2201
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Course and characteristics of work disability 3 years before and after lumbar spine decompression surgery- a national population-based study. Sci Rep 2018; 8:11811. [PMID: 30087405 PMCID: PMC6081436 DOI: 10.1038/s41598-018-30211-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022] Open
Abstract
Despite decompression surgery being a widespread intervention for patients with dorsopathies (i.e. back pain) affecting the lumbar spine, the scientific knowledge on patterns and characteristics of work disability before and after the surgery is limited. Sickness absence (SA) and disability pension (DP) were examined three years before and after surgery in 8558 patients aged 25–60 years who underwent lumbar spine decompression surgery in Sweden. They were compared to individuals with diagnosed dorsopathies but no surgery and individuals from the general population as matched comparison groups. According to Group Based Trajectory models, in patients with decompression surgery, 39% had low levels of SA/DP during the entire study period and 15% started with low levels of SA/DP, which increased in the year before, and declined to almost zero in the second year after surgery. Three trajectory groups (12%, 17%, and 18%) started at different levels of SA/DP, which increased in the years before, and declined in the third year after surgery. The trajectory groups in the comparison groups showed lower levels of work disability. Sex, education, and the use of antidepressants and analgesics the year before surgery played an important role to explain the variance of trajectory groups in patients with surgery.
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2202
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[Cladribine tablets : Oral immunotherapy of relapsing-remitting multiple sclerosis with short yearly treatment periods]. DER NERVENARZT 2018. [PMID: 29523912 DOI: 10.1007/s00115-018-0498-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The selective modulation of lymphocyte numbers and function is an attractive concept in the treatment of relapsing-remitting multiple sclerosis (RMS). OBJECTIVE Cladribine tablets (Mavenclad®), an oral RMS medication with an innovative treatment concept, have been available since August 2017. This review article summarizes the currently available clinical study data on cladribine tablets and aspects of their use in clinical practice. RESULTS Cladribine tablets are administered during two treatment phases of 8-10 (two times 4-5) days with a 1-year interval. The drug selectively reduces the number of T and B lymphocytes, which are subsequently gradually reconstituted with divergent kinetics. A pronounced and sustained effect on the clinical and paraclinical MS disease activity is achieved with good tolerability and a favorable overall safety profile. After completing the two short treatment phases, a relevant proportion of the treated patients experience a prolonged treatment-free period with absence of relevant disease activity. Regular monitoring of lymphocyte counts and reliable contraception during the required time frames are the most important safety measures. There is no evidence of an increased risk of malignancies. CONCLUSION Cladribine tablets are an important addition to the therapeutic landscape in RMS. With patient-friendly short dosing periods and a favorable adverse event profile, cladribine tablets provide a sustained and strong reduction of MS disease activity. The primary target population for cladribine tablets is patients with relevant MS disease activity (highly active RMS) while on first-line treatment, e. g. with injectable disease-modifying drugs.
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2203
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Withiel TD, Wong D, Ponsford JL, Cadilhac DA, Stolwyk RJ. Feasibility and effectiveness of computerised cognitive training for memory dysfunction following stroke: A series of single case studies. Neuropsychol Rehabil 2018; 30:829-852. [PMID: 30058468 DOI: 10.1080/09602011.2018.1503083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Computerised cognitive training (CCT) approaches to memory rehabilitation represent an attractive alternative to traditional approaches; however, there is limited empirical evidence to support their use. An AB with follow up single case design was repeated across five participants to explore the feasibility and effectiveness of CCT on subjective memory in patients with stroke. Target behaviour was subjective everyday and prospective memory failures which were assessed weekly. Following baseline (three weeks), participants completed six weeks of LumosityTM training in their homes. Data were analysed visually and statistically. The frequency of prospective memory failures decreased during intervention for one participant, while the frequency of prospective and everyday memory failures decreased significantly during the follow up period for another participant. Yet, significantly more everyday and prospective memory failures were reported following training by one study participant. No significant change in subjective memory ratings was found for remaining participants. Regarding secondary outcomes, meaningful changes on objective measures of memory were not observed, despite considerable inter-individual variability. Three participants reported improvement in individualised memory goals, while two participants described a decline. Overall, LumosityTM training appears feasible; however, no consistent evidence to support effectiveness of this CCT on subjective or objective memory was found.
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Affiliation(s)
- Toni D Withiel
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.,Allied Health, Royal Melbourne Hospital, Melbourne, Australia
| | - Dana Wong
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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2204
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Cohen JA, Comi G, Arnold DL, Bar-Or A, Selmaj KW, Steinman L, Havrdová EK, Cree BA, Montalbán X, Hartung HP, Huang V, Frohna P, Skolnick BE, Kappos L. Efficacy and safety of ozanimod in multiple sclerosis: Dose-blinded extension of a randomized phase II study. Mult Scler 2018; 25:1255-1262. [PMID: 30043658 PMCID: PMC6681431 DOI: 10.1177/1352458518789884] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Ozanimod, an oral immunomodulator, selectively targets sphingosine
1-phosphate receptors 1 and 5. Objective: Evaluate efficacy, safety, and tolerability of ozanimod in relapsing multiple
sclerosis. Methods: In the RADIANCE Part A phase II study (NCT01628393), participants with
relapsing multiple sclerosis were randomized (1:1:1) to once-daily ozanimod
hydrochloride (0.5 or 1 mg) or placebo. After 24 weeks, participants could
enter a 2-year, dose-blinded extension. Ozanimod-treated participants
continued their assigned dose; placebo participants were re-randomized (1:1)
to ozanimod hydrochloride 0.5 or 1 mg (equivalent to ozanimod 0.46 and
0.92 mg). Results: A total of 223 (89.6%) of the 249 participants completed the blinded
extension. At 2 years of the extension, the percentage of participants who
were gadolinium-enhancing lesion-free ranged from 86.5% to 94.6%. Unadjusted
annualized relapse rate during the blinded extension (week 24—end of
treatment) was 0.32 for ozanimod hydrochloride 0.5 mg → ozanimod
hydrochloride 0.5 mg, 0.18 for ozanimod hydrochloride 1 mg → ozanimod
hydrochloride 1 mg, 0.30 for placebo → ozanimod hydrochloride 0.5 mg, and
0.18 for placebo → ozanimod hydrochloride 1 mg. No second-degree or higher
atrioventricular block or serious opportunistic infection was reported. Conclusion: Ozanimod demonstrated sustained efficacy in participants continuing treatment
up to 2 years and reached similar efficacy in participants who switched from
placebo; no unexpected safety signals emerged.
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Affiliation(s)
- Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Douglas L Arnold
- NeuroRx Research and Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Lawrence Steinman
- Department of Neurology & Neurological Sciences, Beckman Center for Molecular Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Eva K Havrdová
- Department of Neurology and Center for Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Bruce Ac Cree
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Xavier Montalbán
- Division of Neurology and St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/Cemcat, Vall d'Hebron University Hospital and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Vivian Huang
- Biostatistics, Celgene Corporation, San Diego, CA, USA
| | - Paul Frohna
- Clinical Development, Celgene Corporation, San Diego, CA, USA
| | | | - Ludwig Kappos
- Neurologic Clinic and Polyclinic, University Hospital of Basel and University of Basel, Basel, Switzerland
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2205
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Morris G, Maes M, Murdjeva M, Puri BK. Do Human Endogenous Retroviruses Contribute to Multiple Sclerosis, and if So, How? Mol Neurobiol 2018; 56:2590-2605. [PMID: 30047100 PMCID: PMC6459794 DOI: 10.1007/s12035-018-1255-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/17/2018] [Indexed: 12/24/2022]
Abstract
The gammaretroviral human endogenous retrovirus (HERV) families MRSV/HERV-W and HERV-H (including the closely related HERV-Fc1) are associated with an increased risk of multiple sclerosis (MS). Complete HERV sequences betray their endogenous retroviral origin, with open reading frames in gag, pro, pol and env being flanked by two long terminal repeats containing promoter and enhancer sequences with the capacity to regulate HERV transactivation and the activity of host genes in spite of endogenous epigenetic repression mechanisms. HERV virions, RNA, cDNA, Gag and Env, and antibodies to HERV transcriptional products, have variously been found in the blood and/or brain and/or cerebrospinal fluid of MS patients, with the HERV expression level being associated with disease status. Furthermore, some HERV-associated single nucleotide polymorphisms (SNPs), such as rs662139 T/C in a 3-kb region of Xq22.3 containing a HERV-W env locus, and rs391745, upstream of the HERV-Fc1 locus on the X chromosome, are associated with MS susceptibility, while a negative association has been reported with SNPs in the tripartite motif-containing (TRIM) protein-encoding genes TRIM5 and TRIM22. Factors affecting HERV transcription include immune activation and inflammation, since HERV promoter regions possess binding sites for related transcription factors; oxidative stress, with oxidation of guanine to 8-oxoguanine and conversion of cytosine to 5-hydroxymethylcytosine preventing binding of methyl groups transferred by DNA methyltransferases; oxidative stress also inhibits the activity of deacetylases, thereby favouring the acetylation of histone lysine residues favouring gene expression; interferon beta; natalizumab treatment; impaired epigenetic regulation; and the sex of patients.
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Affiliation(s)
- Gerwyn Morris
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Maes
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Marianna Murdjeva
- Department of Microbiology and Immunology, Medical University, Plovdiv, Bulgaria
| | - Basant K Puri
- Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK.
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2206
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Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to Rituximab. Case Rep Neurol Med 2018; 2018:5190794. [PMID: 30112230 PMCID: PMC6077610 DOI: 10.1155/2018/5190794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023] Open
Abstract
During treatment with fingolimod, B cells are redistributed from blood to secondary lymphoid organs, where they are protected from the effect of anti-CD20 and other cell-depleting therapies. We describe a multiple sclerosis patient who had almost complete depletion of B cells in blood during and shortly after treatment with fingolimod. He developed severe disease activity resembling immune reconstitution syndrome after switching from fingolimod to rituximab, with first dose being six weeks after fingolimod cessation. Following recommendations from the Swedish MS Association, rituximab treatment was started as one single dose of 1000 mg. In patients treated with fingolimod, pathogenic B cells may still be sequestered in secondary lymph nodes if this dose is given early. To deplete such B cells as they egress from the lymph nodes, we propose that a second dose of rituximab a few weeks after the first dose should be considered.
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2207
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Pandit L, Mustafa S, Nakashima I, Takahashi T, Kaneko K. MOG-IgG-associated disease has a stereotypical clinical course, asymptomatic visual impairment and good treatment response. Mult Scler J Exp Transl Clin 2018; 4:2055217318787829. [PMID: 30038790 PMCID: PMC6050870 DOI: 10.1177/2055217318787829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives We investigated the clinical characteristics and treatment response in myelin
oligodendrocyte glycoprotein antibody (MOG-IgG)-associated disease and
looked for evidence of subclinical disease. Methods We prospectively evaluated the frequency and pattern of relapse, tested
afferent visual function and monitored treatment response in 42 south Asian
patients from a single centre. Results Eighteen patients (42.9%) had monophasic and 24 (57.1%) a relapsing course.
Disease duration was longer (P<0.02) in those with a
relapsing course. Median time to the second attack was prolonged
(P<0.04) in patients with recurrent transverse
myelitis when compared with neuromyelitis optica spectrum disorder and
recurrent optic neuritis. Thirteen out of 17 patients (76.5%) initially
presenting with optic neuritis developed recurrent optic neuritis later.
After the first attack of transverse myelitis, 17 out of 22 (77.3%) had
disease confined to the spinal cord. Optical coherence tomography detected
peripapillary retinal nerve fibre layer thickness
(P<0.05) and macular ganglion cell complex volume
(P<0.005) abnormalities in seven out of 10 (70.0%)
patients without clinical optic neuritis. Immunosuppressants induced
remission in 17 out of 22 (77.3%) patients during a median follow-up of 48
months and the median Expanded Disability Status Score was 1 (range
1–10). Conclusion Our study highlighted the tendency for stereotypical attacks in
MOG-IgG-associated disease, heterogeneity in clinical course among subtypes,
subclinical visual impairment and the need for early and sustained
immunosuppressive therapy.
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Affiliation(s)
- Lekha Pandit
- Department of Neurology, Nitte University, India
| | | | - Ichiro Nakashima
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | - Toshyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | - Kimhiko Kaneko
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
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2208
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Supratak A, Datta G, Gafson AR, Nicholas R, Guo Y, Matthews PM. Remote Monitoring in the Home Validates Clinical Gait Measures for Multiple Sclerosis. Front Neurol 2018; 9:561. [PMID: 30057565 PMCID: PMC6053510 DOI: 10.3389/fneur.2018.00561] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/22/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The timed 25-foot walk (T25FW) is widely used as a clinic performance measure, but has yet to be directly validated against gait speed in the home environment. Objectives: To develop an accurate method for remote assessment of walking speed and to test how predictive the clinic T25FW is for real-life walking. Methods: An AX3-Axivity tri-axial accelerometer was positioned on 32 MS patients (Expanded Disability Status Scale [EDSS] 0-6) in the clinic, who subsequently wore it at home for up to 7 days. Gait speed was calculated from these data using both a model developed with healthy volunteers and individually personalized models generated from a machine learning algorithm. Results: The healthy volunteer model predicted gait speed poorly for more disabled people with MS. However, the accuracy of individually personalized models was high regardless of disability (R-value = 0.98, p-value = 1.85 × 10-22). With the latter, we confirmed that the clinic T25FW is strongly predictive of the maximum sustained gait speed in the home environment (R-value = 0.89, p-value = 4.34 × 10-8). Conclusion: Remote gait monitoring with individually personalized models is accurate for patients with MS. Using these models, we have directly validated the clinical meaningfulness (i.e., predictiveness) of the clinic T25FW for the first time.
