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Abualhasan A, Naseer MA, Shalaby N, El-Jaafary SI, Farghaly M, Shehata HS, Doma ES, Al-Azayem SA. Reliability and validity of the Arabic version of brief international cognitive assessment for multiple sclerosis in Egyptian pediatric multiple sclerosis patients. Mult Scler Relat Disord 2024; 82:105374. [PMID: 38134604 DOI: 10.1016/j.msard.2023.105374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/02/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND & OBJECTIVES About one-third of pediatric-onset MS (POMS) patients report cognitive impairment. This case-control study aimed to assess the reliability and validity of the Arabic version of the Brief International Cognitive Assessment for MS (BICAMS) in Egyptian POMS patients. METHODS A case-control study was conducted on 30 POMS patients aged 9 to 17 years old and 30 healthy controls. Both groups underwent the following tests: neuropsychological testing using the BICAMS-validated Arabic version battery involving the Symbol Digit Modality Test (SDMT), California Verbal Learning Test 2nd edition (CVLT-II) and revised Brief Visuospatial Retention Test (BVRT-R). Test-retest data were obtained from MS patients and controls 2 weeks following the primary evaluation. Mean variances between both groups were evaluated, controlling for age, gender, and educational level. RESULTS MS patients scored significantly lower on the SDMT, CVLT-II, and BVMT-R tests than healthy controls (P-value <0.001). Test-retest reliability was satisfactory for SDMT, CVLT-II total, and BVRT-R in MS patients and controls with r values of 0.73, 0.83, and 0.80, respectively. CONCLUSION BICAMS is a feasible approach to cognitive screening in POMS and adults. The Arabic version of BICAMS is a reliable and valid tool for the cognitive assessment of pediatric MS patients in different clinical and research settings.
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Affiliation(s)
| | | | - Nevin Shalaby
- Department of Neurology, Cairo University, Cairo, Egypt
| | | | - Marwa Farghaly
- Department of Neurology, Cairo University, Cairo, Egypt.
| | | | - Ebtehal S Doma
- Department of Neurology, Cairo University, Cairo, Egypt.
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202
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Jaboob A, Asmi AA, Islam MM, Rezvi S, Redha I, Al-Khabouri J, Al-Zakwani I, Al-Qassabi A, Al-Abri H, Gujjar AR. Frequency of Dimethyl Fumarate-Induced Lymphopenia among Omani Patients with Multiple Sclerosis. Sultan Qaboos Univ Med J 2024; 24:44-51. [PMID: 38434464 PMCID: PMC10906776 DOI: 10.18295/squmj.9.2023.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/24/2023] [Accepted: 08/22/2023] [Indexed: 03/05/2024] Open
Abstract
Objectives Dimethyl fumarate (DMF) is known to cause lymphopenia when used to treat patients with multiple sclerosis (MS). However, research on DMF therapy in the Arab world, especially in Oman, is scarce. This study aimed to analyse the prevalence of lymphopenia among Omani patients with MS and their reasons for discontinuing DMF therapy. Methods In this retrospective study, the medical records of Omani patients with MS who were treated using DMF at two tertiary hospitals in Muscat, Oman, from February 2017 to February 2023 were reviewed. Their demographic, clinical and laboratory data were retrieved and analysed. Absolute lymphocyte count values at baseline and at the last follow-up, as well as the reasons for discontinuing DMF therapy, were collected. Descriptive and inferential statistical techniques were used for data analysis. Binary-logistic regression analysis was used to identify the risk factors for DMF-induced lymphopenia. Results A total of 64 Omani patients with MS were included in this study. The majority of the study participants (n = 40; 63%) were female. All included patients started DMF therapy at the mean age of 33 ± 7.7 years. After administration of DMF, 14 (21.9%) patients developed grades 1-3 of lymphopenia. The DMF therapy was discontinued for 23 (36.0%) patients, mainly in response to adverse events or confirmed pregnancy. Female gender was the only significant predictor of DMF-induced lymphopenia (P = 0.037). Conclusions Most Omani patients with MS had mild lymphopenia (grades 1-2). Early adverse events and pregnancy were the main reasons provided for discontinuing DMF therapy.
