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Vila-Bedmar S, Nourbakhsh B, Anzalone S, Waubant E. Clinical Reasoning: Left hemiparesis, ataxia, and optic neuritis in a child previously treated for pineoblastoma. Neurology 2016; 86:e161-e165. [PMID: 27163667 DOI: 10.1212/wnl.0000000000002562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sara Vila-Bedmar
- From the Department of Neurology (S.V.-B.), Hospital Universitario 12 de Octubre, Madrid, Spain; and Department of Neurology (B.N., S.A., E.W.), University of California San Francisco.
| | - Bardia Nourbakhsh
- From the Department of Neurology (S.V.-B.), Hospital Universitario 12 de Octubre, Madrid, Spain; and Department of Neurology (B.N., S.A., E.W.), University of California San Francisco
| | - Susan Anzalone
- From the Department of Neurology (S.V.-B.), Hospital Universitario 12 de Octubre, Madrid, Spain; and Department of Neurology (B.N., S.A., E.W.), University of California San Francisco
| | - Emmanuelle Waubant
- From the Department of Neurology (S.V.-B.), Hospital Universitario 12 de Octubre, Madrid, Spain; and Department of Neurology (B.N., S.A., E.W.), University of California San Francisco
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102
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Twilt M, Benseler SM. Central nervous system vasculitis in adults and children. HANDBOOK OF CLINICAL NEUROLOGY 2016; 133:283-300. [PMID: 27112683 DOI: 10.1016/b978-0-444-63432-0.00016-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary angiitis of the central nervous system (PACNS) is an inflammatory brain disease targeting the cerebral blood vessels, leading to a wide spectrum of signs and symptoms, including neurologic deficits, cognitive dysfunction, and psychiatric symptoms. The inflammation could be reversible if diagnosed and treated early. The diagnosis requires the careful consideration and rapid evaluation of systemic underlying conditions and disease mimics. The differential diagnosis is distinctly different for angiography-positive and -negative PACNS subtypes and differs depending on age, so there is childhood PACNS or adult PACNS. Distinct disease subtypes have been described, with characteristic disease course, neuroimaging findings, and histopathologic features. Novel and traditional biomarkers, including von Willebrand factor antigen and cytokine levels, can help diagnose, and define subtype and disease activity. Treatment of PACNS should be tailored to the disease subtypes and clinical symptoms. Beyond immunosuppression it should include medications to control symptoms in order to support and enhance the child's or adult's ability to actively participate in rehabilitation. The mortality of PACNS has decreased; studies determining the morbidity and its determinants are urgently needed.
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Affiliation(s)
- Marinka Twilt
- Division of Rheumatology, Department of Pediatrics, Aarhus University Hospital and Faculty of Medicine, University of Aarhus, Aarhus, Denmark; Division of Rheumatology, Department of Paediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susanne M Benseler
- Division of Rheumatology, Department of Paediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.
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103
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Scheepe JR, Wong YYM, van Pelt ED, Ketelslegers IA, Catsman-Berrevoets CE, van den Hoek J, Hintzen RQ, Neuteboom RF. Neurogenic lower urinary tract dysfunction in the early disease phase of paediatric multiple sclerosis. Mult Scler 2015; 22:1490-1494. [PMID: 26589894 DOI: 10.1177/1352458515618541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/01/2015] [Indexed: 11/17/2022]
Abstract
Neurogenic lower urinary tract dysfunction (LUTD) in multiple sclerosis (MS) is highly prevalent in adults, but has not previously been described in paediatric MS. A total of 24 consecutive children with newly diagnosed MS were prospectively assessed for bladder and bowel problems early after diagnosis. Five of 24 children (21%) showed LUTD during assessment. One of these patients did not report voiding complaints. This high prevalence of LUTD indicates that all recently diagnosed patients with paediatric MS should be evaluated early in their disease and treated for urinary problems in order to prevent potential damage to the upper urinary tract.
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Affiliation(s)
| | - Yu Yi M Wong
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - E Daniëlle van Pelt
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - Immy A Ketelslegers
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - Coriene E Catsman-Berrevoets
- Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands/Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | | | - Rogier Q Hintzen
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - Rinze F Neuteboom
- Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands/Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
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104
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Vitaliti G, Matin N, Tabatabaie O, Di Traglia M, Pavone P, Lubrano R, Falsaperla R. Natalizumab in multiple sclerosis: discontinuation, progressive multifocal leukoencephalopathy and possible use in children. Expert Rev Neurother 2015; 15:1321-41. [PMID: 26513633 DOI: 10.1586/14737175.2015.1102061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the early 1990s, attention was drawn to the migration of immune cells into the central nervous system via the blood-brain barrier. The literature showed that lymphocytes binding to the endothelium were successfully inhibited by an antibody against α4β1 integrin. These biological findings resulted in the development of a humanized antibody to α4 integrin - natalizumab (NTZ) - to treat multiple sclerosis (MS). Here, we provide a systematic review and meta-analysis on the efficacy and safety of natalizumab, trying to answer the question whether its use may be recommended both in adult and in pediatric age groups as standard MS treatment. Our results highlight the improvement of clinical and radiological findings in treated patients (p < 0.005), confirming NTZ efficacy. Nevertheless, if NTZ is shown to be efficient, further studies should be performed to evaluate its safety and to target the MS profile that could benefit from this treatment.