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Affiliation(s)
- Akara Supratak
- Data Science Institute, Imperial College LondonLondon, United Kingdom
| | - Gourab Datta
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Arie R. Gafson
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Richard Nicholas
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
- Charing Cross Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | - Yike Guo
- Data Science Institute, Imperial College LondonLondon, United Kingdom
| | - Paul M. Matthews
- Data Science Institute, Imperial College LondonLondon, United Kingdom
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
- Charing Cross Hospital, Imperial College Healthcare Trust, London, United Kingdom
- UK Dementia Research Institute, Imperial College London, London, United Kingdom
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2209
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Trend S, Jones AP, Cha L, Byrne SN, Geldenhuys S, Fabis-Pedrini MJ, Carroll WM, Cole JM, Booth DR, Lucas RM, Kermode AG, French MA, Hart PH. Higher Serum Immunoglobulin G3 Levels May Predict the Development of Multiple Sclerosis in Individuals With Clinically Isolated Syndrome. Front Immunol 2018; 9:1590. [PMID: 30057580 PMCID: PMC6053531 DOI: 10.3389/fimmu.2018.01590] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/27/2018] [Indexed: 11/13/2022] Open
Abstract
Clinically isolated syndrome (CIS) is a first episode of neurological symptoms that may precede a diagnosis of multiple sclerosis (MS). Therefore, studying individuals with CIS may lead to breakthroughs in understanding the development and pathogenesis of MS. In this study, serum levels of immunoglobulin (Ig)G, IgA, IgM, and IgG1–4 were measured in 20 people with CIS and compared with those in 10 healthy controls (HC) and 8 people with MS. Serum Ig levels in individuals with CIS were compared with (a) the time to their conversion from CIS to MS, (b) serum levels of antibodies to Epstein–Barr virus, (c) frequencies of T regulatory (Treg), T follicular regulatory (Tfr), and B cell subsets, and (d) Treg/Tfr expression of Helios. Serum IgG, IgM, and IgG2 levels were significantly lower in people with CIS than HC, and IgG, IgM, and IgG1 levels were significantly lower in people with CIS than MS. After adjusting for age, sex, and serum 25(OH) vitamin D3 [25(OH)D] levels, CIS was associated with lower serum levels of IgG and IgG2 compared with HC (p = 0.001 and p < 0.001, respectively). People with MS had lower IgG2 levels (p < 0.001) and IgG2 proportions (%IgG; p = 0.007) compared with HC. After adjusting for age, sex, and 25(OH)D, these outcomes remained, in addition to lower serum IgA levels (p = 0.01) and increased IgG3 levels (p = 0.053) in people with MS compared with HC. Furthermore, serum from people with MS had increased proportions of IgG1 and IgG3 (p = 0.03 and p = 0.02, respectively), decreased proportions of IgG2 (p = 0.007), and greater ratios of “upstream” to “downstream” IgG subclasses (p = 0.001) compared with HC. Serum IgG3 proportions (%IgG) from people with CIS correlated with the frequency of plasmablasts in peripheral blood (p = 0.02). Expression of Helios by Treg and Tfr cell subsets from individuals with CIS correlated with levels of serum IgG2 and IgG4. IgG3 levels and proportions of IgG3 (%IgG) in serum at CIS diagnosis were inversely correlated with the time until conversion to MS (p = 0.018 and p < 0.001, respectively), suggesting they may be useful prognostic markers of individuals with CIS who rapidly convert to MS.
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Affiliation(s)
- Stephanie Trend
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Anderson P Jones
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Lilian Cha
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Scott N Byrne
- Sydney Medical School, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Sian Geldenhuys
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, Australia
| | - Judith M Cole
- St John of God Dermatology Clinic, St John of God Hospital, Perth, WA, Australia
| | - David R Booth
- Sydney Medical School, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology & Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, Australia.,Institute for Immunology and Infectious Disease, Murdoch University, Perth, WA, Australia
| | - Martyn A French
- UWA Medical School and School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Prue H Hart
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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2210
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Vollmer B, Ontaneda D, Bandyopadhyay A, Cohn S, Nair K, Sillau S, Bermel RA, Corboy JR, Fox RJ, Vollmer T, Cohen JA, Alvarez E, Hersh CM. Discontinuation and comparative effectiveness of dimethyl fumarate and fingolimod in 2 centers. Neurol Clin Pract 2018; 8:292-301. [PMID: 30140580 PMCID: PMC6105060 DOI: 10.1212/cpj.0000000000000487] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Dimethyl fumarate (DMF) and fingolimod (FTY) are approved oral disease-modifying therapies for relapsing multiple sclerosis (MS). Observational studies are valuable when randomized clinical trials cannot be done due to ethical or practical reasons. Two-site studies allow investigators to further ascertain external validity of previously examined treatment effect differences. Limited head-to-head 2-site studies exist comparing DMF and FTY. Methods Patients prescribed DMF (n = 737) and FTY (n = 535) from 2 academic multiple sclerosis (MS) centers (Cleveland Clinic and University of Colorado) were identified. Discontinuation and disease activity endpoints were assessed using propensity score (PS) weighting. Covariates used in the PS model included demographics and clinical and MRI characteristics. Results PS weighting demonstrated excellent covariate balance. Discontinuation was more common in DMF (44.2%) compared to FTY (34.8%) over 24 months (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.21–1.99, p < 0.001). The leading cause for discontinuation was intolerability for both DMF (56.1% of DMF discontinuations) and FTY (46.2% of FTY discontinuations) (OR 1.65, 95% CI 1.21–2.25, p = 0.002). The proportion of patients with clinical relapses was low for both medications (DMF, 15.1%; FTY, 13.1%). There was no difference in the proportion of patients with relapses (OR 1.27, 95% CI 0.90–1.80, p = 0.174), gadolinium-enhancing lesions (OR 1.42, 95% CI 0.92–2.20, p = 0.114), or new T2 lesions on brain MRI (OR 1.13, 95% CI 0.83–1.55, p = 0.433). Conclusions This combined analysis suggests DMF and FTY have similar effectiveness in a large, 2-site clinical population over 24 months. Discontinuation of both DMTs was common and occurred more frequently with DMF, largely driven by intolerability.
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Affiliation(s)
- Brandi Vollmer
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Daniel Ontaneda
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Anasua Bandyopadhyay
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Sam Cohn
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Kavita Nair
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Stefan Sillau
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Robert A Bermel
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - John R Corboy
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Robert J Fox
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Timothy Vollmer
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Jeffrey A Cohen
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Enrique Alvarez
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
| | - Carrie M Hersh
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus (BV, KN, SS, JRC, TV, EA), University of Colorado, Denver; Mellen Center for Multiple Sclerosis Treatment and Research (DO, RAB, RJF, JAC), Cleveland Clinic, OH; Emory University (AB), Atlanta, GA; Department of Neurology (SC), Cleveland Clinic, OH; and Lou Ruvo Center for Brain Health (CMH), Cleveland Clinic, Las Vegas, NV
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2211
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Frau J, Sormani MP, Signori A, Realmuto S, Baroncini D, Annovazzi P, Signoriello E, Maniscalco GT, La Gioia S, Cordioli C, Frigeni B, Rasia S, Fenu G, Grasso R, Sartori A, Lanzillo R, Stromillo ML, Rossi S, Forci B, Cocco E. Clinical activity after fingolimod cessation: disease reactivation or rebound? Eur J Neurol 2018; 25:1270-1275. [DOI: 10.1111/ene.13694] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J. Frau
- Department of Medical Sciences and Public Health University of Cagliari CagliariItaly
| | - M. P. Sormani
- Department of Health Sciences Section of Biostatistics University of Genova GenovaItaly
| | - A. Signori
- Department of Health Sciences Section of Biostatistics University of Genova GenovaItaly
| | - S. Realmuto
- Department of Experimental Biomedicine and Clinical Neurosciences University of Palermo PalermoItaly
| | - D. Baroncini
- Multiple Sclerosis Study Centre AO s. Antonio Abate GallarateItaly
| | - P. Annovazzi
- Multiple Sclerosis Study Centre AO s. Antonio Abate GallarateItaly
| | - E. Signoriello
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences Second University of Naples NaplesItaly
| | - G. T. Maniscalco
- Neurological Clinic and Multiple Sclerosis Centre of ‘AORN A.Cardarelli’ NaplesItaly
| | - S. La Gioia
- USC Neurologia ASST Papa Giovanni XXIII BergamoItaly
| | - C. Cordioli
- Multiple Sclerosis Center Spedali Civili of Brescia Presidio di Montichiari BresciaItaly
| | - B. Frigeni
- USC Neurologia ASST Papa Giovanni XXIII BergamoItaly
| | - S. Rasia
- Multiple Sclerosis Center Spedali Civili of Brescia Presidio di Montichiari BresciaItaly
| | - G. Fenu
- Department of Medical Sciences and Public Health University of Cagliari CagliariItaly
| | - R. Grasso
- Neurologia Universitaria OORR FoggiaItaly
| | - A. Sartori
- Clinica Neurologica Azienda Ospedaliero‐Universitaria Ospedali Riuniti di Trieste TriesteItaly
| | - R. Lanzillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology Multiple Sclerosis Centre Federico II University NaplesItaly
| | - M. L. Stromillo
- Department of Medicine, Surgery and Neuroscience University of Siena SienaItaly
| | - S. Rossi
- Neuroimmunology and Neuromuscular Diseases Unit IRCCS Fondazione Istituto Neurologico Carlo Besta MilanoItaly
| | - B. Forci
- Dipartimento di Neuroscienze Azienda Ospedaliero‐Universitaria Careggi Area del farmaco e Salute del bambino (NEUROFARBA) Florence Italy
| | - E. Cocco
- Department of Medical Sciences and Public Health University of Cagliari CagliariItaly
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2212
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Sola-Valls N, Blanco Y, Sepúlveda M, Llufriu S, Martínez-Lapiscina EH, Zubizarreta I, Pulido-Valdeolivas I, Montejo C, Villoslada P, Saiz A. Combined walking outcome measures identify clinically meaningful response to prolonged-release fampridine. Ther Adv Neurol Disord 2018; 11:1756286418780007. [PMID: 29977342 PMCID: PMC6024337 DOI: 10.1177/1756286418780007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/15/2018] [Indexed: 11/17/2022] Open
Abstract
Background Gait impairment is common in multiple sclerosis (MS) and negatively impacts patients' health-related quality of life (HRQoL). Prolonged-release fampridine (PR-fam) improves walking speed, but it is unclear which walking measures are the most suitable for identifying treatment response. Our aim was to assess the effect of PR-fam and the outcome measures that best identify short- and long-term clinically meaningful response. Methods We conducted a prospective study in 32 MS patients treated with PR-fam for a year. The assessments at 2 weeks, 3, 6 and 12 months included: timed 25-foot walk (T25FW), 6-minute walk test (6MWT), MS Walking Scale-12 (MSWS-12), a five-level version of the EuroQoL-5 dimensions, and accelerometry. PR-fam response was defined as an improvement in T25FW ⩾20%. Results Twenty-five (78%) patients were considered responders after 2 weeks of PR-fam and improved significantly in all measures. Responders to T25FW and MSWS-12 (n = 19) showed a significant improvement in HRQoL and accelerometer data compared with responders only to T25FW (n = 6). At 1 year, 15/20 (75%) patients remained responders, but only those with permanent response to T25FW and MSWS-12 (n = 8; 53%) showed a significant improvement in 6MWT and HRQoL. Conclusion The combination of T25FW and MSWS-12 identify better those patients with a clinically significant benefit of PR-fam.