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Affiliation(s)
- Ahmed Jaboob
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
- Department of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Abdullah Al Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - M. Mazharul Islam
- Department of Statistics, College of Science, Sultan Qaboos University, Muscat, Oman
| | - Syed Rezvi
- Department of Family Medicine & Public Health, Sultan Qaboos University, Muscat, Oman
| | - Iman Redha
- Neurology Department, Khoula Hospital, Muscat, Oman
| | | | - Ibrahim Al-Zakwani
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ahmed Al-Qassabi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
- Department of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Haifa Al-Abri
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
- Department of Medicine, Sultan Qaboos University, Muscat, Oman
- Neurology Department, Khoula Hospital, Muscat, Oman
| | - Arunodaya R. Gujjar
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
- Department of Medicine, Sultan Qaboos University, Muscat, Oman
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203
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Stoll S, Costello K, Newsome SD, Schmidt H, Sullivan AB, Hendin B. Insights for Healthcare Providers on Shared Decision-Making in Multiple Sclerosis: A Narrative Review. Neurol Ther 2024; 13:21-37. [PMID: 38180727 PMCID: PMC10787702 DOI: 10.1007/s40120-023-00573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Shared decision-making (SDM) between the patient and their healthcare provider (HCP) in developing treatment plans is increasingly recognized as central to improving treatment adherence and, ultimately, patient outcomes. In multiple sclerosis (MS), SDM is particularly crucial for optimizing treatment in a landscape that has grown more complex with the availability of newer, high-efficacy MS therapies. However, little direct evidence on the effectiveness of SDM is available to guide practice. Multiple factors, including patient age, ethnic background, perceptions, invisible MS symptoms, and psychological comorbidities can influence a patient's willingness and ability to participate in SDM. HCPs need to appreciate these factors and ask the right questions to break down obstacles to SDM. The HCP has a responsibility to help patients feel adequately informed and comfortable in having an active role in their care. This review identifies potential barriers to SDM and provides a strategy for HCPs to overcome these obstacles through patient (and caregiver) discussions to ensure optimal patient satisfaction with treatment and thus the best possible outcomes for their patients.
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Affiliation(s)
| | | | - Scott D Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hollie Schmidt
- Accelerated Cure Project for Multiple Sclerosis, Waltham, MA, USA
| | - Amy B Sullivan
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Barry Hendin
- Integrated Multiple Sclerosis Center, Phoenix, AZ, USA
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Mohammadzamani M, Kazemzadeh K, Chand S, Thapa S, Ebrahimi N, Yazdan Panah M, Shaygannejad V, Mirmosayyeb O. Insights into the interplay between Epstein-Barr virus (EBV) and multiple sclerosis (MS): A state-of-the-art review and implications for vaccine development. Health Sci Rep 2024; 7:e1898. [PMID: 38361801 PMCID: PMC10867693 DOI: 10.1002/hsr2.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/12/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Background and Aims Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS). MS results from an inflammatory process leading to the loss of neural tissue and increased disability over time. The role of Epstein Barr Virus (EBV), as one of the most common global viruses, in MS development has been the subject of several studies. However, many related questions are still unanswered. This study aimed to review the connection between MS and EBV and provide a quick outline of MS prevention using EBV vaccination. Methods For this narrative review, an extensive literature search using specific terms was conducted across online databases, including PubMed/Medline, Scopus, Web of Science, and Google Scholar, to identify pertinent studies. Results Several studies proved that almost 100% of people with MS showed a history of EBV infection, and there was an association between high titers of EBV antibodies and an increased risk of MS development. Various hypotheses are proposed for how EBV may contribute to MS directly and indirectly: (1) Molecular Mimicry, (2) Mistaken Self, (3) Bystander Damage, and (4) Autoreactive B cells infected with EBV. Conclusion Given the infectious nature of EBV and its ability to elude the immune system, EBV emerges as a strong candidate for being the underlying cause of MS. The development of an EBV vaccine holds promise for preventing MS; however, overcoming the challenge of creating a safe and efficacious vaccine presents a significant obstacle.
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Affiliation(s)
- Mahtab Mohammadzamani
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Kimia Kazemzadeh
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Swati Chand
- Westchester Medical CenterNew York Medical CollegeValhallaNew YorkUSA
| | - Sangharsha Thapa
- Department of Neurology, Westchester Medical CenterNew York Medical CollegeValhallaUSA
| | - Narges Ebrahimi
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | | | - Vahid Shaygannejad
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
- Department of NeurologyIsfahan University of Medical SciencesIsfahanIran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
- Department of NeurologyIsfahan University of Medical SciencesIsfahanIran
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205
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Pardo CA. Clinical Approach to Myelopathy Diagnosis. Continuum (Minneap Minn) 2024; 30:14-52. [PMID: 38330471 DOI: 10.1212/con.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article describes an integrative strategy to evaluate patients with suspected myelopathy, provides advice on diagnostic approach, and outlines the framework for the etiologic diagnosis of myelopathies. LATEST DEVELOPMENTS Advances in diagnostic neuroimaging techniques of the spinal cord and improved understanding of the immune pathogenic mechanisms associated with spinal cord disorders have expanded the knowledge of inflammatory and noninflammatory myelopathies. The discovery of biomarkers of disease, such as anti-aquaporin 4 and anti-myelin oligodendrocyte glycoprotein antibodies involved in myelitis and other immune-related mechanisms, the emergence and identification of infectious disorders that target the spinal cord, and better recognition of myelopathies associated with vascular pathologies have expanded our knowledge about the broad clinical spectrum of myelopathies. ESSENTIAL POINTS Myelopathies include a group of inflammatory and noninflammatory disorders of the spinal cord that exhibit a wide variety of motor, sensory, gait, and sensory disturbances and produce major neurologic disability. Both inflammatory and noninflammatory myelopathies comprise a broad spectrum of pathophysiologic mechanisms and etiologic factors that lead to specific clinical features and presentations. Knowledge of the clinical variety of myelopathies and understanding of strategies for the precise diagnosis, identification of etiologic factors, and implementation of therapies can help improve outcomes.
