terzi
- Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | | | - Guy Laureys
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Jose Luis Sanchez-Menoyo
- Department of Neurology, Hospital de Galdakao-Usansolo, Biocruces-Bizkaia Health Research Institute, Galdakao, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jiwon Oh
- St. Michael's Hospital, Toronto, ON, Canada
| | - Pamela McCombe
- The University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, OLD, Australia
| | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Alexandre Prat
- CHUM MS Center and Universite de Montreal, Montreal, QC, Canada
| | - Pierre Duquette
- CHUM MS Center and Universite de Montreal, Montreal, QC, Canada
| | - Bassem I Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal; Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Mark Slee
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jens Kuhle
- Neurology, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, ARNAS Garibaldi, Catania, Italy
| | - Daniele LA Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Abdallah Al Asmi
- College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Sultan Qaboos University, Al-Khodh, Oman
| | - Emma Tallantyre
- Department of Neurology, University Hospital of Wales; Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Neil P Robertson
- Department of Neurology, University Hospital of Wales; Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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Vardakas I, Dorst J, Huss A, Mayer B, Fangerau T, Taranu D, Tumani H, Senel M. Serum neurofilament light chain and glial fibrillary acidic protein for predicting response to apheresis in steroid-refractory multiple sclerosis relapses. Eur J Neurol 2024; 31:e16323. [PMID: 38700322 PMCID: PMC11235822 DOI: 10.1111/ene.16323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND PURPOSE The predictive value of serum neurofilament light chain (sNfL) and serum glial fibrillary acidic protein (sGFAP) for apheresis outcome in steroid-refractory multiple sclerosis (MS) relapse has not yet been evaluated. METHODS We used pre- and postapheresis serum samples from 38 participants of the IAPEMS trial (clinicaltrials.gov: NCT02671682), which investigated the use of immunoadsorption versus plasma exchange for the treatment of steroid-refractory MS attacks. Response to apheresis was classified based on improvement on (i) the Expanded Disability Status Scale (EDSS), (ii) the affected functional system scores (FSS) of the EDSS, or (iii) the visual acuity for patients with optic neuritis, 4 weeks postapheresis. sNFL and sGFAP were measured by single molecule arrays. RESULTS Preprocedural sGFAP levels could discriminate between responders and nonresponders, determined by FSS improvement (p = 0.017). In multivariate logistic regression analysis, younger age (odds ratio [OR] = 0.781, 95% confidence interval [CI] = 0.635-0.962, p = 0.020) and lower sGFAP levels (OR = 0.948, 95% CI = 0.903-0.995, p = 0.031) could predict response to apheresis in the overall cohort. We could observe a trend towards a favourable apheresis outcome with higher sNfL levels (OR = 1.413, 95% CI = 0.965-2.069, p = 0.076). Analysis of the sNfL-to-sGFAP ratio showed an OR of 1.924 (95% CI = 1.073-3.451, p = 0.028) for predicting apheresis response. The ratio showed a better predictive value than the individual parameters. Neither biomarker was affected by the number of steroid cycles preapheresis. CONCLUSIONS Lower sGFAP levels, a higher sNfL-to-sGFAP ratio, and younger age are associated with a favourable apheresis outcome.
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Affiliation(s)
| | | | - André Huss
- Department of NeurologyUniversity of UlmUlmGermany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical BiometryUniversity of UlmUlmGermany
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Stefan KA, Ciotti JR. MOG Antibody Disease: Nuances in Presentation, Diagnosis, and Management. Curr Neurol Neurosci Rep 2024; 24:219-232. [PMID: 38805147 DOI: 10.1007/s11910-024-01344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE OF REVIEW Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a distinct neuroinflammatory condition characterized by attacks of optic neuritis, transverse myelitis, and other demyelinating events. Though it can mimic multiple sclerosis and neuromyelitis optica spectrum disorder, distinct clinical and radiologic features which can discriminate these conditions are now recognized. This review highlights recent advances in our understanding of clinical manifestations, diagnosis, and treatment of MOGAD. RECENT FINDINGS Studies have identified subtleties of common clinical attacks and identified more rare phenotypes, including cerebral cortical encephalitis, which have broadened our understanding of the clinicoradiologic spectrum of MOGAD and culminated in the recent publication of proposed diagnostic criteria with a familiar construction to those diagnosing other neuroinflammatory conditions. These criteria, in combination with advances in antibody testing, should simultaneously lead to wider recognition and reduced incidence of misdiagnosis. In addition, recent observational studies have raised new questions about when to treat MOGAD chronically, and with which agent. MOGAD pathophysiology informs some of the relatively unique clinical and radiologic features which have come to define this condition, and similarly has implications for diagnosis and management. Further prospective studies and the first clinical trials of therapeutic options will answer several remaining questions about the peculiarities of this condition.