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Affiliation(s)
- Núria Sola-Valls
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Yolanda Blanco
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Sepúlveda
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Llufriu
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena H Martínez-Lapiscina
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irati Zubizarreta
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Montejo
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Villoslada
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Albert Saiz
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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2213
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Hyncicova E, Kalina A, Vyhnalek M, Nikolai T, Martinkovic L, Lisy J, Hort J, Meluzinova E, Laczó J. Health-related quality of life, neuropsychiatric symptoms and structural brain changes in clinically isolated syndrome. PLoS One 2018; 13:e0200254. [PMID: 29979757 PMCID: PMC6034869 DOI: 10.1371/journal.pone.0200254] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 06/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Neuropsychiatric symptoms and reduced health-related quality of life (HRQoL) are frequent in multiple sclerosis, where are associated with structural brain changes, but have been less studied in clinically isolated syndrome (CIS). Objective To characterize HRQoL, neuropsychiatric symptoms (depressive symptoms, anxiety, apathy and fatigue), their interrelations and associations with structural brain changes in CIS. Methods Patients with CIS (n = 67) and demographically matched healthy controls (n = 46) underwent neurological and psychological examinations including assessment of HRQoL, neuropsychiatric symptoms and cognitive functioning, and MRI brain scan with global, regional and lesion load volume measurement. Results The CIS group had more, mostly mild, depressive symptoms and anxiety, and lower HRQoL physical and social subscores (p≤0.037). Neuropsychiatric symptoms were associated with most HRQoL subscores (β≤-0.34, p≤0.005). Cognitive functioning unlike clinical disability was associated with depressive symptoms and lower HRQoL emotional subscores (β≤-0.29, p≤0.019). Depressive symptoms and apathy were associated with right temporal, left insular and right occipital lesion load (ß≥0.29, p≤0.032). Anxiety was associated with lower white matter volume (ß = -0.25, p = 0.045). Conclusion Mild depressive symptoms and anxiety with decreased HRQoL are present in patients with CIS. Neuropsychiatric symptoms contributing to decreased HRQoL are the result of structural brain changes and require complex therapeutic approach in patients with CIS.
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Affiliation(s)
- Eva Hyncicova
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Adam Kalina
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Tomas Nikolai
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Lukas Martinkovic
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jiri Lisy
- Department of Radiology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jakub Hort
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Eva Meluzinova
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jan Laczó
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
- * E-mail:
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2214
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Motl RW. Promotion of physical activity and exercise in multiple sclerosis: Importance of behavioral science and theory. Mult Scler J Exp Transl Clin 2018; 4:2055217318786745. [PMID: 30090642 PMCID: PMC6077908 DOI: 10.1177/2055217318786745] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/07/2018] [Accepted: 05/30/2018] [Indexed: 12/29/2022] Open
Abstract
There is an obvious disconnect between evidence of benefits and rates of participation in exercise and physical activity among people living with multiple sclerosis (MS). We propose that the problem with exercise behavior in MS (i.e. lack of broad or increasing participation by people with MS despite evidence of meaningful benefits) might be ameliorated through the inclusion of behavior change theory in the design of exercise programs and promotion efforts, as has been undertaken in other populations such as breast cancer survivors. This paper reviews Social Cognitive Theory as an example approach for informing interventions for increasing exercise and physical activity behavior outside of MS and provides an overview of current knowledge regarding the application of this theory for physical activity in MS. We then outline future research necessary for informing trials that design, implement, and test theory-based interventions for physical activity promotion in MS. If theories of behavior change are adopted for informing exercise and physical activity research in MS, we can take a major step forward in addressing the problem of exercise and physical activity participation that has plagued the field for more than 25 years.
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Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, 336 SHPB, 1720 2nd Ave. S., Birmingham, AL 35294, USA.
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2215
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Willingham TB, Melbourn J, Moldavskiy M, McCully KK, Backus D. Case Report: Effect of Antigravity Treadmill Training on Muscle Oxidative Capacity, Muscle Endurance, and Walking Function in a Person with Multiple Sclerosis. Int J MS Care 2018; 20:186-190. [PMID: 30150903 DOI: 10.7224/1537-2073.2017-035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Exercise training can improve skeletal muscle metabolism in persons with multiple sclerosis (MS). However, quantification of exercise-mediated improvements in muscle metabolism has been limited, particularly in people with high levels of disability. We evaluated the effect of 9 weeks of antigravity treadmill training on muscle oxidative capacity and muscle endurance and assessed the relationship to walking function in a person with MS. Methods One person with MS (Expanded Disability Status Scale score, 6.5) performed treadmill training for 24 minutes approximately twice weekly for 9 weeks (16 sessions) using an antigravity treadmill system. Before and after the intervention phase, we measured muscle oxidative capacity in the medial gastrocnemius using near-infrared spectroscopy after 15 to 20 seconds of electrical stimulation; muscle endurance in the medial gastrocnemius using accelerometer-based mechanomyography during 9 minutes of twitch electrical stimulation in three stages (3 minutes per stage) of increasing frequency (2, 4, and 6 Hz); muscle strength (plantarflexion) using a maximal voluntary contraction; and walking function using the Timed 25-Foot Walk test and the 2-Minute Walk Test. Results Muscle oxidative capacity increased from 0.73 min-1 to 1.08 min-1 (48%). Muscle endurance increased from 75.9% to 84.0% at 2 Hz, from 67.8% to 76.2% at 4 Hz, and from 13.5% to 44.7% at 6 Hz. Maximal voluntary contraction decreased by 0.68 kg (15%), Timed 25-Foot Walk test speed decreased by 0.19 ft/s (20%), and 2-Minute Walk Test distance increased by 65 m (212%). Conclusions Muscle oxidative capacity and muscle endurance, as well as walking function, improved in a person with MS after training on an antigravity treadmill.
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2216
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Human IgM antibody rHIgM22 promotes phagocytic clearance of myelin debris by microglia. Sci Rep 2018; 8:9392. [PMID: 29925848 PMCID: PMC6010437 DOI: 10.1038/s41598-018-27559-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/01/2018] [Indexed: 12/12/2022] Open
Abstract
In multiple sclerosis (MS), demyelinated CNS lesions fail to sufficiently remyelinate, despite the presence of oligodendrocyte precursor cells (OPCs) capable of differentiating into mature oligodendrocytes. MS lesions contain damaged myelin debris that can inhibit OPC maturation and hinder repair. rHIgM22 is an experimental human recombinant IgM antibody that promotes remyelination in animal models and is being examined in patients with MS. rHIgM22 binds to CNS myelin and partially rescues OPC process outgrowth on myelin. Since rHIgM22 does not affect OPC process outgrowth in vitro on permissive substrate, we examined the possibility that it acts by enhancing phagocytic clearance of myelin debris by microglia. In this study, we tested if rHIgM22 binding could tag myelin for microglial phagocytosis. A mouse microglial cell line and primary rat microglia were treated with myelin and rHIgM22 and assayed for myelin phagocytosis. We found that: 1) rHIgM22 stimulates myelin phagocytosis in a dose-dependent manner; 2) rHIgM22-mediated myelin phagocytosis requires actin polymerization; and 3) rHIgM22-stimulation of myelin phagocytosis requires activity of rHIgM22 Fc domain and activation of Complement Receptor 3. Since myelin inhibits OPC differentiation, stimulation of phagocytic clearance of damaged myelin may be an important means by which rHIgM22 promotes remyelination.
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2217
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Corfield F, Langdon D. A Systematic Review and Meta-Analysis of the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS). Neurol Ther 2018; 7:287-306. [PMID: 29923070 PMCID: PMC6283796 DOI: 10.1007/s40120-018-0102-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract Multiple sclerosis (MS) is a neurological disease of the central nervous system which can lead to a range of severe physical disabilities. A large proportion of those affected will experience cognitive impairment, which is associated with a worse prognosis. Effective assessment of cognition in MS has been problematic due to a lack of suitable scales. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed in 2010 as part of an international endeavour to facilitate cognitive assessment. Aim The aim of this systematic review and meta-analysis was to synthesise the available literature published as part of the BICAMS international validation protocol. Methods A literature search conducted using PubMed, PsycINFO and Google Scholar identified 16 studies for inclusion in the systematic review, 14 of which could be included in a meta-analysis. Results BICAMS has been widely validated across 11 languages and 14 individual cultures and locations. The meta-analysis demonstrated that BICAMS identified significantly reduced cognitive functioning in adults with MS compared to healthy controls. This was true for all three cognitive domains assessed by BICAMS: information processing speed (g = 0.943, 95% CI 0.839, 1.046, g < 0.001), immediate verbal recall memory (g = 0.688, 95% CI 0.554, 0.822, p < 0.001) and immediate visual recall memory (g = 0.635, 95% CI 0.534, 0.736, p < 0.001). Conclusion BICAMS has been widely applied across cultures and languages to assess cognition in MS. BICAMS offers a feasible, cost-effective means of assessing cognition in MS worldwide. Further validation studies are underway to support this project.
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Affiliation(s)
- Freya Corfield
- Psychology Department, Royal Holloway, University of London, Egham, Surrey, UK
| | - Dawn Langdon
- Psychology Department, Royal Holloway, University of London, Egham, Surrey, UK.
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2218
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Alhazzani AA, Alshahrani A, Alqahtani M, Alamri R, Alqahtani R, Alqahtani M, Alahmarii M. Insomnia among non-depressed multiple sclerosis patients: a cross-sectional study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:17. [PMID: 29962828 PMCID: PMC6002438 DOI: 10.1186/s41983-018-0016-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/17/2017] [Indexed: 01/21/2023] Open
Abstract
Background Insomnia is a common problem that affects approximately 50% of patients with multiple sclerosis (MS), who suffer from sleep disturbances. In general, persons with insomnia are at a higher risk of developing depression. This study was conducted to assess insomnia among non-depressed MS patients in Saudi Arabia. Methods Based on the Patient Health Questionnaire-9 (PHQ-9), those who scored 4 or less for depression out of 598 MS patients were selected (n = 112). A cross-sectional study was conducted to interview 112 non-depressed MS patients in order to assess insomnia among them. A data collection sheet has been designed by the researchers. It comprised socio-demographic variables (e.g., gender, age, area of residence, and marital status) and clinical variables (disease duration, age at disease onset, previous diagnosis of depression, and used antidepressant drugs). Insomnia was assessed by the Insomnia Severity Index (ISI), while severity of illness was assessed using the Patient Determined Disease Steps (PDDS). Results A total of 72 patients (64.3%) were females, and 62 (55.4%) were married. Their mean age was 32.6 years (SD = 8.9), ranging from 15 to 56 years. As for educational level, 64 (57.1%) had a Bachelor degree. The mean age at disease onset was 26 years (SD = 8.9). The mean duration of illness was 1.9 years. Symptoms of insomnia were present among 14 patients (12.5%). No statistical significance was found between the mean PDSS of insomnia and non-insomnia patients. Significant differences were present between insomnia and non-insomnia patients as regards their education level (P = 0.005) and use of antidepressant drugs (P = 0.008). Conclusions Prevalence of insomnia among non-depressed MS patients is low. Insomnia is associated with educational and use of antidepressants. Further research is needed to assess severity of different types of insomnia among depressed and non-depressed MS patients.
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Affiliation(s)
- A A Alhazzani
- 1Neurology Section, Department of Medicine, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,4College of Medicine, King Khalid University, PO Box 4557, Abha, 61412 Saudi Arabia.,5Neurology Section, Department of Medicine, King Khalid University, P.O. Box 641, Abha, Saudi Arabia
| | - A Alshahrani
- 2Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M Alqahtani
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - R Alamri
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - R Alqahtani
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - M Alqahtani
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - M Alahmarii
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
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2219
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Mallucci G, Annovazzi P, Miante S, Torri-Clerici V, Matta M, La Gioia S, Cavarretta R, Mantero V, Costantini G, D'Ambrosio V, Zaffaroni M, Ghezzi A, Perini P, Rossi S, Bertolotto A, Rottoli MR, Rovaris M, Balgera R, Cavalla P, Montomoli C, Bergamaschi R. Two-year real-life efficacy, tolerability and safety of dimethyl fumarate in an Italian multicentre study. J Neurol 2018; 265:1850-1859. [PMID: 29948245 DOI: 10.1007/s00415-018-8916-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dimethyl-fumarate (DMF) demonstrated efficacy and safety in relapsing-remitting multiple sclerosis (MS) in randomized clinical trials. OBJECTIVES To track and evaluate post-market DMF profile in real-world setting. MATERIALS AND METHODS Patients receiving DMF referred to Italian MS centres were enrolled and prospectively followed, collecting demographic clinical and radiological data. RESULTS Among the 735 included patients, 45.4% were naïve to disease-modifying therapies, 17.8% switched to DMF because of tolerance, 27.4% switched to DMF because of lack of efficacy, and 9.4% switched to DMF because of safety concerns. Median DMF exposure was 17 months (0-33). DMF reduced the annual relapse rate (ARR) by 63.2%. At 12 and 24 months, 85 and 76% of patients were relapse-free. NEDA-3 status after 12 months of DMF treatment was maintained by 47.5% of patients. 89 and 70% of patients at 12 and 24 months regularly continued DMF. Most frequent adverse events (AEs) were flushing (37.2%) and gastro-enteric AEs (31.1%). CONCLUSION Our post-market study corroborated that DMF is a safe and effective drug. Additionally, the study suggested that naïve patients strongly benefit from DMF and that DMF improved ARR also in patients who were horizontally switched from injectable therapies due to tolerability and efficacy issues.