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206
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Kamath V, Yanek LR, Neufeld KJ, Lewis A, Aziz H, Le LM, Tian J, Moghekar A, Hogue CW, Brown CH. Poor olfaction prior to cardiac surgery: Association with cognition, plasma neurofilament light, and post-operative delirium. Int J Geriatr Psychiatry 2024; 39:e6066. [PMID: 38314872 PMCID: PMC10958662 DOI: 10.1002/gps.6066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Post-operative delirium (POD) affects up to 50% of cardiac surgery patients, with higher incidence in older adults. There is increasing need for screening tools that identify individuals most vulnerable to POD. Here, we examined the relationship between pre-operative olfaction and both incident POD and POD severity in patients undergoing cardiac surgery. We also examined cross-sectional relationships between baseline olfaction, cognition, and plasma neurofilament light (NfL). METHODS Individuals undergoing cardiac surgery (n = 189; mean age = 70 years; 75% men) were enrolled in a clinical trial of cerebral autoregulation monitoring. At baseline, odor identification performance (Brief Smell Identification Test), cognitive performance, and plasma concentrations of NfL levels (Simoa™ NF-Light Assay) were measured. Delirium was assessed with the Confusion Assessment Method (CAM) or CAM-ICU, and delirium severity was assessed using the Delirium Rating Scale-Revised-98. The association of baseline olfaction, delirium incidence, and delirium severity was examined in regression models adjusting for age, duration of cardiopulmonary bypass, logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), and baseline cognition. RESULTS Olfactory dysfunction was present in 30% of patients, and POD incidence was 44%. Pre-operative olfactory dysfunction was associated with both incident POD (OR = 3.17, p = 0.001) and greater severity of POD after cardiac surgery (OR = 3.94 p < 0.001) in models adjusted for age, duration of bypass, and a surgical risk score. The addition of baseline cognition attenuated the strength of the association, but it remained significant for incident POD (OR = 2.25, p = 0.04) and POD severity (OR 2.10, p = 0.04). Poor baseline olfaction was associated with greater baseline cognitive dysfunction (p < 0.001) and increased baseline plasma NfL concentrations (p = 0.04). Neither age, cognition, nor baseline NFL concentration modified the association of impaired olfaction and delirium outcomes. CONCLUSIONS Olfactory assessment may be a useful pre-surgical screening tool for the identification of patients undergoing cardiac surgery at increased risk of POD. Identifying those at highest risk for severe delirium and poor cognitive outcomes following surgery would allow for earlier intervention and pre-operative rehabilitation strategies, which could ultimately impact the functional disability and morbidity associated with POD.
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Affiliation(s)
- Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa R Yanek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karin J Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Alexandria Lewis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hamza Aziz
- Department of Surgery Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lan M Le
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Emergent Biosolutions Company, Gaithersburg, Maryland, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles W Hogue
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles H Brown
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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207
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Levy M. Immune-Mediated Myelopathies. Continuum (Minneap Minn) 2024; 30:180-198. [PMID: 38330478 PMCID: PMC10868882 DOI: 10.1212/con.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Immune-mediated myelopathies are conditions in which the immune system attacks the spinal cord. This article describes the distinguishing characteristics of immune-mediated myelopathies and treatment strategies for patients affected by these disorders. LATEST DEVELOPMENTS New biomarkers, such as aquaporin 4 and myelin oligodendrocyte glycoprotein antibodies, in the blood and spinal fluid have led to the identification of antigen-specific immune-mediated myelopathies and approved therapies to prevent disease progression. ESSENTIAL POINTS The first step in the diagnosis of an immune-mediated myelopathy is confirming that the immune system is the cause of the attack by excluding non-immune-mediated causes. The second step is to narrow the differential diagnosis based on objective biomarkers such as serology and MRI patterns. The third step is to treat the specific immune-mediated myelopathy by using evidence-based medicine.