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Affiliation(s)
- Kelsey A Stefan
- Department of Neurology, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA
| | - John R Ciotti
- Department of Neurology, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA.
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Jeyakumar N, Lerch M, Dale RC, Ramanathan S. MOG antibody-associated optic neuritis. Eye (Lond) 2024; 38:2289-2301. [PMID: 38783085 PMCID: PMC11306565 DOI: 10.1038/s41433-024-03108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a demyelinating disorder, distinct from multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). MOGAD most frequently presents with optic neuritis (MOG-ON), often with characteristic clinical and radiological features. Bilateral involvement, disc swelling clinically and radiologically, and longitudinally extensive optic nerve hyperintensity with associated optic perineuritis on MRI are key characteristics that can help distinguish MOG-ON from optic neuritis due to other aetiologies. The detection of serum MOG immunoglobulin G utilising a live cell-based assay in a patient with a compatible clinical phenotype is highly specific for the diagnosis of MOGAD. This review will highlight the key clinical and radiological features which expedite diagnosis, as well as ancillary investigations such as visual fields, visual evoked potentials and cerebrospinal fluid analysis, which may be less discriminatory. Optical coherence tomography can identify optic nerve swelling acutely, and atrophy chronically, and may transpire to have utility as a diagnostic and prognostic biomarker. MOG-ON appears to be largely responsive to corticosteroids, which are often the mainstay of acute management. However, relapses are common in patients in whom follow-up is prolonged, often in the context of early or rapid corticosteroid tapering. Establishing optimal acute therapy, the role of maintenance steroid-sparing immunotherapy for long-term relapse prevention, and identifying predictors of relapsing disease remain key research priorities in MOG-ON.
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Affiliation(s)
- Niroshan Jeyakumar
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Magdalena Lerch
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Clinical Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- TY Nelson Department of Neurology, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Department of Neurology, Concord Hospital, Sydney, NSW, Australia.
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Jellinger KA. Depression and anxiety in multiple sclerosis. Review of a fatal combination. J Neural Transm (Vienna) 2024; 131:847-869. [PMID: 38869643 DOI: 10.1007/s00702-024-02792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
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Singer BA, Wray S, Gudesblatt M, Bumstead B, Ziemssen T, Bonnell A, Scaramozza M, Levin S, Shanmugasundaram M, Chen H, Mendoza JP, Lewin JB, Shankar SL. Lymphopenia is Not the Primary Therapeutic Mechanism of Diroximel Fumarate in Relapsing-Remitting Multiple Sclerosis: Subgroup Analyses of the EVOLVE-MS-1 Study. Neurol Ther 2024; 13:1273-1285. [PMID: 38935202 PMCID: PMC11263526 DOI: 10.1007/s40120-024-00637-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION In EVOLVE-MS-1 (NCT02634307), mean absolute lymphocyte count (ALC) on diroximel fumarate (DRF) declined from baseline by approximately 28% in year 1, then stabilized, similar to ALC decline observed with dimethyl fumarate (DMF). Prior studies reported that clinical efficacy of DMF was not substantially different in patients with and without lymphopenia. METHODS EVOLVE-MS-1-an open-label, 96-week, phase 3 study-assessed DRF safety and exploratory efficacy in patients with relapsing-remitting multiple sclerosis. This study analyzes efficacy-related outcomes comparing (1) patients with lymphopenia (≥ 1 ALC below lower limit of normal [LLN]) and without (all ALCs ≥ LLN); (2) across quartiles stratified by week 96 ALC decline from baseline: Q1 (≥ 47% decline); Q2 (30% to < 47% decline); Q3 (12% to < 30% decline); Q4 (< 12% decline). RESULTS Baseline characteristics were similar between patients without (n = 593) and with lymphopenia (n = 452). At week 96, adjusted annualized relapse rate (ARR; 95% confidence interval) was 0.14 (0.11-0.17) without lymphopenia and 0.12 (0.09-0.15) with lymphopenia. Estimated proportions with 12-week confirmed disability progression (CDP12) at week 96 were 10.2% without and 9.3% with lymphopenia. When stratified by quartiles (Q1-Q4), ARR at week 96 was 0.11 (Q1), 0.09 (Q2), 0.13 (Q3), and 0.17 (Q4). Estimated proportions with CDP12 at week 96 were 9.6% (Q1), 10.2% (Q2), 5.7% (Q3), and 10.9% (Q4). At week 96, no evidence of disease activity was achieved by 47.2% (Q1), 47.8% (Q2), 45.4% (Q3), and 37.3% (Q4) of patients. CONCLUSION In DRF-treated patients in EVOLVE-MS-1, clinical and radiological measurements indicated reduced disease activity regardless of lymphopenia or magnitude of ALC decline from baseline; however, patients who had greater ALC declines appeared to have numerically lower ARR and higher proportions free from relapses and gadolinium-enhancing lesions compared with those with smallest decline. This supports prior evidence that, while lymphopenia may contribute to fumarate efficacy outcomes, it is not the primary mechanism of action. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02634307.