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Affiliation(s)
- Giulia Mallucci
- Inter-department Multiple Sclerosis Research Centre, IRCCS Mondino Mondino, Pavia, Italy.
| | - P Annovazzi
- Multiple Sclerosis Study Centre, ASST Valle Olona, Gallarate, VA, Italy
| | - S Miante
- Department of Neurosciences, The Multiple Sclerosis Centre, University Hospital of Padova, Padua, Italy
| | - V Torri-Clerici
- Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C, Besta IRCCS Foundation, Milan, Italy
| | - M Matta
- Regional Multiple Sclerosis Centre, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - S La Gioia
- SS Malattie Autoimmuni USC Neurologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - R Cavarretta
- Multiple Sclerosis Center, IRRCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - V Mantero
- Neurological Department, A. Manzoni Hospital, Lecco, Italy
| | - G Costantini
- Department of Neuroscience, University of Torino, Turin, Italy
| | - V D'Ambrosio
- Inter-department Multiple Sclerosis Research Centre, IRCCS Mondino Mondino, Pavia, Italy
| | - M Zaffaroni
- Multiple Sclerosis Study Centre, ASST Valle Olona, Gallarate, VA, Italy
| | - A Ghezzi
- Multiple Sclerosis Study Centre, ASST Valle Olona, Gallarate, VA, Italy
| | - P Perini
- Department of Neurosciences, The Multiple Sclerosis Centre, University Hospital of Padova, Padua, Italy
| | - S Rossi
- Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C, Besta IRCCS Foundation, Milan, Italy
| | - A Bertolotto
- Regional Multiple Sclerosis Centre, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - M R Rottoli
- SS Malattie Autoimmuni USC Neurologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M Rovaris
- Multiple Sclerosis Center, IRRCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - R Balgera
- Neurological Department, A. Manzoni Hospital, Lecco, Italy
| | - P Cavalla
- Department of Neuroscience, University of Torino, Turin, Italy
| | - C Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, University of Pavia, Pavia, Italy
| | - R Bergamaschi
- Inter-department Multiple Sclerosis Research Centre, IRCCS Mondino Mondino, Pavia, Italy
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2220
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Managing Multiple Sclerosis: Treatment Initiation, Modification, and Sequencing. Can J Neurol Sci 2018; 45:489-503. [DOI: 10.1017/cjn.2018.17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AbstractRecent therapeutic advances in the management of multiple sclerosis (MS) have raised questions about the selection of appropriate patient candidates for various treatments and, if the plan is to move from one treatment to another, the appropriate sequencing of these therapies. The selected approach should provide optimal disease management without limiting future therapeutic options based on safety concerns, and recognize potential future treatments and the possibility of combination therapies. Additional challenges include incorporation of patient needs and preferences into the overall therapeutic approach, in order to ensure optimal outcomes in the short and long term. The objective of this manuscript is to provide an overview of what is currently known regarding the impact of various therapies for MS on future therapeutic choices (sequencing). In this context, we reviewed the available evidence in support of various treatments and, based on the presence of disease activity, suggested a scheme for switching or escalating therapy with the main focus on sequencing of therapeutic approaches.
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2221
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Gafson AR, Kim K, Cencioni MT, van Hecke W, Nicholas R, Baranzini SE, Matthews PM. Mononuclear cell transcriptome changes associated with dimethyl fumarate in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e470. [PMID: 30283812 PMCID: PMC6168332 DOI: 10.1212/nxi.0000000000000470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/23/2018] [Indexed: 01/28/2023]
Abstract
Objective To identify short-term changes in gene expression in peripheral blood mononuclear cells (PBMCs) associated with treatment response to dimethyl fumarate (DMF, Tecfidera) in patients with relapsing-remitting MS (RRMS). Methods Blood samples were collected from 24 patients with RRMS (median Expanded Disability Status Scale score, 2.0; range 1–7) at baseline, 6 weeks, and 15 months after the initiation of treatment with DMF (BG-12; Tecfidera). Seven healthy controls were also recruited, and blood samples were collected over the same time intervals. PBMCs were extracted from blood samples and sequenced using next-generation RNA sequencing. Treatment responders were defined using the composite outcome measure “no evidence of disease activity” (NEDA-4). Time-course and cross-sectional differential expression analyses were performed to identify transcriptomic markers of treatment response. Results Treatment responders (NEDA-4 positive, 8/24) over the 15-month period had 478 differentially expressed genes (DEGs) 6 weeks after the start of treatment. These were enriched for nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and inhibition of nuclear factor κB (NFκB) pathway transcripts. For patients who showed signs of disease activity, there were no DEGs at 6 weeks relative to their (untreated) baseline. Contrasting transcriptomes expressed at 6 weeks with those at 15 months of treatment, 0 and 1,264 DEGs were found in the responder and nonresponder groups, respectively. Transcripts in the nonresponder group (NEDA-4 negative, 18/24) were enriched for T-cell signaling genes. Conclusion Short-term PBMC transcriptome changes reflecting activation of the Nrf2 and inhibition of NFκB pathways distinguish patients who subsequently show a medium-term treatment response with DMF. Relative stabilization of gene expression patterns may accompany treatment-associated suppression of disease activity.
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Affiliation(s)
- Arie R Gafson
- Division of Brain Sciences (A.R.G., M.T.C., R.N.), Department of Medicine, Imperial College London; the Department of Neurology (K.K.), Weill Institute for Neurosciences, University of California, San Francisco; icometrix (W.v.H.), Begaultlaan, Leuven, Belgium; the Department of Neurology (S.E.B.), Weill Institute for Neurosciences, Institute for Human Genetics and Graduate Program in Bioinformatics, University of California, San Francisco; and Division of Brain Sciences (P.M.M.), Department of Medicine, the Centre for Neurotechnology and the UK Dementia Research Institute, Imperial College London
| | - Kicheol Kim
- Division of Brain Sciences (A.R.G., M.T.C., R.N.), Department of Medicine, Imperial College London; the Department of Neurology (K.K.), Weill Institute for Neurosciences, University of California, San Francisco; icometrix (W.v.H.), Begaultlaan, Leuven, Belgium; the Department of Neurology (S.E.B.), Weill Institute for Neurosciences, Institute for Human Genetics and Graduate Program in Bioinformatics, University of California, San Francisco; and Division of Brain Sciences (P.M.M.), Department of Medicine, the Centre for Neurotechnology and the UK Dementia Research Institute, Imperial College London
| | - Maria T Cencioni
- Division of Brain Sciences (A.R.G., M.T.C., R.N.), Department of Medicine, Imperial College London; the Department of Neurology (K.K.), Weill Institute for Neurosciences, University of California, San Francisco; icometrix (W.v.H.), Begaultlaan, Leuven, Belgium; the Department of Neurology (S.E.B.), Weill Institute for Neurosciences, Institute for Human Genetics and Graduate Program in Bioinformatics, University of California, San Francisco; and Division of Brain Sciences (P.M.M.), Department of Medicine, the Centre for Neurotechnology and the UK Dementia Research Institute, Imperial College London
| | - Wim van Hecke
- Division of Brain Sciences (A.R.G., M.T.C., R.N.), Department of Medicine, Imperial College London; the Department of Neurology (K.K.), Weill Institute for Neurosciences, University of California, San Francisco; icometrix (W.v.H.), Begaultlaan, Leuven, Belgium; the Department of Neurology (S.E.B.), Weill Institute for Neurosciences, Institute for Human Genetics and Graduate Program in Bioinformatics, University of California, San Francisco; and Division of Brain Sciences (P.M.M.), Department of Medicine, the Centre for Neurotechnology and the UK Dementia Research Institute, Imperial College London
| | - Richard Nicholas
- Division of Brain Sciences (A.R.G., M.T.C., R.N.), Department of Medicine, Imperial College London; the Department of Neurology (K.K.), Weill Institute for Neurosciences, University of California, San Francisco; icometrix (W.v.H.), Begaultlaan, Leuven, Belgium; the Department of Neurology (S.E.B.), Weill Institute for Neurosciences, Institute for Human Genetics and Graduate Program in Bioinformatics, University of California, San Francisco; and Division of Brain Sciences (P.M.M.), Department of Medicine, the Centre for Neurotechnology and the UK Dementia Research Institute, Imperial College London
| | - Sergio E Baranzini
- Division of Brain Sciences (A.R.G., M.T.C., R.N.), Department of Medicine, Imperial College London; the Department of Neurology (K.K.), Weill Institute for Neurosciences, University of California, San Francisco; icometrix (W.v.H.), Begaultlaan, Leuven, Belgium; the Department of Neurology (S.E.B.), Weill Institute for Neurosciences, Institute for Human Genetics and Graduate Program in Bioinformatics, University of California, San Francisco; and Division of Brain Sciences (P.M.M.), Department of Medicine, the Centre for Neurotechnology and the UK Dementia Research Institute, Imperial College London
| | - Paul M Matthews
- Division of Brain Sciences (A.R.G., M.T.C., R.N.), Department of Medicine, Imperial College London; the Department of Neurology (K.K.), Weill Institute for Neurosciences, University of California, San Francisco; icometrix (W.v.H.), Begaultlaan, Leuven, Belgium; the Department of Neurology (S.E.B.), Weill Institute for Neurosciences, Institute for Human Genetics and Graduate Program in Bioinformatics, University of California, San Francisco; and Division of Brain Sciences (P.M.M.), Department of Medicine, the Centre for Neurotechnology and the UK Dementia Research Institute, Imperial College London
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2222
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Mescheriakova JY, Verkerk AJ, Amin N, Uitterlinden AG, van Duijn CM, Hintzen RQ. Linkage analysis and whole exome sequencing identify a novel candidate gene in a Dutch multiple sclerosis family. Mult Scler 2018; 25:909-917. [PMID: 29873607 PMCID: PMC6545620 DOI: 10.1177/1352458518777202] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a complex disease resulting from the joint effect of many genes. It has been speculated that rare variants might explain part of the missing heritability of MS. OBJECTIVE To identify rare coding genetic variants by analyzing a large MS pedigree with 11 affected individuals in several generations. METHODS Genome-wide linkage screen and whole exome sequencing (WES) were performed to identify novel coding variants in the shared region(s) and in the known 110 MS risk loci. The candidate variants were then assessed in 591 MS patients and 3169 controls. RESULTS Suggestive evidence for linkage was obtained to 7q11.22-q11.23. In WES data, a rare missense variant p.R183C in FKBP6 was identified that segregated with the disease in this family. The minor allele frequency was higher in an independent cohort of MS patients than in healthy controls (1.27% vs 0.95%), but not significant (odds ratio (OR) = 1.33 (95% confidence interval (CI): 0.8-2.4), p = 0.31). CONCLUSION The rare missense variant in FKBP6 was identified in a large Dutch MS family segregating with the disease. This association to MS was not found in an independent MS cohort. Overall, genome-wide studies in larger cohorts are needed to adequately investigate the role of rare variants in MS risk.
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Affiliation(s)
- Julia Y Mescheriakova
- Department of Neurology, MS Center ErasMS, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Najaf Amin
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Rogier Q Hintzen
- Department of Neurology, MS Center ErasMS, Erasmus Medical Centre, Rotterdam, The Netherlands
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2223
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McGlasson S, Wiseman S, Wardlaw J, Dhaun N, Hunt DPJ. Neurological Disease in Lupus: Toward a Personalized Medicine Approach. Front Immunol 2018; 9:1146. [PMID: 29928273 PMCID: PMC5997834 DOI: 10.3389/fimmu.2018.01146] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/07/2018] [Indexed: 12/11/2022] Open
Abstract
The brain and nervous system are important targets for immune-mediated damage in systemic lupus erythematosus (SLE), resulting in a complex spectrum of neurological syndromes. Defining nervous system disease in lupus poses significant challenges. Among the difficulties to be addressed are a diversity of clinical manifestations and a lack of understanding of their mechanistic basis. However, despite these challenges, progress has been made in the identification of pathways which contribute to neurological disease in SLE. Understanding the molecular pathogenesis of neurological disease in lupus will inform both classification and approaches to clinical trials.
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Affiliation(s)
- Sarah McGlasson
- MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- The Anne Rowling Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart Wiseman
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna Wardlaw
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David P. J. Hunt
- MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom
- The UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- The Anne Rowling Clinic, University of Edinburgh, Edinburgh, United Kingdom
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2224
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Abstract
INTRODUCTION Mobility disability is one of the most widespread and impactful consequences of multiple sclerosis (MS). Disease modifying drugs (DMDs) may delay the progression of disability over time; however, there is minimal evidence supporting the efficacy of DMDs for reversing mobility disability or restoring ambulatory function in persons with MS. Areas covered: This review outlines symptomatic pharmacologic and non-pharmacologic therapeutic approaches that target mobility disability with the goal of restoring and improving walking function. First, the efficacy of dalfampridine, currently the only Food and Drug Administration approved symptomatic pharmacologic agent that improves walking in persons with MS is described. Next, a review of the efficacy of non-pharmacologic therapies for improving walking, including exercise training, physical therapy, and gait training is given. Last, guidance on future research on mobility in MS is provided by emphasizing the importance of combinatory treatment approaches that include multiple intervention modalities, as the best treatment plan likely involves a comprehensive, multidisciplinary approach. Expert commentary: There has been an increased effort to develop symptom-specific treatments in MS that directly target mobility disability; however, more research is needed to determine the efficacy of these rehabilitative strategies alone and together for improving walking in persons with MS.