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208
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Aryanian Z, Balighi K, Emadi SN, Hatami P. Rituximab as a maintenance treatment in patients with pemphigus vulgaris: When is the right time for discontinuation? J Cosmet Dermatol 2024; 23:406-408. [PMID: 37916650 DOI: 10.1111/jocd.16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Naser Emadi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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209
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Aladdin YS, Alqarni DA, Alamoudi SW, Alharbi AA, Fudhah WA, Alghamdi G, Attar A. The Safety Profile of Common COVID-19 Vaccines in Patients With Multiple Sclerosis. Cureus 2024; 16:e54852. [PMID: 38533153 PMCID: PMC10964219 DOI: 10.7759/cureus.54852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Background and objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). In light of the COVID-19 pandemic that emerged in late 2019, the World Health Organization (WHO) has endorsed mass immunization to enhance the population's immunity against the virus. However, certain concerns have been raised about the safety of COVID-19 vaccines among patients with autoimmune disorders, including those with multiple sclerosis (MS). Further research is required to address these concerns and to gain deeper insights into the possible complications of COVID-19 vaccines among MS patients. This study aimed to assess the side effects of COVID-19 vaccines among MS patients. Methods An observational cross-sectional study was conducted between May and November 2023 at the National Guard Hospital, Jeddah, Saudi Arabia. All MS patients enrolled in our local registry system and provided phone numbers were included in the study. A total of 208 MS patients were surveyed via phone interviews, and data were collected regarding their demographics, MS history, COVID-19 history, SARS-CoV-2 vaccination status, and their exposure to disease-modifying therapies (DMTs). All results were analyzed using Stata software. Statistical significance was set at a CI of 95% and a p-value <0.05. Results In our cohort, 128 (61.5%) patients had received three doses of the COVID-19 vaccine, while 68 (32.7%) had received two doses; four patients (2.0%) had received only one dose, five (2.4%) had not received the vaccine, and the number of doses was unknown for the remaining three patients (1.4%). The BNT162b2 mRNA COVID-19 Vaccine from Pfizer-BioNTech was the most commonly administered (n=136 patients, 66.0%), followed byChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca (n=47 patients, 22.8%), and mRNA-1273 SARS-CoV-2 Vaccine from Moderna (n=5 patients, 2.4%). Of note, 139 patients (69.5%) reported experiencing adverse events after receiving the vaccine, and the ChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca was significantly associated with higher rates of side effects, in 87.8% of the patients. Conclusion A sizable proportion of MS patients experienced self-limiting side effects from exposure to the COVID-19 vaccine. The rates and incidence of side effects were similar to those encountered in the general population. None of the adverse effects recorded in our population of MS patients were serious or life-threatening. We recommend that physicians encourage patients with MS who have never received COVID-19 vaccination to get promptly vaccinated as the risks of COVID-19 infection far outweigh the minor risks associated with COVID-19 vaccination.
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Affiliation(s)
- Yasser S Aladdin
- Neurology Section, Department of Medicine, King Abdulaziz Medical City, Jeddah, SAU
| | - Danah A Alqarni
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Sheifa W Alamoudi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdulrahman A Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Waad A Fudhah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ghaida Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ahmed Attar
- Department of Neurology, King Abdulaziz Medical City, Jeddah, SAU
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Kragsnaes MS, Jensen JRB, Nilsson AC, Malik MI, Munk HL, Pedersen JK, Horn HC, Kruhøffer M, Kristiansen K, Mullish BH, Marchesi JR, Kjeldsen J, Röttger R, Ellingsen T. Dynamics of inflammation-associated plasma proteins following faecal microbiota transplantation in patients with psoriatic arthritis and healthy controls: exploratory findings from the FLORA trial. RMD Open 2024; 10:e003750. [PMID: 38296309 PMCID: PMC10836383 DOI: 10.1136/rmdopen-2023-003750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES The gut microbiota can mediate both pro and anti-inflammatory responses. In patients with psoriatic arthritis (PsA), we investigated the impact of faecal microbiota transplantation (FMT), relative to sham transplantation, on 92 inflammation-associated plasma proteins. METHODS This study relates to the FLORA trial cohort, where 31 patients with moderate-to-high peripheral PsA disease activity, despite at least 3 months of methotrexate treatment, were included in a 26-week, double-blind, randomised, sham-controlled trial. Participants were allocated to receive either one gastroscopic-guided healthy donor FMT (n=15) or sham (n=16). Patient plasma samples were collected at baseline, week 4, 12 and 26 while samples from 31 age-matched and sex-matched healthy controls (HC) were collected at baseline. Samples were analysed using proximity extension assay technology (Olink Target-96 Inflammation panel). RESULTS Levels of 26 proteins differed significantly between PsA and HC pre-FMT (adjusted p<0.05), of which 10 proteins were elevated in PsA: IL-6, CCL20, CCL19, CDCP1, FGF-21, HGF, interferon-γ (IFN-γ), IL-18R1, monocyte chemotactic protein 3, and IL-2. In the FMT group, levels of 12 proteins changed significantly across all timepoints (tumour necrosis factor (TNF), CDCP1, IFN-γ, TWEAK, signalling lymphocytic activation molecule (SLAMF1), CD8A, CD5, Flt3L, CCL25, FGF-23, CD6, caspase-8). Significant differences in protein levels between FMT and sham-treated patients were observed for TNF (p=0.002), IFN-γ (p=0.011), stem cell factor (p=0.024), matrix metalloproteinase-1 (p=0.038), and SLAMF1 (p=0.042). FMT had the largest positive effect on IFN-γ, Axin-1 and CCL25 and the largest negative effect on CCL19 and IL-6. CONCLUSIONS Patients with active PsA have a distinct immunological plasma protein signature compared with HC pre-FMT. FMT affects several of these disease markers, including sustained elevation of IFN-γ. TRIAL REGISTRATION NUMBER NCT03058900.