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Affiliation(s)
- Barry A Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, St. Louis, MO, USA
| | - Sibyl Wray
- Hope Neurology MS Center, Knoxville, TN, USA
| | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | | | | | - Seth Levin
- Biogen, 225 Binney St., Cambridge, MA, 02142, USA
| | | | - Hailu Chen
- Biogen, 225 Binney St., Cambridge, MA, 02142, USA
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Adamová LM, Slezáková D, Hric I, Nechalová L, Berisha G, Olej P, Chren M, Chlapcová A, Penesová A, Minár M, Bielik V. Impact of dance classes on motor and cognitive functions and gut microbiota composition in multiple sclerosis patients: Randomized controlled trial. Eur J Sport Sci 2024; 24:1186-1196. [PMID: 38967986 PMCID: PMC11295098 DOI: 10.1002/ejsc.12166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/31/2024] [Accepted: 06/24/2024] [Indexed: 07/07/2024]
Abstract
Evidence suggests that multiple sclerosis (MS) induces a decline in motor and cognitive function and provokes a shift in gut microbiome composition in patients. Therefore, the aim of the study was to explore the effect of dance classes on the motor and cognitive functions and gut microbiota composition of MS patients. In this randomized controlled trial, 36 patients were randomly divided into two groups: the experimental group (n = 18) and the passive control group (n = 18). Supervised rock and roll and sports dance classes were performed for 12 weeks at a frequency of two times a week. Before and after the intervention, fecal samples were taken and the motor and cognitive function assessments were completed. Fecal microbiota were categorized using primers targeting the V3-V4 region of 16S rDNA. Our results revealed significant differences in mobility performance (T25-FWT), attention and working memory (TMT B), and finger dexterity (9-HPT) within the experimental group. Furthermore, we reported favorable shifts in gut microbial communities (an increase in Blautia stercoris and a decrease in Ruminococcus torques) within the experimental group. In conclusion, our randomized control trial on the effects of 12-week dance classes in MS patients found significant improvements in motor and cognitive functions, with further moderate influence on gut microbiota composition.
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Affiliation(s)
- Louise Mária Adamová
- Second Department of NeurologyFaculty of MedicineComenius UniversityUniversity Hospital in BratislavaBratislavaSlovakia
| | - Darina Slezáková
- Second Department of NeurologyFaculty of MedicineComenius UniversityUniversity Hospital in BratislavaBratislavaSlovakia
| | - Ivan Hric
- Biomedical Research CenterInstitute of Clinical and Translational ResearchSlovak Academy of SciencesBratislavaSlovakia
- Department of Molecular BiologyFaculty of Natural SciencesComenius University in BratislavaBratislavaSlovakia
| | - Libuša Nechalová
- Biomedical Research CenterInstitute of Clinical and Translational ResearchSlovak Academy of SciencesBratislavaSlovakia
- Department of Biological and Medical ScienceFaculty of Physical Education and SportComenius University in BratislavaBratislavaSlovakia
| | - Genc Berisha
- Department of Biological and Medical ScienceFaculty of Physical Education and SportComenius University in BratislavaBratislavaSlovakia
| | - Peter Olej
- Department of GymnasticsFaculty of Physical Education and SportComenius University in BratislavaBratislavaSlovakia
| | - Matej Chren
- Department of GymnasticsFaculty of Physical Education and SportComenius University in BratislavaBratislavaSlovakia
| | - Adela Chlapcová
- Department of GymnasticsFaculty of Physical Education and SportComenius University in BratislavaBratislavaSlovakia
| | - Adela Penesová
- Biomedical Research CenterInstitute of Clinical and Translational ResearchSlovak Academy of SciencesBratislavaSlovakia
- Department of Biological and Medical ScienceFaculty of Physical Education and SportComenius University in BratislavaBratislavaSlovakia
| | - Michal Minár
- Second Department of NeurologyFaculty of MedicineComenius UniversityUniversity Hospital in BratislavaBratislavaSlovakia
| | - Viktor Bielik
- Department of Biological and Medical ScienceFaculty of Physical Education and SportComenius University in BratislavaBratislavaSlovakia