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Affiliation(s)
- Jessica F. Baird
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian M. Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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2225
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De Angelis F, Plantone D, Chataway J. Pharmacotherapy in Secondary Progressive Multiple Sclerosis: An Overview. CNS Drugs 2018; 32:499-526. [PMID: 29968175 DOI: 10.1007/s40263-018-0538-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Multiple sclerosis is an immune-mediated inflammatory disease of the central nervous system characterised by demyelination, neuroaxonal loss and a heterogeneous clinical course. Multiple sclerosis presents with different phenotypes, most commonly a relapsing-remitting course and, less frequently, a progressive accumulation of disability from disease onset (primary progressive multiple sclerosis). The majority of people with relapsing-remitting multiple sclerosis, after a variable time, switch to a stage characterised by gradual neurological worsening known as secondary progressive multiple sclerosis. We have a limited understanding of the mechanisms underlying multiple sclerosis, and it is believed that multiple genetic, environmental and endogenous factors are elements driving inflammation and ultimately neurodegeneration. Axonal loss and grey matter damage have been regarded as amongst the leading causes of irreversible neurological disability in the progressive stages. There are over a dozen disease-modifying therapies currently licenced for relapsing-remitting multiple sclerosis, but none of these has provided evidence of effectiveness in secondary progressive multiple sclerosis. Recently, there has been some early modest success with siponimod in secondary progressive multiple sclerosis and ocrelizumab in primary progressive multiple sclerosis. Finding treatments to delay or prevent the courses of secondary progressive multiple sclerosis is an unmet and essential goal of the research in multiple sclerosis. In this review, we discuss new findings regarding drugs with immunomodulatory, neuroprotective or regenerative properties and possible treatment strategies for secondary progressive multiple sclerosis. We examine the field broadly to include trials where participants have progressive or relapsing phenotypes. We summarise the most relevant results from newer investigations from phase II and III randomised controlled trials over the past decade, with particular attention to the last 5 years.
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Affiliation(s)
- Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK.
| | - Domenico Plantone
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
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2226
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Dimethyl fumarate induces a persistent change in the composition of the innate and adaptive immune system in multiple sclerosis patients. Sci Rep 2018; 8:8194. [PMID: 29844361 PMCID: PMC5974280 DOI: 10.1038/s41598-018-26519-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
The effects of dimethyl fumarate (DMF) on the immune system in multiple sclerosis (MS) are not completely elucidated. In this study, an extensive immunophenotypic analysis of innate and adaptive immune cells of DMF-treated MS patients was performed. Peripheral blood immune cell phenotypes were determined using flow cytometry in a follow-up study of 12 MS patients before, after 3 and 12 months of DMF treatment and a cross-sectional study of 25 untreated and 64 DMF-treated MS patients. Direct effects of DMF on B cells were analyzed in vitro. After 12 months of DMF treatment, percentages of monocytes, natural killer cells, naive T and B cells and transitional B cells increased. Percentages of (effector) memory T cells, (non) class-switched memory B cells and double negative B cells decreased together with CD4+ T cells expressing interferon-γ (IFN-γ), granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin-17 (IL-17). DMF treatment was fully effective as of 6 months and directly induced apoptosis and decreased expression of costimulatory CD40, antigen presentation molecule MHCII and B cell activating factor receptor (BAFFR) on B cells. DMF induced a persistent change of the immune system of MS patients, directly induced apoptosis and reduced expression of functional markers on B cells.
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2227
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Marck CH, De Livera AM, Brown CR, Neate SL, Taylor KL, Weiland TJ, Hadgkiss EJ, Jelinek GA. Health outcomes and adherence to a healthy lifestyle after a multimodal intervention in people with multiple sclerosis: Three year follow-up. PLoS One 2018; 13:e0197759. [PMID: 29791509 PMCID: PMC5965868 DOI: 10.1371/journal.pone.0197759] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Modifiable risk factors such as smoking and sedentary lifestyle adversely affect multiple sclerosis (MS) progression. Few multimodal behavioural interventions have been conducted for people with MS, and follow-up beyond 1 year is rare for lifestyle interventions. This study assessed adoption and adherence to healthy lifestyle behaviours and health outcomes 3 years after a lifestyle modification intervention, using generalized estimating equation models to account for within-participant correlation over time. METHODS 95 people with MS completed baseline surveys before participating in 5-day MS lifestyle risk-factor modification workshops. 76 and 78 participants completed the 1-year and 3-year follow-up surveys respectively. Mean age at 3-year follow-up was 47 years, 72% were female, most (62.8%) had MS for 5 years or less, and 73% had relapsing remitting MS (RRMS). RESULTS Compared to baseline, participants reported clinically meaningful increases in physical (mean difference (MD): 8.0, 95% Confidence Interval (CI): 5.2-10.8) and mental health (MD: 9.2, CI: 5.8-12.6) quality of life (QOL) at 1-year, and physical (MD: 8.7, CI: 5.3-12.2) and mental health (MD: 8.0, CI: 4.2-11.8) QOL at 3-year follow-up. There was a small decrease in disability from baseline to 1-year follow-up (MD: 0.9, CI: 0.9,1.0) and to 3-year follow-up (MD: 1.0, CI: 0.9,1.0), which was not clinically meaningful. Of those with RRMS, compared to baseline, fewer had a relapse during the year before 1-year follow-up (OR: 0.1, CI 0.0-0.2) and 3-year follow-up (OR: 0.15, CI 0.06-0.33). Participants' healthy diet score, the proportion meditating ≥1 hours a week, supplementing with ≥ 5000IU vitamin D daily, and supplementing with omega-3 flaxseed oil increased at 1-year follow-up and was sustained, although slightly lower at 3-year follow-up. However, there was no evidence for a change in physical activity and not enough smokers to make meaningful comparisons. Medication use increased at 1-year follow-up and at 3-year follow-up. CONCLUSION The results provide evidence that lifestyle risk factor modification is feasible and sustainable over time, in a small self-selected and motivated sample of people with MS. Furthermore, participation in a lifestyle intervention is not associated with a decrease in MS medication use.
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Affiliation(s)
- Claudia H. Marck
- Neuroepidemiology Unit, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
- Disability and Health, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
- * E-mail:
| | - Alysha M. De Livera
- Neuroepidemiology Unit, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Keryn L. Taylor
- Neuroepidemiology Unit, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
| | | | - George A. Jelinek
- Neuroepidemiology Unit, the Melbourne School of Population and Global Health, the University of Melbourne, Victoria, Australia
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2228
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Groen K, Maltby VE, Lea RA, Sanders KA, Fink JL, Scott RJ, Tajouri L, Lechner-Scott J. Erythrocyte microRNA sequencing reveals differential expression in relapsing-remitting multiple sclerosis. BMC Med Genomics 2018; 11:48. [PMID: 29783973 PMCID: PMC5963124 DOI: 10.1186/s12920-018-0365-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/01/2018] [Indexed: 02/06/2023] Open
Abstract
Background There is a paucity of knowledge concerning erythrocytes in the aetiology of Multiple Sclerosis (MS) despite their potential to contribute to disease through impaired antioxidant capacity and altered haemorheological features. Several studies have identified an abundance of erythrocyte miRNAs and variable profiles associated with disease states, such as sickle cell disease and malaria. The aim of this study was to compare the erythrocyte miRNA profile of relapsing-remitting MS (RRMS) patients to healthy sex- and age-matched controls. Methods Erythrocytes were purified by density-gradient centrifugation and RNA was extracted. Following library preparation, samples were run on a HiSeq4000 Illumina instrument (paired-end 100 bp sequencing). Sequenced erythrocyte miRNA profiles (9 patients and 9 controls) were analysed by DESeq2. Differentially expressed miRNAs were validated by RT-qPCR using miR-152-3p as an endogenous control and replicated in a larger cohort (20 patients and 18 controls). After logarithmic transformation, differential expression was determined by two-tailed unpaired t-tests. Logistic regression analysis was carried out and receiver operating characteristic (ROC) curves were generated to determine biomarker potential. Results A total of 236 erythrocyte miRNAs were identified. Of twelve differentially expressed miRNAs in RRMS two showed increased expression (adj. p < 0.05). Only modest fold-changes were evident across differentially expressed miRNAs. RT-qPCR confirmed differential expression of miR-30b-5p (0.61 fold, p < 0.05) and miR-3200-3p (0.36 fold, p < 0.01) in RRMS compared to healthy controls. Relative expression of miR-3200-5p (0.66 fold, NS p = 0.096) also approached significance. MiR-3200-5p was positively correlated with cognition measured by audio-recorded cognitive screen (r = 0.60; p < 0.01). MiR-3200-3p showed greatest biomarker potential as a single miRNA (accuracy = 75.5%, p < 0.01, sensitivity = 72.7%, specificity = 84.0%). Combining miR-3200-3p, miR-3200-5p, and miR-30b-5p into a composite biomarker increased accuracy to 83.0% (p < 0.05), sensitivity to 77.3%, and specificity to 88.0%. Conclusions This is the first study to report differences in erythrocyte miRNAs in RRMS. While the role of miRNAs in erythrocytes remains to be elucidated, differential expression of erythrocyte miRNAs may be exploited as biomarkers and their potential contribution to MS pathology and cognition should be further investigated. Electronic supplementary material The online version of this article (10.1186/s12920-018-0365-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kira Groen
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Centre for Information Based Medicine, Level 3 West, Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Vicki E Maltby
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Centre for Information Based Medicine, Level 3 West, Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Rodney A Lea
- Centre for Information Based Medicine, Level 3 West, Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Institute of Health and Biomedical Innovations, Genomics Research Centre, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Katherine A Sanders
- Centre for Anatomical and Human Sciences, Hull York Medical School, Hull, HU6 7RX, UK
| | - J Lynn Fink
- Diamantina Institute, University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Rodney J Scott
- Centre for Information Based Medicine, Level 3 West, Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Division of Molecular Genetics, Pathology North, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Lotti Tajouri
- Faculty of Health Sciences and Medicine, Bond University, QLD, Robina, 4229, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Centre for Information Based Medicine, Level 3 West, Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia.
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2229
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Mills EA, Mao-Draayer Y. Aging and lymphocyte changes by immunomodulatory therapies impact PML risk in multiple sclerosis patients. Mult Scler 2018; 24:1014-1022. [PMID: 29774781 DOI: 10.1177/1352458518775550] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
New potent immunomodulatory therapies for multiple sclerosis (MS) are associated with increased risk for progressive multifocal leukoencephalopathy (PML). It is unclear why a subset of treated patients develops PML, but patient age has emerged as an important risk factor. PML is caused by the JC virus and aging is associated with immune senescence, which increases susceptibility to infection. With the goal of improving PML risk stratification, we here describe the lymphocyte changes that occur with disease-modifying therapies (DMTs) associated with high or moderate risk toward PML in MS patients, how these changes compare to immune aging, and which measures best correlate with risk. We reviewed studies examining how these therapies alter patient immune profiles, which revealed the induction of changes to lymphocyte number and/or function that resemble immunosenescence. Therefore, the immunosuppressive activity of these MS DMTs may be enhanced in the context of an immune system that is already exhibiting features of senescence.
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Affiliation(s)
- Elizabeth A Mills
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA/Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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2230
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Goodin DS, Reder AT, Traboulsee AL, Li DK, Langdon D, Cutter G, Cook S, O'Donnell T, Kremenchutzky M, Oger J, Koelbach R, Pohl C, Wicklein EM. Predictive validity of NEDA in the 16- and 21-year follow-up from the pivotal trial of interferon beta-1b. Mult Scler 2018; 25:837-847. [PMID: 29761737 DOI: 10.1177/1352458518773511] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Long-term follow-up from the randomized trial of interferon beta-1b (IFNB-1b) permitted the assessment of different definitions of no evidence of disease activity (NEDA) for predicting long-term outcome in multiple sclerosis (MS). OBJECTIVE To examine the predictive validity of different NEDA definitions. METHODS Predictive validity for negative disability outcomes (NDOs) at 16 years and survival at 21 years post-randomization were assessed. NEDA in the first 2 years was defined as follows: clinical NEDA: no relapses or Expanded Disability Status Scale (EDSS) progression from baseline to Year 2; NEDA-3a: no relapses, no confirmed ⩾1-point EDSS progression, and no new T2-active lesions; NEDA-3b: no relapses, no EDSS progression, and no increase in T2 burden of disease (T2-BOD); and NEDA-4: no relapses, no EDSS progression, and no increase in T2-BOD or atrophy. NDOs were defined as death, need for wheelchair, EDSS ⩾6, or progressive MS. RESULTS A total of 245 and 371 patients were evaluated at 16 and 21 years, respectively. Clinical NEDA predicted NDOs ( p = 0.0029), as did baseline EDSS ( p < 0.0001), baseline T2-BOD ( p < 0.0001), and change in T2-BOD ( p = 0.0033). IFNB-1b treatment ( p = 0.0251), relapse rate in the 2 years before study start ( p = 0.0260), T2-BOD at baseline ( p = 0.0014), and change in T2-BOD ( p = 0.0129) predicted survival at 21 years. CONCLUSION Clinical NEDA predicted long-term disability outcome. By contrast, definitions of NEDA that included on-therapy changes in magnetic resonance imaging variables did not increase the predictive validity.