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Affiliation(s)
- Maja Skov Kragsnaes
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Muhammad Irfan Malik
- Department of Mathematics and Computer Science (IMADA), University of Southern Denmark, Odense, Denmark
| | - Heidi Lausten Munk
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jens Kristian Pedersen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Karsten Kristiansen
- Department of Biology, Laboratory of Genomics and Molecular Biomedicine, University of Copenhagen, Copenhagen, Denmark
- Institute of Metagenomics, Qingdao-Europe Advanced Institute for Life Sciences, Qingdao, China
| | - Benjamin H Mullish
- Division of Digestive Diseases, Imperial College London Faculty of Medicine, London, UK
- Department of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Julian R Marchesi
- Division of Digestive Diseases, Imperial College London Faculty of Medicine, London, UK
| | - Jens Kjeldsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Richard Röttger
- Department of Mathematics and Computer Science (IMADA), University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Shaygannejad V, Mirmosayyeb O, Bagherieh S, Shaygan P, Ghajarzadeh M. The Efficacy of Fingolimod and Interferons in Controlling Disability and Relapse Rate in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis. Int J Prev Med 2024; 14:131. [PMID: 38449687 PMCID: PMC10916411 DOI: 10.4103/ijpvm.ijpvm_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/27/2022] [Indexed: 03/08/2024] Open
Abstract
Background Fingolimod and interferons are used in the relapse form of multiple sclerosis (MS). The goal of this systematic review and meta-analysis was to evaluate the efficacy of fingolimod versus interferon in patients with MS. The systematic search was done in PubMed, Scopus, Embase, Web of Science, and Google Scholar. Methods The references of included studies as well as conference abstracts were searched up to July 2021. The literature search revealed 8211 articles, and after deleting duplicates 5594 remained. For the meta-analysis, four studies were included. The standardized mean difference (SMD) of the Expanded Disability Status Scale (EDSS) after treatment (interferon vs fingolimod) was -0.06 (95% CI: -0.28, 0.17) (I2 = 80.2%, P = 0.002). Results The SMD of the annual relapse rate (ARR) after treatment (interferon - fingolimod) was -0.08 (95% CI: -0.53, 0.36) (I2 = 95.5%, P < 0.001). The SMD of the ARR after treatment and before treatment in the interferon group was - 1.45, (95% CI: -1.55, -1.36) (I2 = 0, P = 0.3). The SMD of ARR after treatment and before treatment in the fingolimod group was - 1.3, (95% CI: -1.94, -0.65) (I2 = 97.4%, P < 0.001). Conclusions: The results of this systematic review show that efficacy of interferon and fingolimod in controlling relapse rate and disability is similar.
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Affiliation(s)
- Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Bagherieh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Shaygan
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Ghajarzadeh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
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212
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Scalia M, Borzuola R, Parrella M, Borriello G, Sica F, Monteleone F, Maida E, Macaluso A. Neuromuscular Electrical Stimulation Does Not Influence Spinal Excitability in Multiple Sclerosis Patients. J Clin Med 2024; 13:704. [PMID: 38337396 PMCID: PMC10856365 DOI: 10.3390/jcm13030704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus Hoffmann reflex (H-reflex), between MS patients and healthy individuals, under three experimental conditions involving the ankle planta flexor muscles: (1) passive NMES (pNMES); (2) NMES superimposed onto isometric voluntary contraction (NMES+); and (3) isometric voluntary contraction (ISO). (2) Methods: In total, 20 MS patients (MS) and 20 healthy individuals as the control group (CG) took part in a single experimental session. Under each condition, participants performed 15 repetitions of 6 s at 20% of maximal voluntary isometric contraction, with 6 s of recovery between repetitions. Before and after each condition, H-reflex amplitudes were recorded. (3) Results: In MS, H-reflex amplitude did not change under any experimental condition (ISO: p = 0.506; pNMES: p = 0.068; NMES+: p = 0.126). In CG, H-reflex amplitude significantly increased under NMES+ (p = 0.01), decreased under pNMES (p < 0.000) and was unaltered under ISO (p = 0.829). (4) Conclusions: The different H-reflex responses between MS and CG might reflect a reduced ability of MS patients in modulating spinal excitability.