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Turner M, Laws M, Griffiths M, Turner K, Dempsey L, Laws SM, Cruickshank T. The relationships between multidimensional sleep health and work productivity in individuals with neurological conditions. J Sleep Res 2024; 33:e14107. [PMID: 38069583 DOI: 10.1111/jsr.14107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 07/17/2024]
Abstract
Numerous studies have reported the negative impacts of poor sleep on work productivity in the general population. However, despite the known sleep issues that individuals living with neurological conditions experience, no study has explored its impact on their work productivity. Sleep health is a concept that includes multiple domains of sleep, measured with a combination of objective and subjective measures. Therefore, this study aimed to ascertain the associations between sleep health and its domains and work productivity in individuals with neurological conditions. Sleep health domains were determined through actigraphy data collected over 1 week and sleep questionnaires. Work productivity was assessed via the Work Productivity and Activity Impairment Questionnaire. A comparison of sleep health scores between demographic variables was performed using Mann-Whitney U and Kruskal-Wallis tests. Associations between the sleep health domains and work productivity were performed using linear regression models. There were no significant differences in sleep health scores between sex, smoking status, education level, employment status or any work productivity domain. Individuals with non-optimal sleep timing had greater absenteeism (22.99%) than the optimal group. Individuals with non-optimal sleep quality had an increase in presenteeism (30.85%), work productivity loss (26.44%) and activity impairment (25.81%) compared to those in the optimal group. The findings from this study highlight that self-reported sleep quality has the largest impact on work productivity. Improving individuals' sleep quality through triage for potential sleep disorders or improving their sleep hygiene (sleep behaviour and environment) may positively impact work productivity.
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Affiliation(s)
- Mitchell Turner
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Manja Laws
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Madeline Griffiths
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Turner
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Leah Dempsey
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Simon M Laws
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Travis Cruickshank
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
- Perron Institute for Neurological and Translational Sciences, Perth, Western Australia, Australia
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Sechi E. NMOSD and MOGAD. Continuum (Minneap Minn) 2024; 30:1052-1087. [PMID: 39088288 DOI: 10.1212/con.0000000000001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
OBJECTIVE This article reviews the clinical features, MRI characteristics, diagnosis, and treatment of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). The main differences between these disorders and multiple sclerosis (MS), the most common demyelinating disease of the central nervous system (CNS), are also highlighted. LATEST DEVELOPMENTS The past 20 years have seen important advances in understanding rare demyelinating CNS disorders associated with AQP4 IgG and myelin oligodendrocyte glycoprotein (MOG) IgG. The rapidly expanding repertoire of immunosuppressive agents approved for the treatment of AQP4-NMOSD and emerging as potentially beneficial in MOGAD mandates prompt recognition of these diseases. Most of the recent literature has focused on the identification of clinical and MRI features that help distinguish these diseases from each other and MS, simultaneously highlighting major diagnostic pitfalls that may lead to misdiagnosis. An awareness of the limitations of currently available assays for AQP4 IgG and MOG IgG detection is fundamental for identifying rare false antibody positivity and avoiding inappropriate treatments. For this purpose, diagnostic criteria have been created to help the clinician interpret antibody testing results and recognize the clinical and MRI phenotypes associated with AQP4-NMOSD and MOGAD. ESSENTIAL POINTS An awareness of the specific clinical and MRI features associated with AQP4-NMOSD and MOGAD and the limitations of currently available antibody testing assays is crucial for a correct diagnosis and differentiation from MS. The growing availability of effective treatment options will lead to personalized therapies and improved outcomes.