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Affiliation(s)
- Douglas S Goodin
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Anthony T Reder
- Department of Neurology, The University of Chicago, Chicago, IL, USA
| | | | - David Kb Li
- The University of British Columbia, Vancouver, BC, Canada
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Gary Cutter
- Department of Biostatistics, UAB School of Public Health, Birmingham, AL, USA
| | - Stuart Cook
- Department of Neurosciences, Rutgers University, Newark, NJ, USA
| | | | | | - Joel Oger
- Department of Neurology, The University of British Columbia, Vancouver, BC, Canada
| | | | - Christoph Pohl
- Bayer AG, Berlin, Germany; University Hospital Bonn, Bonn, Germany
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2231
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Scotti B, Disanto G, Sacco R, Guigli M, Zecca C, Gobbi C. Effectiveness and safety of Rituximab in multiple sclerosis: an observational study from Southern Switzerland. PLoS One 2018; 13:e0197415. [PMID: 29758075 PMCID: PMC5951582 DOI: 10.1371/journal.pone.0197415] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/01/2018] [Indexed: 01/17/2023] Open
Abstract
Background Despite positive results from phase II and observational studies, Rituximab (RTX) is not currently approved for multiple sclerosis (MS) treatment and can only be used off-label. Objective To characterize MS patients treated with RTX and investigate its effectiveness and safety in a clinical practice setting. Methods Observational analysis of data collected from MS patients at the Neurocenter of Southern Switzerland. Relapses, EDSS worsening, MRI lesion accrual and "evidence of disease activity” (EDA) status were described by Cox regression. RTX and natalizumab treated patients were matched by propensity scores. Results Out of 453 MS patients, 82 were treated with RTX, 43 (52.4%) relapsing-remitting (RRMS) and 39 (47.6%) progressive MS (median age = 48 [40–54] years, females n = 60 [73.2%], EDSS = 4.0 [2.5–6.0], median follow-up = 1.5 [1.0–2.5] years). Three relapses occurred and 59 (75.6%) patients had not EDA at follow-up end. Time to EDA was similar in RTX and natalizumab treated RRMS patients (HR = 1.64, 95%CI = 0.46–5.85, p = 0.44). Twenty-four patients presented non infusion related adverse events (infections), requiring RTX discontinuation in 6 individuals. Conclusion These results provide further evidence for RTX being effective in MS treatment, to a similar extent to natalizumab in RRMS. Clinicians must be vigilant for the potential occurrence of infections.
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Affiliation(s)
- Barbara Scotti
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Giulio Disanto
- Neurocentre of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Rosaria Sacco
- Neurocentre of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Marilu’ Guigli
- Università della Svizzera Italiana (USI), Facoltà di scienze biomediche, Lugano, Switzerland
| | - Chiara Zecca
- Neurocentre of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Claudio Gobbi
- University Hospital Basel, University of Basel, Basel, Switzerland
- Neurocentre of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
- * E-mail:
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2232
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Harris DJ, Wilson MR, Vine SJ. A Systematic Review of Commercial Cognitive Training Devices: Implications for Use in Sport. Front Psychol 2018; 9:709. [PMID: 29867674 PMCID: PMC5958310 DOI: 10.3389/fpsyg.2018.00709] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/23/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Cognitive training (CT) aims to develop a range of skills, like attention and decision-making, through targeted training of core cognitive functions. While CT can target context specific skills, like movement anticipation, much CT is domain general, focusing on core abilities (e.g., selective attention) for transfer to a range of real-world tasks, such as spotting opponents. Commercial CT (CCT) devices are highly appealing for athletes and coaches due to their ease of use and eye-catching marketing claims. The extent to which this training transfers to performance in the sporting arena is, however, unclear. Therefore, this paper sought to provide a systematic review of evidence for beneficial training effects of CCT devices and evaluate their application to sport. Methods: An extensive search of electronic databases (PubMed, PsychInfo, GoogleScholar, and SportDiscus) was conducted to identify peer-reviewed evidence of training interventions with commercially available CT devices. Forty-three studies met the inclusion criteria and were retained for quality assessment and synthesis of results. Seventeen studies assessed transfer effects beyond laboratory cognitive tests, but only 1 directly assessed transfer to a sporting task. Results: The review of evidence showed limited support for far transfer benefits from CCT devices to sporting tasks, mainly because studies did not target the sporting environment. Additionally, a number of methodological issues with the CCT literature were identified, including small sample sizes, lack of retention tests, and limited replication of findings by researchers independent of the commercial product. Therefore, evidence for sporting benefits is currently limited by the paucity of representative transfer tests and a focus on populations with health conditions. Conclusions: Currently there is little direct evidence that the use of CCT devices can transfer to benefits for sporting performance. This conclusion, however, stems more from a lack of experimental studies in the sporting field and a lack of experimental rigor, rather than convincing null effects. Subsequently, there is an opportunity for researchers to develop more reliable findings in this area through systematic assessment in athletic populations and major methodological improvements.
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Affiliation(s)
- David J Harris
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Mark R Wilson
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Samuel J Vine
- Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
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2233
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Kahraman T, Özdoğar AT, Honan CA, Ertekin Ö, Özakbaş S. The multiple sclerosis work difficulties questionnaire: translation and cross-cultural adaptation to Turkish and assessment of validity and reliability. Disabil Rehabil 2018; 41:2556-2562. [PMID: 29741962 DOI: 10.1080/09638288.2018.1470262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To linguistically and culturally adapt the Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) for use in Turkey, and to examine its reliability and validity. Methods: Following standard forward-back translation of the MSWDQ-23, it was administered to 124 people with multiple sclerosis (MS). Validity was evaluated using related outcome measures including those related to employment status and expectations, disability level, fatigue, walking, and quality of life. Randomly selected participants were asked to complete the MSWDQ-23 again to assess test-retest reliability. Results: Confirmatory factor analysis on the MSWDQ-23 demonstrated a good fit for the data, and the internal consistency of each subscale was excellent. The test-retest reliability for the total score, psychological/cognitive barriers, physical barriers, and external barriers subscales were high. The MSWDQ-23 and its subscales were positively correlated with the employment, disability level, walking, and fatigue outcome measures. Conclusions: This study suggests that the Turkish version of MSWDQ-23 has high reliability and adequate validity, and it can be used to determine the difficulties faced by people with multiple sclerosis in workplace. Moreover, the study provides evidence about the test-retest reliability of the questionnaire. Implications for rehabilitation Multiple sclerosis affects young people of working age. Understanding work-related problems is crucial to enhance people with multiple sclerosis likelihood of maintaining their job. The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a valid and reliable measure of perceived workplace difficulties in people with multiple sclerosis: we presented its validation to Turkish. Professionals working in the field of vocational rehabilitation may benefit from using the MSWDQ-23 to predict the current work outcomes and future employment expectations.
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Affiliation(s)
- Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University , Izmir , Turkey
| | - Asiye Tuba Özdoğar
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University , Izmir , Turkey
| | - Cynthia Alison Honan
- Department of Psychology, School of Medicine, University of Tasmania , Newnham , Australia
| | - Özge Ertekin
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University , Izmir , Turkey
| | - Serkan Özakbaş
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University , Izmir , Turkey
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2234
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Boyko AN, Boyko OV. Cladribine tablets' potential role as a key example of selective immune reconstitution therapy in multiple sclerosis. Degener Neurol Neuromuscul Dis 2018; 8:35-44. [PMID: 30050387 PMCID: PMC6053904 DOI: 10.2147/dnnd.s161450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is one of the most important, disabling, and prevalent neurological disorders of young adults. It is a chronic inflammatory and neurodegenerative disease when autoreactive B and T cells have downstream effects that result in demyelination and neuronal loss. Anti-inflammatory disease-modifying therapies do have proven efficacy in delaying disease and disability progression in MS. While the progress in MS treatments has already improved the prognosis and quality of patients’ lives overall, there are some clear shortcomings and unmet needs in the current MS treatment landscape. The most promising means of MS treatment is selective immune reconstitution therapy (SIRT). This therapy is given in short-duration courses of immunosuppression, producing durable effects on the immune system and preventing nervous tissue loss. This review discusses the mechanisms of action and the data of clinical trials of cladribine tablets as an example of SIRT in MS. The clinical benefits of cladribine tablets in these studies include decreased relapse rate and disability progression with large reductions in lesion activity, and protection against brain volume loss. Whether all of these neurological findings are direct results of lymphocyte depletion, or if there are downstream effects on other, unknown, neurodegenerative processes are yet to be determined, but these clearly point to an interesting area of research.
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Affiliation(s)
- Alexey N Boyko
- Pirogov's Russian National Research University, Department of Neurology, Neurosurgery and Medical Genetics, .,Neurological Department, Usupov's Hospital, Moscow, Russia,
| | - Olga V Boyko
- Pirogov's Russian National Research University, Department of Neurology, Neurosurgery and Medical Genetics, .,Neurological Department, Usupov's Hospital, Moscow, Russia,
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2235
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Roux J, Grimaud O, Leray E. Use of state sequence analysis for care pathway analysis: The example of multiple sclerosis. Stat Methods Med Res 2018; 28:1651-1663. [PMID: 29717944 DOI: 10.1177/0962280218772068] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The concept of care pathways is increasingly being used to enhance the quality of care and to optimize the use of resources for health care. We here propose an innovative method in epidemiology that is derived from social sciences: state sequence analysis (SSA). This method takes into account the chronology of care consumption and allows for identification of specific patterns. A process for using SSA in the health area is proposed and discussed. The main steps are: data coding, measurement of dissimilarities between sequences (focusing on optimal matching methods and the choice of related costs), and application of a clustering method to obtain a typology of sequence patterns. As an example of its use in the health area, SSA was employed to analyse care pathways of a random sample of patients with multiple sclerosis. This sample has been selected from the main French healthcare database covering the period 2007 to 2013 (n = 1 000). A five-cluster typology was obtained which allowed distinction of care consumption groups. Overall, about half of the patients had low care consumption, about one quarter had medium to high consumption, and another quarter had high consumption. We conclude that state sequence analysis is an innovative and flexible methodology that is worth considering in health care research.
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Affiliation(s)
- Jonathan Roux
- 1 METIS Department, EHESP French School of Public Health, Rennes, France.,2 UPRES EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Faculty of Medicine, University of Rennes 1 & EHESP French School of Public Health, Rennes, France.,3 INSERM CIC-P 1414, CHU of Rennes, 2 Rue Henri le Guilloux, Rennes, France
| | - Olivier Grimaud
- 1 METIS Department, EHESP French School of Public Health, Rennes, France.,2 UPRES EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Faculty of Medicine, University of Rennes 1 & EHESP French School of Public Health, Rennes, France
| | - Emmanuelle Leray
- 1 METIS Department, EHESP French School of Public Health, Rennes, France.,2 UPRES EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Faculty of Medicine, University of Rennes 1 & EHESP French School of Public Health, Rennes, France.,3 INSERM CIC-P 1414, CHU of Rennes, 2 Rue Henri le Guilloux, Rennes, France
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2236
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Dorr M, Elze T, Wang H, Lu ZL, Bex PJ, Lesmes LA. New Precision Metrics for Contrast Sensitivity Testing. IEEE J Biomed Health Inform 2018; 22:919-925. [PMID: 28650831 PMCID: PMC6706861 DOI: 10.1109/jbhi.2017.2708745] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Visual sensitivity is comprehensively described by the contrast sensitivity function (CSF), but current routine clinical care does not include its assessment because of the time-consuming need to estimate thresholds for a large number of spatial frequencies. The quick CSF method, however, dramatically reduces testing times by using a Bayesian information maximization rule. We evaluate the test-retest variability of a tablet-based quick CSF implementation in a study with 100 subjects who repeatedly assessed their vision with and without optical correction. We first discuss two commonly used measures of repeatability, intraclass correlation and the Bland-Altman Coefficient of Repeatability, and show that they are vulnerable to artifacts. Instead, we propose to formulate precision as an information retrieval task: from all repeat test scores, can we retrieve a certain individual based on their first test score? We then use rank-based analyses such as mean average precision as a better measure to compare different test metrics, and show that the highest test-retest precision is achieved using a summary statistic, the area under the log CSF (AULCSF). This demonstrates the benefit of assessment of the whole CSF compared to sensitivity at individual spatial frequencies only. AULCSF also yields best discrimination performance (99.2%) between measurements that were taken with and without glasses, respectively, even better than CSF Acuity. The tablet-based quick CSF thus enables the rapid and reliable home monitoring of visual function, which has the potential to improve early diagnosis and treatment of ophthalmic pathologies such as diabetic retinopathy or age-related macular degeneration.