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Affiliation(s)
- Giovanna Vitaliti
- a General Paediatrics Operative Unit , Policlinico-Vittorio-Emanuele University Hospital, University of Catania , Catania , Italy
| | - Nassim Matin
- b Tehran University of Medical Sciences , Tehran , Iran
| | | | - Mario Di Traglia
- c Department of Statistics , La Sapienza University of Rome , Rome , Italy
| | - Piero Pavone
- a General Paediatrics Operative Unit , Policlinico-Vittorio-Emanuele University Hospital, University of Catania , Catania , Italy
| | - Riccardo Lubrano
- d Paediatric Department, Paediatric Nephrology Operative Unit , Sapienza University of Rome , Rome , Italy
| | - Raffaele Falsaperla
- a General Paediatrics Operative Unit , Policlinico-Vittorio-Emanuele University Hospital, University of Catania , Catania , Italy
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105
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Ghezzi A, Moiola L, Pozzilli C, Brescia-Morra V, Gallo P, Grimaldi LME, Filippi M, G GC. Natalizumab in the pediatric MS population: results of the Italian registry. BMC Neurol 2015; 15:174. [PMID: 26407848 PMCID: PMC4583752 DOI: 10.1186/s12883-015-0433-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background Natalizumab is a promising option for pediatric multiple sclerosis (MS) patients with active evolution and a poor response to Interferon-beta or Glatiramer Acetate. However, no data are available in large cohorts of patients and after a long-term follow up. Our study was planned to shed lights on this topic. Methods A registry was established in 2007 in Italy to collect MS cases treated with Natalizumab (NA) before 18 years of age. Results 101 patients were included (69 females), mean age of MS onset 12.9 ± 2.7 years, mean age at NA initiation 14.7 ± 2.4 years. Mean treatment duration was 34.2 ± 18.3 months. During NA treatment, a total of 15 relapses were recorded in 9 patients, annualized relapse rate was 2.3 ± 1.0 in the year prior to NA and decreased to 0.1 ± 0.3 (p < 0.001) at last NA infusion. Mean Expanded Disability Status Scale (EDSS) decreased from 2.6 ± 1.3 at initiation of NA to 1.8 ± 1.2 at the time of last visit (p < 0.001). At brain MRI, new T2 or Gd enhancing lesions were observed in 10/91 patients after 6 months, 6/87 after 12 months, 2/61 after 18 months, 2/68 after 24 months, 3/62 after 30 months, and 5/43 at longer follow up. At the time of last observation, 58 % of patients were free from clinical (relapses/increased EDSS) and/or MRI activity (new T2 or gadolinium-enhancing lesions). No relevant adverse events were recorded. Discussion NA was safe, well tolerated and very efficacious in the large majority of patients. Our data support the use of this medication in subjects with pediatric MS and an aggressive course. Conclusions A relevant reduction of relapse rate and EDSS was observed during NA treatment, compared to pre-treatment period. No evidence of disease activity (NEDA) occurred in 58 % of cases.
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Affiliation(s)
- Angelo Ghezzi
- Multiple Sclerosis Study Center, Hospital of Gallarate, Via Pastori 4, 21013, Gallarate, Italy.
| | - Lucia Moiola
- Department of Neurology, Hospital S. Raffaele, Milan, Italy.
| | - Carlo Pozzilli
- S. Andrea Multiple Sclerosis Center, University of Rome La Sapienza, Rome, Italy.
| | - Vincenzo Brescia-Morra
- MS Centre, Neurosciences, Reproductive and Odontostomatological Sciences Department, Federico II University of Naples, Naples, Italy.
| | - Paolo Gallo
- Department of Neurology, University of Padua, Padua, Italy.