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Jellinger KA. Cognitive impairment in multiple sclerosis: from phenomenology to neurobiological mechanisms. J Neural Transm (Vienna) 2024; 131:871-899. [PMID: 38761183 DOI: 10.1007/s00702-024-02786-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
Multiple sclerosis (MS) is an autoimmune-mediated disease of the central nervous system characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of clinical symptoms, cognitive impairment (CI) is a common and disabling feature greatly affecting the patients' quality of life. Its prevalence is 20% up to 88% with a wide variety depending on the phenotype of MS, with highest frequency and severity in primary progressive MS. Involving different cognitive domains, CI is often associated with depression and other neuropsychiatric symptoms, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. While no specific neuropathological data for CI in MS are available, modern research has provided evidence that it arises from the disease-specific brain alterations. Multimodal neuroimaging, besides structural changes of cortical and deep subcortical gray and white matter, exhibited dysfunction of fronto-parietal, thalamo-hippocampal, default mode and cognition-related networks, disruption of inter-network connections and involvement of the γ-aminobutyric acid (GABA) system. This provided a conceptual framework to explain how aberrant pathophysiological processes, including oxidative stress, mitochondrial dysfunction, autoimmune reactions and disruption of essential signaling pathways predict/cause specific disorders of cognition. CI in MS is related to multi-regional patterns of cerebral disturbances, although its complex pathogenic mechanisms await further elucidation. This article, based on systematic analysis of PubMed, Google Scholar and Cochrane Library, reviews current epidemiological, clinical, neuroimaging and pathogenetic evidence that could aid early identification of CI in MS and inform about new therapeutic targets and strategies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
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Hallberg S, Evertsson B, Lillvall E, Boremalm M, de Flon P, Wang Y, Salzer J, Lycke J, Fink K, Frisell T, Al Nimer F, Svenningsson A. Hypogammaglobulinaemia during rituximab treatment in multiple sclerosis: A Swedish cohort study. Eur J Neurol 2024; 31:e16331. [PMID: 38794973 PMCID: PMC11236063 DOI: 10.1111/ene.16331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND AND PURPOSE Mechanisms behind hypogammaglobulinaemia during rituximab treatment are poorly understood. METHODS In this register-based multi-centre retrospective cohort study of multiple sclerosis (MS) patients in Sweden, 2745 patients from six participating Swedish MS centres were identified via the Swedish MS registry and included between 14 March 2008 and 25 January 2021. The exposure was treatment with at least one dose of rituximab for MS or clinically isolated syndrome, including data on treatment duration and doses. The degree of yearly decrease in immunoglobulin G (IgG) and immunoglobulin M (IgM) levels was evaluated. RESULTS The mean decrease in IgG was 0.27 (95% confidence interval 0.17-0.36) g/L per year on rituximab treatment, slightly less in older patients, and without significant difference between sexes. IgG or IgM below the lower limit of normal (<6.7 or <0.27 g/L) was observed in 8.8% and 8.3% of patients, respectively, as nadir measurements. Six out of 2745 patients (0.2%) developed severe hypogammaglobulinaemia (IgG below 4.0 g/L) during the study period. Time on rituximab and accumulated dose were the main predictors for IgG decrease. Previous treatment with fingolimod and natalizumab, but not teriflunomide, dimethyl fumarate, interferons or glatiramer acetate, were significantly associated with lower baseline IgG levels by 0.80-1.03 g/L, compared with treatment-naïve patients. Switching from dimethyl fumarate or interferons was associated with an additional IgG decline of 0.14-0.19 g/L per year, compared to untreated. CONCLUSIONS Accumulated dose and time on rituximab treatment are associated with a modest but significant decline in immunoglobulin levels. Previous MS therapies may influence additional IgG decline.