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2237
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Londoño AC, Mora CA. Role of CXCL13 in the formation of the meningeal tertiary lymphoid organ in multiple sclerosis. F1000Res 2018; 7:514. [PMID: 30345018 PMCID: PMC6171727 DOI: 10.12688/f1000research.14556.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2018] [Indexed: 11/25/2022] Open
Abstract
Immunomodulatory therapies available for the treatment of patients with multiple sclerosis (MS) accomplish control and neutralization of peripheral immune cells involved in the activity of the disease cascade but their spectrum of action in the intrathecal space and brain tissue is limited, taking into consideration the persistence of oligoclonal bands and the variation of clones of lymphoid cells throughout the disease span. In animal models of experimental autoimmune encephalomyelitis (EAE), the presence of CXCL13 has been associated with disease activity and the blockade of this chemokine could work as a potential complementary therapeutic strategy in patients with MS in order to postpone disease progression. The development of therapeutic alternatives with ability to modify the intrathecal inflammatory activity of the meningeal tertiary lymphoid organ to ameliorate neurodegeneration is mandatory.
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Affiliation(s)
- Ana C Londoño
- Instituto Neurológico de Colombia-INDEC, Medellín, Colombia
| | - Carlos A Mora
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, 20007, USA
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2238
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Londoño AC, Mora CA. Role of CXCL13 in the formation of the meningeal tertiary lymphoid organ in multiple sclerosis. F1000Res 2018; 7:514. [PMID: 30345018 DOI: 10.12688/f1000research.14556.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 01/09/2023] Open
Abstract
Immunomodulatory therapies available for the treatment of patients with multiple sclerosis (MS) accomplish control and neutralization of peripheral immune cells involved in the activity of the disease cascade but their spectrum of action in the intrathecal space and brain tissue is limited, taking into consideration the persistence of oligoclonal bands and the variation of clones of lymphoid cells throughout the disease span. In animal models of experimental autoimmune encephalomyelitis (EAE), the presence of CXCL13 has been associated with disease activity and the blockade of this chemokine could work as a potential complementary therapeutic strategy in patients with MS in order to postpone disease progression. The development of therapeutic alternatives with ability to modify the intrathecal inflammatory activity of the meningeal tertiary lymphoid organ to ameliorate neurodegeneration is mandatory.
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Affiliation(s)
- Ana C Londoño
- Instituto Neurológico de Colombia-INDEC, Medellín, Colombia
| | - Carlos A Mora
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, 20007, USA
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2239
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Ziliotto N, Baroni M, Straudi S, Manfredini F, Mari R, Menegatti E, Voltan R, Secchiero P, Zamboni P, Basaglia N, Marchetti G, Bernardi F. Coagulation Factor XII Levels and Intrinsic Thrombin Generation in Multiple Sclerosis. Front Neurol 2018; 9:245. [PMID: 29731736 PMCID: PMC5919941 DOI: 10.3389/fneur.2018.00245] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022] Open
Abstract
Background Factor XII (FXII) activation initiates the intrinsic (contact) coagulation pathway. It has been recently suggested that FXII could act as an autoimmunity mediator in multiple sclerosis (MS). FXII depositions nearby dentritic cells were detected in the central nervous system of MS patients and increased FXII activity has been reported in plasma of relapsing remitting and secondary progressive MS patients. FXII inhibition has been proposed to treat MS. Objective To investigate in MS patients multiple FXII-related variables, including the circulating amount of protein, its pro-coagulant function, and their variation over time. To explore kinetic activation features of FXII in thrombin generation (TG). Methods In plasma from 74 MS patients and 49 healthy subjects (HS), FXII procoagulant activity (FXII:c) and FXII protein (FXII:Ag) levels were assessed. Their ratio (FXII:ratio) values were derived. Intrinsic TG was evaluated by different triggers. Results Higher FXII:Ag levels (p = 0.003) and lower FXII:ratio (p < 0.001) were detected in MS patients compared with HS. FXII variables were highly correlated over four time points, which supports investigation of FXII contribution to disease phenotype and progression. A significant difference over time was detected for FXII:c (p = 0.031). In patients selected for the lowest FXII:ratio, TG triggered by ellagic acid showed a trend in lower endogenous thrombin potential (ETP) in MS patients compared with HS (p = 0.042). Intrinsic triggering of TG by nucleic acid addition produced longer time parameters in patients than in HS and substantially increased ETP in MS patients (p = 0.004) and TG peak height in HS (p = 0.008). Coherently, lower FXII:ratio and longer lag time (p = 0.02) and time to peak (p = 0.007) point out a reduced response of FXII to activation in part of MS patients. Conclusion In MS patients, factor-specific and modified global assays suggest the presence of increased FXII protein level and reduced function within the intrinsic coagulation pathway. These novel findings support further investigation by multiple approaches of FXII contribution to disease phenotype and progression.
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Affiliation(s)
- Nicole Ziliotto
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Marcello Baroni
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Fabio Manfredini
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy.,Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Rosella Mari
- Hematology Section, Department of Medical Sciences, Centre for Hemostasis and Thrombosis, University of Ferrara, Ferrara, Italy
| | - Erica Menegatti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Rebecca Voltan
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.,LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Paola Secchiero
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.,LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Nino Basaglia
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Giovanna Marchetti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesco Bernardi
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
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2240
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Lutter L, Spierings J, van Rhijn-Brouwer FCC, van Laar JM, van Wijk F. Resetting the T Cell Compartment in Autoimmune Diseases With Autologous Hematopoietic Stem Cell Transplantation: An Update. Front Immunol 2018; 9:767. [PMID: 29731752 PMCID: PMC5920130 DOI: 10.3389/fimmu.2018.00767] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/27/2018] [Indexed: 12/29/2022] Open
Abstract
Autologous hematopoietic stem cell transplantation (aHSCT) for autoimmune diseases has been applied for two decades as a treatment for refractory patients with progressive disease. The rationale behind aHSCT is that high-dose immunosuppression eliminates autoreactive T and B cells, thereby resetting the immune system. Post-aHSCT the cytotoxic CD8+ T cells normalize via clonal expansion due to homeostatic proliferation within a few months. CD4+ T cells recover primarily via thymopoiesis resulting in complete renewal of the T cell receptor (TCR) repertoire which requires years or never normalize completely. The increase in naïve T cells inducing immune tolerance, renewal of especially the regulatory TCR repertoire, and a less pro-inflammatory functional profile of the CD4+ T cells seem essential for successful immune reconstitution inducing long-term remission. There is currently a knowledge gap regarding the immune response in tissue sites post-aHSCT, as well as disease-specific factors that may determine remission or relapse. Future studies on lymphocyte dynamics and function may pave the way for optimized conditioning regimens with a more individualized approach.
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Affiliation(s)
- Lisanne Lutter
- Laboratory of Translational Immunology, Department of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Femke C C van Rhijn-Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Femke van Wijk
- Laboratory of Translational Immunology, Department of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
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2241
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Benichou T, Pereira B, Mermillod M, Tauveron I, Pfabigan D, Maqdasy S, Dutheil F. Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS One 2018; 13:e0195166. [PMID: 29608603 PMCID: PMC5880391 DOI: 10.1371/journal.pone.0195166] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/16/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cardiac autonomic neuropathy in type 2 dibetes mellitus (T2DM) patients is frequent and associated with high cardiovascular mortality. Heart rate variability (HRV) is the gold standard to measure cardiac autonomic neuropathy. We aimed to conduct a systematic review and meta-analysis to evaluate the impact of T2DM on HRV parameters. METHODS The PubMed, Cochrane Library, Embase and Science Direct databases were searched on 1st October 2017 using the keywords "diabetes" AND ("heart rate variability" OR "HRV"). Included articles had to report HRV parameters in T2DM patients and healthy controls measured during 24 hours with a Holter-electrocardiogram. Measurements of HRV retieved were: RR-intervals (or Normal to Normal intervals-NN), standard deviation of RR intervals (SDNN), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), square root of the mean squared difference of successive RR intervals (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio, as per Task Force recommendations. RESULTS We included twenty-five case-control studies with 2,932 patients: 1,356 with T2DM and 1,576 healthy controls. T2DM patients had significantly (P<0.01) lower RR-intervals (effect size = -0.61; 95%CI -1.21 to -0.01), lower SDNN (-0.65; -0.83 to -0.47), lower RMSSD (-0.92; -1.37 to -0.47), lower pNN50 (-0.46; -0.84 to -0.09), lower total power (-1.52; -2.13 to -0.91), lower LF (-1.08; -1.46 to -0.69]), and lower HF (-0.79; -1.09 to -0.50). LF/HF did not differ between groups. Levels of blood glucose and HbA1c were associated with several HRV parameters, as well as Time from diagnosis of T2DM. CONCLUSIONS T2DM was associated with an overall decrease in the HRV of T2DM patients. Both sympathetic and parasympathetic activity were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy.
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Affiliation(s)
- Thomas Benichou
- University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Clinical Research Direction, Clermont–Ferrand, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, LPNC & CNRS, LPNC, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Igor Tauveron
- Université Clermont Auvergne, CNRS, GReD, Inserm, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Daniela Pfabigan
- Peking University, Culture and Social Cognitive Neuroscience Laboratory, School of Psychological and Cognitive Sciences, Beijing, China
| | - Salwan Maqdasy
- Université Clermont Auvergne, CNRS, GReD, Inserm, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont–Ferrand, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
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2242
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Jácome Sánchez EC, García Castillo MA, González VP, Guillén López F, Correa Díaz EP. Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review. Mult Scler J Exp Transl Clin 2018; 4:2055217318768330. [PMID: 29662683 PMCID: PMC5894926 DOI: 10.1177/2055217318768330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/01/2018] [Accepted: 03/08/2018] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) and systemic lupus erythematous (SLE) are autoimmune diseases, the coexistence of which is uncommon in patients. Owing to the rarity of this condition, the distinction between MS and SLE is a diagnostic challenge for neurologists. We present a case report in which MS and SLE were present in the same patient. There are few case reports in the world on the association between MS and SLE. The following case report is the first of its kind in which both MS and SLE are present in a patient from a country with low prevalence of MS such as Ecuador.
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Affiliation(s)
| | | | | | - Fernando Guillén López
- Department of Neurology, Hospital José Carrasco de Cuenca, Popayán y Pacto Andino, Ecuador
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2243
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Abstract
Nowadays, the Internet is the major source to obtain information about diseases and their treatments. The Internet is gaining relevance in the neurological setting, considering the possibility of timely social interaction, contributing to general public awareness on otherwise less-well-known neurological conditions, promoting health equity and improving the health-related coping. Neurological patients can easily find several online opportunities for peer interactions and learning. On the other hand, neurologist can analyze user-generated data to better understand patient needs and to run epidemiological studies. Indeed, analyses of queries from Internet search engines on certain neurological diseases have shown a strict temporal and spatial correlation with the "real world." In this narrative review, we will discuss how the Internet is radically affecting the healthcare of people with neurological disorders and, most importantly, is shifting the paradigm of care from the hands of those who deliver care, into the hands of those who receive it. Besides, we will review possible limitations, such as safety concerns, financial issues, and the need for easy-to-access platforms.
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2244
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Nardin C, Latarche C, Soudant M, Dahan C, Michaud M, Pittion-Vouyovitch S, Guillemin F, Debouverie M, Mathey G. Generational changes in multiple sclerosis phenotype in North African immigrants in France: A population-based observational study. PLoS One 2018; 13:e0194115. [PMID: 29584762 PMCID: PMC5870962 DOI: 10.1371/journal.pone.0194115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/23/2018] [Indexed: 01/21/2023] Open
Abstract
Background The incidence of multiple sclerosis (MS) changes from generation to generation in ethnically different immigrants compared with native-born people. We aimed to determine whether there are generational changes in MS phenotypes among North African immigrants in France. Methods Cohort study with data from a population-based MS registry to compare the clinical characteristics of 80 first (NAG1) and 167 second (NAG2) generation North Africans with MS living in France with 5200 native-born Europeans. Adjusted Cox models were used to test the association between scores of 3 and 6 on the expanded disability status scale (EDSS) and the “origin/generation” variable. Results Cox models for EDSS scores 3 and 6 showed a higher risk of score 3 (hazard ratio = 1.738, 95% confidence interval 1.237 to 2.444; P = .002) and 6 (hazard ratio = 2.372, 95% confidence interval 1.626 to 3.462; P<.0001) for NAG1 than Europeans. Being NAG2 was not significantly associated with higher hazards of scores 3 and 6. Conclusions We found two different phenotypes among NAG1 and NAG2 MS patients in France. NAG1, but not NAG2, have a higher risk of disability than Europeans. This raises the question of environmental factors in MS expression, and advocates appropriate patient management according to generation in immigrants.