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Affiliation(s)
- Martina Scalia
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Riccardo Borzuola
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Martina Parrella
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Giovanna Borriello
- Neurology Unit, San Pietro Fatebenefratelli Hospital, MS Centre, 00189 Rome, Italy
| | - Francesco Sica
- Santa Maria Goretti Hospital, 04100 Latina, Italy; (F.S.); (F.M.)
| | | | - Elisabetta Maida
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
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213
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Amoriello R, Memo C, Ballerini L, Ballerini C. The brain cytokine orchestra in multiple sclerosis: from neuroinflammation to synaptopathology. Mol Brain 2024; 17:4. [PMID: 38263055 PMCID: PMC10807071 DOI: 10.1186/s13041-024-01077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Abstract
The central nervous system (CNS) is finely protected by the blood-brain barrier (BBB). Immune soluble factors such as cytokines (CKs) are normally produced in the CNS, contributing to physiological immunosurveillance and homeostatic synaptic scaling. CKs are peptide, pleiotropic molecules involved in a broad range of cellular functions, with a pivotal role in resolving the inflammation and promoting tissue healing. However, pro-inflammatory CKs can exert a detrimental effect in pathological conditions, spreading the damage. In the inflamed CNS, CKs recruit immune cells, stimulate the local production of other inflammatory mediators, and promote synaptic dysfunction. Our understanding of neuroinflammation in humans owes much to the study of multiple sclerosis (MS), the most common autoimmune and demyelinating disease, in which autoreactive T cells migrate from the periphery to the CNS after the encounter with a still unknown antigen. CNS-infiltrating T cells produce pro-inflammatory CKs that aggravate local demyelination and neurodegeneration. This review aims to recapitulate the state of the art about CKs role in the healthy and inflamed CNS, with focus on recent advances bridging the study of adaptive immune system and neurophysiology.
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Affiliation(s)
- Roberta Amoriello
- International School for Advanced Studies (SISSA/ISAS), 34136, Trieste, Italy.
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, 50139, Florence, Italy.
| | - Christian Memo
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, 50139, Florence, Italy
| | - Laura Ballerini
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, 50139, Florence, Italy
| | - Clara Ballerini
- International School for Advanced Studies (SISSA/ISAS), 34136, Trieste, Italy.
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214
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Marignier R, Laplaud D, Zéphir H, Papeix C, Leray E, Amri E, Piotaix M, de Sèze J. Real-life study to assess effectiveness and safety of eculizumab in patients with neuromyelitis optica spectrum disorders in France: protocol for ECUP4, an observational study. Front Neurol 2024; 14:1303874. [PMID: 38318238 PMCID: PMC10839895 DOI: 10.3389/fneur.2023.1303874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 02/07/2024] Open
Abstract
Background Eculizumab, a humanized monoclonal antibody targeting the C5 complement protein, has been approved for the treatment of neuromyelitis optica spectrum disorders (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive (Ab+). The aim of this study is to evaluate the long-term effectiveness and safety of eculizumab in French adults with NMOSD and to describe patients' characteristics, disability, and quality of life using data collected in a real-world setting. Methods This is the protocol for ECUP4, an ongoing prospective, observational, non-comparative, multicenter study conducted in 32 reference centers in France. Eligible patients must also be enrolled in NOMADMUS, a nested cohort of the French national multiple sclerosis registry (OFSEP). The primary endpoint is the annualized relapse rate. Secondary endpoints include the long-term safety of eculizumab, as well as patients' characteristics, treatment outcomes, disability, pain, visual acuity, and quality of life. Visits and treatments follow routine clinical practice. The case report forms (CRF) comprise data recorded in the context of the NOMADMUS cohort, collected during routine visits. The inclusion period is planned for 3 years, with no limitation on the number of patients enrolled. The maximum follow-up duration will be 5.5 years. Conclusion The efficacy and safety of eculizumab in patients with AQP4+ NMOSD have been demonstrated in randomized clinical trials that showed a significant reduction in the risk of relapse, with a safety profile consistent with other indications. This study will provide clinical and patient-reported evidence of the benefits of eculizumab, using data from a real-world setting in France. Trial registration number This study is registered at the French public repertory Health data Hub, N° F20211228123801. All information can be accessed at: https://www.health-data-hub.fr/.