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
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106
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Fragoso YD, Alves-Leon SV, Barreira AA, Callegaro D, Brito Ferreira ML, Finkelsztejn A, Gomes S, Magno Goncalves MV, Moraes Machado MI, Marques VD, Cunha Matta AP, Papais-Alvarenga RM, Apostolos Pereira SL, Tauil CB. Fingolimod Prescribed for the Treatment of Multiple Sclerosis in Patients Younger Than Age 18 Years. Pediatr Neurol 2015; 53:166-8. [PMID: 26026897 DOI: 10.1016/j.pediatrneurol.2015.03.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/27/2015] [Accepted: 03/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND There have been no clinical trials for approval of medications for treating multiple sclerosis in patients younger than age 18 years. All treatments are based on personal experience and data from open observational studies. Fingolimod is an oral drug for multiple sclerosis that has been shown to be efficient and safe in adults. The aim of our study is to describe patients with multiple sclerosis who started treatment with fingolimod before the age of 18 years. PARTICIPANTS AND METHODS Seventeen patients treated with fingolimod were identified in the Brazilian database of children and adolescents with multiple sclerosis. The average time of use of the drug was 8.6 months. RESULTS Fingolimod showed a good safety and efficacy profile in these patients, all of whom had very active multiple sclerosis. After starting treatment with fingolimod, only one patient had a relapse and a new lesion on magnetic resonance imaging. The patients' degree of disability did not progress. No major adverse events were reported in relation to the first dose of the drug, nor in the short- and medium-term treatment. No patient has been followed for longer than 18 months, thus limiting long-term conclusions. CONCLUSIONS Off-label use of fingolimod in patients younger than age 18 years may be a good therapeutic option for multiple sclerosis control.
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Affiliation(s)
- Yara Dadalti Fragoso
- Department of Neurology and MS Unit, Universidade Metropolitana de Santos, Santos, SP, Brazil.
| | - Soniza Vieira Alves-Leon
- Department of Neurology and MS Unit, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Department of Neurology and MS Unit, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Dagoberto Callegaro
- Department of Neurology and MS Unit, Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Alessandro Finkelsztejn
- Department of Neurology and MS Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Sidney Gomes
- Department of Neurology and MS Unit, Hospital Beneficencia Portuguesa and Hospital Paulistano, Sao Paulo, SP, Brazil
| | | | | | | | | | | | | | - Carlos Bernardo Tauil
- Department of Neurology and MS Unit, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
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107
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Fatal Acute Myeloid Leukemia With 11q23 MLL Gene Rearrangement Following Mitoxantrone Treatment in a Case of Childhood-onset Multiple Sclerosis. J Pediatr Hematol Oncol 2015; 37:413-4. [PMID: 25851557 DOI: 10.1097/mph.0000000000000336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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108
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Dang PT, Bui Q, D'Souza CS, Orian JM. Modelling MS: Chronic-Relapsing EAE in the NOD/Lt Mouse Strain. Curr Top Behav Neurosci 2015; 26:143-177. [PMID: 26126592 DOI: 10.1007/7854_2015_378] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Modelling complex disorders presents considerable challenges, and multiple sclerosis (MS) is no exception to this rule. The aetiology of MS is unknown, and its pathophysiology is poorly understood. Moreover, the last two decades have witnessed a dramatic revision of the long-held view of MS as an inflammatory demyelinating white matter disease. Instead, it is now regarded as a global central nervous system (CNS) disorder with a neurodegenerative component. Currently, there is no animal model recapitulating MS immunopathogenesis. Available models are based on autoimmune-mediated demyelination, denoted experimental autoimmune encephalomyelitis (EAE) or virally or chemically induced demyelination. Of these, the EAE model has been the most commonly used. It has been extensively improved since its first description and now exists as a number of variants, including genetically modified and humanized versions. Nonetheless, EAE is a distinct disease, and each variant models only certain facets of MS. Whilst the search for more refined MS models must continue, it is important to further explore where mechanisms underlying EAE provide proof-of-principle for those driving MS pathogenesis. EAE variants generated with the myelin component myelin oligodendrocyte glycoprotein (MOG) have emerged as the preferred ones, because in this particular variant disease is associated with both T- and B-cell effector mechanisms, together with demyelination. MOG-induced EAE in the non-obese diabetic (NOD) mouse strain exhibits a chronic-relapsing EAE clinical profile and high disease incidence. We describe the generation of this variant, its contribution to the understanding of MS immune and pathogenetic mechanisms and potential for evaluation of candidate therapies.
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Affiliation(s)
- Phuc T Dang
- Department of Biochemistry and La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Quyen Bui
- Department of Biochemistry and La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Claretta S D'Souza
- Department of Biochemistry and La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jacqueline M Orian
- Department of Biochemistry and La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, 3086, Australia.
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109
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Millichap JG, Millichap JJ. Cognitive Outcome of Childhood-Onset Multiple Sclerosis Patients. Pediatr Neurol Briefs 2014. [DOI: 10.15844/pedneurbriefs-28-11-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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