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Affiliation(s)
- Clotilde Nardin
- Nancy University Hospital, Department of Neurology, Nancy, France
- Saint-Denis Hospital, Department of Neurology, Saint-Denis, France
| | - Clotilde Latarche
- Nancy University Hospital, Université de Lorraine, Inserm CIC 1433 Clinical epidemiology, Nancy, France
| | - Marc Soudant
- Nancy University Hospital, Université de Lorraine, Inserm CIC 1433 Clinical epidemiology, Nancy, France
| | - Camille Dahan
- Nancy University Hospital, Department of Neurology, Nancy, France
| | - Maud Michaud
- Nancy University Hospital, Department of Neurology, Nancy, France
| | | | - Francis Guillemin
- Nancy University Hospital, Université de Lorraine, Inserm CIC 1433 Clinical epidemiology, Nancy, France
| | - Marc Debouverie
- Nancy University Hospital, Department of Neurology, Nancy, France
- Université de Lorraine, APEMAC, Nancy, France
| | - Guillaume Mathey
- Nancy University Hospital, Department of Neurology, Nancy, France
- Université de Lorraine, APEMAC, Nancy, France
- * E-mail:
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2245
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Vijayasingham L, Mairami FF. Employment of patients with multiple sclerosis: the influence of psychosocial-structural coping and context. Degener Neurol Neuromuscul Dis 2018; 8:15-24. [PMID: 30050385 PMCID: PMC6053901 DOI: 10.2147/dnnd.s131729] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with multiple sclerosis tend to report higher levels of work difficulties and negative outcomes, such as voluntary and involuntary work termination and reduced work participation. In this article, we discuss the complex interactions of disease, personal coping strategies, and social and structural factors that contribute to their work experiences and outcomes. An overview of the coping strategies and actions that leverage personal and context-level factors and dynamics is also provided to support the overall goal of continued work in patients with MS.
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Affiliation(s)
- Lavanya Vijayasingham
- Jeffrey Cheah School of Medicine, Monash University Malaysia, Bandar Sunway, Malaysia, .,Multiple Sclerosis Society of Malaysia, Petaling Jaya, Malaysia,
| | - Fatima Fanna Mairami
- Jeffrey Cheah School of Medicine, Monash University Malaysia, Bandar Sunway, Malaysia,
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2246
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Henriksen A, Haugen Mikalsen M, Woldaregay AZ, Muzny M, Hartvigsen G, Hopstock LA, Grimsgaard S. Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables. J Med Internet Res 2018; 20:e110. [PMID: 29567635 PMCID: PMC5887043 DOI: 10.2196/jmir.9157] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/18/2017] [Accepted: 01/06/2018] [Indexed: 01/05/2023] Open
Abstract
Background New fitness trackers and smartwatches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile apps. With recent advances in mobile sensor technology, privately collected physical activity data can be used as an addition to existing methods for health data collection in research. Furthermore, data collected from these devices have possible applications in patient diagnostics and treatment. With an increasing number of diverse brands, there is a need for an overview of device sensor support, as well as device applicability in research projects. Objective The objective of this study was to examine the availability of wrist-worn fitness wearables and analyze availability of relevant fitness sensors from 2011 to 2017. Furthermore, the study was designed to assess brand usage in research projects, compare common brands in terms of developer access to collected health data, and features to consider when deciding which brand to use in future research. Methods We searched for devices and brand names in six wearable device databases. For each brand, we identified additional devices on official brand websites. The search was limited to wrist-worn fitness wearables with accelerometers, for which we mapped brand, release year, and supported sensors relevant for fitness tracking. In addition, we conducted a Medical Literature Analysis and Retrieval System Online (MEDLINE) and ClinicalTrials search to determine brand usage in research projects. Finally, we investigated developer accessibility to the health data collected by identified brands. Results We identified 423 unique devices from 132 different brands. Forty-seven percent of brands released only one device. Introduction of new brands peaked in 2014, and the highest number of new devices was introduced in 2015. Sensor support increased every year, and in addition to the accelerometer, a photoplethysmograph, for estimating heart rate, was the most common sensor. Out of the brands currently available, the five most often used in research projects are Fitbit, Garmin, Misfit, Apple, and Polar. Fitbit is used in twice as many validation studies as any other brands and is registered in ClinicalTrials studies 10 times as often as other brands. Conclusions The wearable landscape is in constant change. New devices and brands are released every year, promising improved measurements and user experience. At the same time, other brands disappear from the consumer market for various reasons. Advances in device quality offer new opportunities for research. However, only a few well-established brands are frequently used in research projects, and even less are thoroughly validated.
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Affiliation(s)
- André Henriksen
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Martin Haugen Mikalsen
- Department of Computer Science, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | | | - Miroslav Muzny
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.,Spin-Off Company and Research Results Commercialization Center, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Gunnar Hartvigsen
- Department of Computer Science, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Laila Arnesdatter Hopstock
- Department of Health and Care Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
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2247
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Bakker DS, Garritsen FM, Leavis HL, van der Schaft J, Bruijnzeel-Koomen CAFM, van den Broek MPH, de Bruin-Weller MS. Lymphopenia in atopic dermatitis patients treated with oral immunosuppressive drugs. J DERMATOL TREAT 2018. [PMID: 29526121 DOI: 10.1080/09546634.2018.1451619] [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: 10/17/2022]
Abstract
INTRODUCTION Oral immunosuppressive drugs are commonly used in the treatment of atopic dermatitis (AD). In patients with autoimmune- and rheumatic diseases, these drugs have been associated with lymphopenia. Lymphopenia is related to an increased risk of opportunistic infections. The incidence of lymphopenia in patients with AD treated with oral immunosuppressive drugs is yet unknown. OBJECTIVE To evaluate the occurrence of recurrent lymphopenia in patients with AD treated with oral immunosuppressive drugs and to make recommendations for screening in daily practice. METHODS Patients with recurrent lymphopenia (i.e. >5 times lymphocyte counts below 0.8 × 109/L) during treatment with oral immunosuppressive drugs were included from our immunosuppressive drugs database and further analyzed. RESULTS A total of 360 AD patients, treated with oral immunosuppressive drugs, were screened. A recurrent lymphopenia during treatment was found in 11 patients. In 8/11 patients, recurrent lymphopenia was observed during concomitant treatment with prednisone. No serious infections were observed. CONCLUSION Lymphopenia is occasionally seen in AD patients treat with oral immunosuppressive drugs. Concomitant treatment with prednisone seems to be a risk factor. We suggest to include monitoring of lymphocyte counts in the standard follow-up for all AD patients treated with oral immunosuppressive drugs.
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Affiliation(s)
- Daphne S Bakker
- a Department of Dermatology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Floor M Garritsen
- a Department of Dermatology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Helen L Leavis
- b Department of Rheumatology and Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Jorien van der Schaft
- a Department of Dermatology , University Medical Center Utrecht , Utrecht , The Netherlands
| | | | - Marcel P H van den Broek
- c Department of Clinical Pharmacy , University Medical Center Utrecht , Utrecht , The Netherlands.,d Department of Clinical Pharmacy , St Antonius Hospital , Nieuwegein , The Netherlands
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2248
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Lu M, Taylor BV, Körner H. Genomic Effects of the Vitamin D Receptor: Potentially the Link between Vitamin D, Immune Cells, and Multiple Sclerosis. Front Immunol 2018; 9:477. [PMID: 29593729 PMCID: PMC5857605 DOI: 10.3389/fimmu.2018.00477] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/22/2018] [Indexed: 12/12/2022] Open
Abstract
Vitamin D has a plethora of functions that are important for the maintenance of general health and in particular, the functional integrity of the immune system, such as promoting an anti-inflammatory cytokine profile and reducing the Treg/Th17 ratio. Multiple sclerosis (MS) is a chronic, inflammatory, and neurodegenerative central nervous system (CNS) disorder of probable autoimmune origin. MS is characterized by recurring or progressive demyelination and degeneration of the CNS due in part to a misguided immune response to as yet undefined (CNS) antigens, potentially including myelin basic protein and proteolipid protein. MS has also been shown to be associated significantly with environmental factors such as the lack of vitamin D. The role of vitamin D in the pathogenesis and progression of MS is complex. Recent genetic studies have shown that various common MS-associated risk-single-nucleotide polymorphisms (SNPs) are located within or in the vicinity of genes associated with the complex metabolism of vitamin D. The functional aspects of these genetic associations may be explained either by a direct SNP-associated loss- or gain-of-function in a vitamin D-associated gene or due to a change in the regulation of gene expression in certain immune cell types. The development of new genetic tools using next-generation sequencing: e.g., chromatin immunoprecipitation sequencing (ChIP-seq) and the accompanying rapid progress of epigenomics has made it possible to recognize that the association between vitamin D and MS could be based on the extensive and characteristic genomic binding of the vitamin D receptor (VDR). Therefore, it is important to analyze comprehensively the spatiotemporal VDR binding patterns that have been identified using ChIP-seq in multiple immune cell types to reveal an integral profile of genomic VDR interaction. In summary, the aim of this review is to connect genomic effects vitamin D has on immune cells with MS and thus, to contribute to a better understanding of the influence of vitamin D on the etiology and the pathogenesis of this complex autoimmune disease.
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Affiliation(s)
- Ming Lu
- Menzies Institute for Medical Research Tasmania, Hobart, TAS, Australia
| | - Bruce V. Taylor
- Menzies Institute for Medical Research Tasmania, Hobart, TAS, Australia
| | - Heinrich Körner
- Menzies Institute for Medical Research Tasmania, Hobart, TAS, Australia
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education, Engineering Technology Research Center of Anti-inflammatory and Immunodrugs in Anhui Province, Hefei, China
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2249
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Massey JC, Sutton IJ, Ma DDF, Moore JJ. Regenerating Immunotolerance in Multiple Sclerosis with Autologous Hematopoietic Stem Cell Transplant. Front Immunol 2018; 9:410. [PMID: 29593711 PMCID: PMC5857574 DOI: 10.3389/fimmu.2018.00410] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/14/2018] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory disorder of the central nervous system where evidence implicates an aberrant adaptive immune response in the accrual of neurological disability. The inflammatory phase of the disease responds to immunomodulation to varying degrees of efficacy; however, no therapy has been proven to arrest progression of disability. Recently, more intensive therapies, including immunoablation with autologous hematopoietic stem cell transplantation (AHSCT), have been offered as a treatment option to retard inflammatory disease, prior to patients becoming irreversibly disabled. Empirical clinical observations support the notion that the immune reconstitution (IR) that occurs following AHSCT is associated with a sustained therapeutic benefit; however, neither the pathogenesis of MS nor the mechanism by which AHSCT results in a therapeutic benefit has been clearly delineated. Although the antigenic target of the aberrant immune response in MS is not defined, accumulated data suggest that IR following AHSCT results in an immunotolerant state through deletion of pathogenic clones by a combination of direct ablation and induction of a lymphopenic state driving replicative senescence and clonal attrition. Restoration of immunoregulation is evidenced by changes in regulatory T cell populations following AHSCT and normalization of genetic signatures of immune homeostasis. Furthermore, some evidence exists that AHSCT may induce a rebooting of thymic function and regeneration of a diversified naïve T cell repertoire equipped to appropriately modulate the immune system in response to future antigenic challenge. In this review, we discuss the immunological mechanisms of IR therapies, focusing on AHSCT, as a means of recalibrating the dysfunctional immune response observed in MS.
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Affiliation(s)
- Jennifer C Massey
- Haematology and Bone Marrow Transplantation, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,Neurology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,Centre for Applied Medical Research, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ian J Sutton
- Neurology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - David D F Ma
- Haematology and Bone Marrow Transplantation, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,Centre for Applied Medical Research, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - John J Moore
- Haematology and Bone Marrow Transplantation, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,Centre for Applied Medical Research, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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2250
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Abstract
Background Obesity-related diseases cause costs to society. We studied the cost of work absenteeism before and after gastric bypass and the effects of postoperative diabetes resolution. Patients and Methods Data were obtained from the Scandinavian Obesity Surgery Registry (SOReg) (national coverage >98%) and cross-matched with data from the Social insurance Agency (coverage 100%) for the period ±3 years from operation. In 2010, a total of 7454 bariatric surgeries were performed; the study group is 4971 unique individuals with an annual income of >10,750 Euros and complete data sets. A sex-, age-, and income-matched reference population was identified for comparison. Results Patients with obesity had preoperatively a 3.5-fold higher absenteeism. During follow-up (FU), the ratio relative to the reference population remained constant. An increase of 12–14 net absenteeism days was observed in the first 3 months after surgery. Female sex (OR 1.5, CI 1.13–1.8), preoperative anti-depressant use (OR 1.5, CI 1.3–1.9), low income (OR 1.4, CI 1.2–1.8), and a history of sick leave (OR 1.004, CI 1.003–1.004) were associated with increased absenteeism during FU. Diabetes resolution did not decrease absenteeism from preoperative values. Conclusions Patients with obesity have higher preoperative absenteeism than the reference population. Operation caused an increase the first 90 days after surgery of 12–13 days. There were no relative increases in absenteeism in the next 3 years; patients did not deviate from preoperative patterns but followed the trend of the reference population. Preoperative diabetes did not elevate that level during FU; diabetes resolution did not lower absenteeism.
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