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Affiliation(s)
- Susanna Hallberg
- Department of Clinical SciencesKarolinska Institutet, Danderyds SjukhusStockholmSweden
| | - Björn Evertsson
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Ellen Lillvall
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Malin Boremalm
- Department of Clinical Science, NeurosciencesUmeå UniversityUmeåSweden
| | - Pierre de Flon
- Department of Clinical Sciences, Neurosciences, Unit of Neurology, ÖstersundUmeå UniversityUmeåSweden
| | - Yunzhang Wang
- Department of Clinical SciencesKarolinska Institutet, Danderyds SjukhusStockholmSweden
| | - Jonatan Salzer
- Department of Clinical Science, NeurosciencesUmeå UniversityUmeåSweden
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Katharina Fink
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Faiez Al Nimer
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Anders Svenningsson
- Department of Clinical SciencesKarolinska Institutet, Danderyds SjukhusStockholmSweden
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Ghezzi A. Old and New Strategies in the Treatment of Pediatric Multiple Sclerosis: A Personal View for a New Treatment Approach. Neurol Ther 2024; 13:949-963. [PMID: 38822947 PMCID: PMC11263277 DOI: 10.1007/s40120-024-00633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
Up to 10 years ago the most common approach to the treatment of pediatric MS (ped-MS) was to start with IFNB or GA (so-called first-line therapies or moderate-efficacy disease-modifying therapies [ME-DMTs]) and to switch to more aggressive treatments (or high-efficacy disease-modifying therapies [HE-DMTs]) in non-responder patients. The use of HE-DMTs as first choice was recommended in selected cases with an active, aggressive form of MS. Indications for the treatment of ped-MS were essentially derived from data of observational studies. Recently, results of three randomized clinical trials have been published as well as data from many observational studies evaluating the effect of new and more active DMTs, with clear evidence that HE-DMTs are more effective than ME-DMTs. Therefore, the paradigm of treatment for patients with MS onset before 18 years of age should be changed, offering treatment with HE-DMTs as first option, because of their superior effectiveness to prevent relapses and disease progression. HE-DMTs present an overall reassuring safety profile and obtain better adherence to treatment.
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Affiliation(s)
- Angelo Ghezzi
- Dipartimento di Scienze della Salute, Università Piemonte Orientale A. Avogadro, Via Solaroli 17, 28100, Novara, Italy.
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Lapucci C, Frau J, Cocco E, Coghe G, Petracca M, Lanzillo R, Brescia Morra V, Nicoletti CG, Landi D, Marfia G, Vercellino M, Cavalla P, Bianco A, Mirabella M, Torri Clerici V, Tomas E, Ferrò MT, Grossi P, Nozzolillo A, Moiola L, Zaffaroni M, Ronzoni M, Pinardi F, Novi G, Cellerino M, Uccelli A, Inglese M. Ocrelizumab in MS patients with persistence of disease activity after alemtuzumab: A multi-center Italian study. Mult Scler 2024; 30:1151-1162. [PMID: 39143825 DOI: 10.1177/13524585241266509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
BACKGROUND The reason why some multiple sclerosis (MS) patients show disease activity after alemtuzumab (ALM) is still unclear, but ocrelizumab (OCR) could represent an interesting sequential therapeutic approach. OBJECTIVES To investigate safety and efficacy of OCR in MS patients with disease activity after two ALM courses. METHODS Observational retrospective multi-centers Italian cohort study. RESULTS Seventy-two subjects were included. Mean follow-up (FU) was 2.4 (±1) years. Forty-five patients (62.5%) experienced at least one adverse event (AE), with infections accounting for 96.7% of cases. A reduction in total lymphocytes was observed between OCR start and 6 months FU, driven by BCD19+ lymphocytes depletion (p < 0.001). Immunoglobulin M (IgM) levels decreased between OCR start and 6 months FU (p < 0.001). At 2-year FU, relapse, magnetic resonance imaging (MRI) activity and disability worsening-free survival were 92.1%, 90.8%, and 89.2%. The evidence of inflammatory activity between the two ALM courses was associated with higher risk of relapse, MRI activity, and NEDA-3 status loss in relapsing-remitting multiple sclerosis (RRMS; p = 0.02, p = 0.05, p = 0.01, respectively). CONCLUSIONS OCR after two ALM courses seemed to be safe and effective. Early IgM hypogammaglobulinemia occurred in a high proportion of patients. The evidence of inflammatory activity between ALM courses seemed to increase the risk of MS re-activation on OCR treatment.