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Affiliation(s)
- Romain Marignier
- Service de Neurologie, SEP Neuroinflammation et Pathologies de la Myéline, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM) - Hôpital Pierre Wertheimer, Bron, France
| | - David Laplaud
- Service de Neurologie du CHU de Nantes, CR2TI-Inserm U1064, CRC-SEP Pays de la Loire, Nantes Université, Nantes, France
| | - Hélène Zéphir
- Service de Neurologie du CHU Hôpital Roger Salengro, Lille, France
| | - Caroline Papeix
- Service de Neurologie, Hôpital Fondation A. de Rothshchild, Paris, France
| | - Emmanuelle Leray
- Univ Rennes, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
| | - Ekbel Amri
- Alexion, AstraZeneca Rare Disease, Levallois Perret, France
| | | | - Jérôme de Sèze
- Service de Neurologie du Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
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215
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Habibi MA, Yazdan Panah M, Vaheb S, Olfatifar M, Shaygannejad A, Mokary Y, Ghasemi M, Thapa S, Shaygannejad V, Mirmosayyeb O. Validity and reliability of the Persian version of Recce stigma scale in people with multiple sclerosis and its impact on quality of life. BMC Neurol 2024; 24:36. [PMID: 38254066 PMCID: PMC10802045 DOI: 10.1186/s12883-024-03544-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND There is often a fear of social stigma experienced by people with multiple sclerosis (pwMS), which negatively impacts the quality of their lives (QoL). Currently, no Persian-validated questionnaire is available to assess this issue in pwMS. This study aimed to assess the validaty and reliability of the Persian version of Reece Stigma Scale Multiple Sclerosis (RSS-MS) questionnaire for pwMS. METHOD This cross-sectional was conducted between January and February 2023 in Isfahan, Iran. The demographic and clinical information and the RSS-MS and Multiple Sclerosis Impact Scale-29 (MSIS-29) questionnaires were recorded from pwMS. The content validity index (CVI) and content validity ratio (CVR) have been used to evaluate validity. To identify the factors supporting the MS-related stigma, an exploratory factor analysis (EFA) was conducted. RESULTS The present study recruited 194 pwMS. Based on factor analysis, only two factors had eigenvalues ≥ 1.0 and exhibited high internal consistency. The Cronbach's α coefficient for internal consistency of the RSS-MS scale was 0.822. More evidence for the construct validity suggested that having higher levels of stigma is significantly correlated with psychological (r = 0.468, p-value < 0.001) and physical dimensions (r = 0.585, p-value < 0.001) of MSIS-29. Expanded Disability Status Scale, disease duration, and treatment duration did not show a significant correlation with stigma (p-value > 0.05). CONCLUSION This study indicated that the modified version of the RSS-MS scale in the Persian language showed acceptable validity and reliability for evaluating the stigma among Persian pwMS. Furthermore, this study emphasizes the cruciality of monitoring and addressing stigma among pwMS, as it can potentially enhance medical, psychological, physical, and QoL outcomes.
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Affiliation(s)
- Mohammad Amin Habibi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Yazdan Panah
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Meysam Olfatifar
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Ghasemi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sangharsha Thapa
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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216
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Perucca L, Scarano S, Russo G, Robecchi Majnardi A, Caronni A. Fatigue may improve equally after balance and endurance training in multiple sclerosis: a randomised, crossover clinical trial. Front Neurol 2024; 15:1274809. [PMID: 38385033 PMCID: PMC10880192 DOI: 10.3389/fneur.2024.1274809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Fatigue and poor balance are frequent and severe problems in multiple sclerosis (MS) that may interact. Endurance training is known to be effective on fatigue. This study aims to test if balance training is more effective against MS fatigue. Methods A randomised crossover trial was run, recruiting 31 MS people (21 women; median age: 46 years, range: 30-64; median EDSS: 4, range: 2.5-5). Participants received balance and endurance training alternately (15 one-to-one sessions, 5 days/week) and were assessed before (T0), after (T1), and 30 days after treatment ended (T2). The Modified Fatigue Impact Scale (MFIS) with scores linearised through Rasch analysis was the primary outcome (the lower the measure, the better the condition, i.e., the lower the fatigue symptoms). The Equiscale balance scale and posturography (EquiTest) were used to assess balance. Linear mixed-effects models with ANOVA were used for significance testing. Results Thirteen participants had no carryover effect and were included in the primary analysis. Fatigue significantly changed across the three time points (F2,58 = 16.0; p < 0.001), but no difference across treatments was found. Altogether, both treatments significantly improved the MFIS measure at T1 (95%CI: -1.24 logits; mean: -1.67 to -0.81 logits) and T2 (95%CI: -1.04; mean: -1.49 to -0.60) compared to T0 (95%CI: -0.51; mean: -0.95 to -0.08; p ≤ 0.001). Equiscale and posturography highlighted balance improvement after balance training but not after endurance training. Conclusion Balance and endurance training could similarly reduce fatigue in MS patients in the short term. However, only balance training also improved balance in MS.