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Affiliation(s)
| | - Jessica Frau
- Centro regionale per la diagnosi e la cura della Sclerosi Multipla, ASL Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Centro regionale per la diagnosi e la cura della Sclerosi Multipla, ASL Cagliari, Cagliari, Italy
- Department of Medical Sciences and Public Health, Università degli studi di Cagliari, Cagliari, Italy
| | - Giancarlo Coghe
- Centro regionale per la diagnosi e la cura della Sclerosi Multipla, ASL Cagliari, Cagliari, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | | | - Doriana Landi
- MS Center, Tor Vergata University of Rome, Rome, Italy
| | | | - Marco Vercellino
- Division of Neurology, Department of Neuroscience and Mental Health, City of Health and Science, University Hospital of Torino, Turin, Italy
| | - Paola Cavalla
- Division of Neurology, Department of Neuroscience and Mental Health, City of Health and Science, University Hospital of Torino, Turin, Italy
| | - Assunta Bianco
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca per la Sclerosi Multipla "Anna Paola Batocchi," Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Torri Clerici
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Eugenia Tomas
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Maria Teresa Ferrò
- Neuroimmunology, Neurological Unit, Cerebrovascular Department, Center for Multiple Sclerosis, ASST Crema, Crema, Italy
| | - Paola Grossi
- Neuroimmunology, Neurological Unit, Cerebrovascular Department, Center for Multiple Sclerosis, ASST Crema, Crema, Italy
| | - Agostino Nozzolillo
- Multiple Sclerosis Center, Neurology Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lucia Moiola
- Multiple Sclerosis Center, Neurology Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mauro Zaffaroni
- Centro Sclerosi Multipla, Ospedale di Gallarate-ASST della Valle Olona, Gallarate, Italy
| | - Marco Ronzoni
- U.O. Neurologia, ASST Rhodense, Garbagnate Milanese, Italy
| | - Federica Pinardi
- IRCCS Istituto delle scienze neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla Bologna, Bologna, Italy
| | - Giovanni Novi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Antonio Uccelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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50
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Officer L, Armon C, Barkhaus P, Beauchamp M, Benatar M, Bertorini T, Bowser R, Bromberg M, Brown A, Carbunar OM, Carter GT, Crayle J, Denson K, Feldman E, Fullam T, Heiman-Patterson T, Jackson C, Jhooty S, Levinson D, Li X, Linares A, Mallon E, Mascias Cadavid J, Mcdermott C, Mushannen T, Ostrow L, Patel R, Pattee G, Ratner D, Sun Y, Sladky J, Wicks P, Bedlack R. ALSUntangled #75: Portable neuromodulation stimulator therapy. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:648-652. [PMID: 38666601 DOI: 10.1080/21678421.2024.2346825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 07/25/2024]
Abstract
Spurred by patient interest, ALSUntangled herein examines the potential of the Portable Neuromodulation Stimulator (PoNS™) in treating amyotrophic lateral sclerosis (ALS). The PoNS™ device, FDA-approved for the treatment of gait deficits in adult patients with multiple sclerosis, utilizes translingual neurostimulation to stimulate trigeminal and facial nerves via the tongue, aiming to induce neuroplastic changes. While there are early, promising data for PoNS treatment to improve gait and balance in multiple sclerosis, stroke, and traumatic brain injury, no pre-clinical or clinical studies have been performed in ALS. Although reasonably safe, high costs and prescription requirements will limit PoNS accessibility. At this time, due to the lack of ALS-relevant data, we cannot endorse the use of PoNS as an ALS treatment.
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Affiliation(s)
- Laurel Officer
- Department of Neurology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Carmel Armon
- Department of Neurology, Shamir Medical Center, Tzrifin, Israel
| | - Paul Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Michael Benatar
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Tulio Bertorini
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert Bowser
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Mark Bromberg
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Andrew Brown
- Department of Neurology, University of Miami, Miami, FL, USA
| | | | - Gregory T Carter
- Department of Rehabilitation, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Jesse Crayle
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Keelie Denson
- Department of Neurology, Houston Methodist Hospital, Houston, TX, USA
| | - Eva Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Timothy Fullam
- Department of Neurology, Brooke Army Medical Center, San Antonio, TX, USA
| | | | - Carlayne Jackson
- Department of Neurology, UT Health San Antonio, San Antonio, Texas, USA
| | - Sartaj Jhooty
- Department of Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Xiaoyan Li
- Department of Neurology, Duke University, Durham, NC, USA
| | | | | | - Javier Mascias Cadavid
- ALS Unit, Neurology Department, Hospital La Paz Institute for Health Research, Madrid, Spain
| | | | | | - Lyle Ostrow
- Department of Neurology, Temple Health, Philadelphia, PA, USA
| | - Ronak Patel
- Department of Neurology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Gary Pattee
- Department of Neurology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dylan Ratner
- Undergraduate, Tulane University, New Orleans, LA, USA
| | - Yuyao Sun
- Department of Neurology, University of Kentucky, Lexington, KY, USA, and
| | - John Sladky
- Department of Neurology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Paul Wicks
- Independent Consultant, Lichfield, England, UK
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