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Affiliation(s)
- Laura Perucca
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Scarano
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanna Russo
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
| | - Antonio Robecchi Majnardi
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
| | - Antonio Caronni
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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217
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Shabani M, Shobeiri P, Nouri S, Moradi Z, Amenu RA, Mehrabi Nejad MM, Rezaei N. Risk of flare or relapse in patients with immune-mediated diseases following SARS-CoV-2 vaccination: a systematic review and meta-analysis. Eur J Med Res 2024; 29:55. [PMID: 38229141 DOI: 10.1186/s40001-024-01639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Patients with autoimmune and immune-mediated diseases (AI-IMD) are at greater risk of COVID-19 infection; therefore, they should be prioritized in vaccination programs. However, there are concerns regarding the safety of COVID-19 vaccines in terms of disease relapse, flare, or exacerbation. In this study, we aimed to provide a more precise and reliable vision using systematic review and meta-analysis. METHODS PubMed-MEDLINE, Embase, and Web of Science were searched for original articles reporting the relapse/flare in adult patients with AI-IMD between June 1, 2020 and September 25, 2022. Subgroup analysis and sensitivity analysis were conducted to investigate the sources of heterogeneity. Statistical analysis was performed using R software. RESULTS A total of 134 observations of various AI-IMDs across 74 studies assessed the rate of relapse, flare, or exacerbation in AI-IMD patients. Accordingly, the crude overall prevalence of relapse, flare, or exacerbation was 6.28% (95% CI [4.78%; 7.95%], I2 = 97.6%), changing from 6.28% (I2 = 97.6%) to 6.24% (I2 = 65.1%) after removing the outliers. AI-IMD patients administering mRNA, vector-based, and inactive vaccines showed 8.13% ([5.6%; 11.03%], I2 = 98.1%), 0.32% ([0.0%; 4.03%], I2 = 93.5%), and 3.07% ([1.09%; 5.9%], I2 = 96.2%) relapse, flare, or exacerbation, respectively (p-value = 0.0086). In terms of disease category, nephrologic (26.66%) and hematologic (14.12%) disorders had the highest and dermatologic (4.81%) and neurologic (2.62%) disorders exhibited to have the lowest crude prevalence of relapse, flare, or exacerbation (p-value < 0.0001). CONCLUSION The risk of flare/relapse/exacerbation in AI-IMD patients is found to be minimal, especially with vector-based vaccines. Vaccination against COVID-19 is recommended in this population.
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Affiliation(s)
- Mahya Shabani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, 14194, Tehran, 1419733141, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Shadi Nouri
- Arak University of Medical Sciences, Arak, Iran
| | - Zahra Moradi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Robel Assefa Amenu
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mohammad-Mehdi Mehrabi Nejad
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Qarib St, Keshavarz Blvd, 14194, Tehran, 1419733141, Iran.
| | - Nima Rezaei
- Department of Immunology, Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, 14194, Tehran, 1419733141, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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Ongphichetmetha T, Aungsumart S, Siritho S, Apiwattanakul M, Tanboon J, Rattanathamsakul N, Prayoonwiwat N, Jitprapaikulsan J. Tumefactive demyelinating lesions: a retrospective cohort study in Thailand. Sci Rep 2024; 14:1426. [PMID: 38228919 PMCID: PMC10791607 DOI: 10.1038/s41598-024-52048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
Tumefactive demyelinating lesions (TDL), characterized by large (≥ 2 cm) demyelinating lesions mimicking tumors, are a rare manifestation of the central nervous system inflammatory demyelinating diseases (CNS-IDD). Distinguishing TDL from other brain lesions can be challenging, often necessitating biopsy or advanced diagnostics. The natural history of TDL varies among races. This study aimed to assess demographics, clinical and radiological features, laboratory findings, management, and outcomes of Thai patients with TDL. We retrospectively reviewed records of twenty-six patients with TDL from the Multiple Sclerosis and Related Disorders registry from two tertiary medical centers. Among 1102 CNS-IDD patients, 26 (2.4%) had TDL. The median age at TDLs onset was 34.5 years (range 17-75); 69.2% were female. Over 70% manifested TDL as their initial CNS-IDD presentation. Common presenting symptoms included motor deficits, sensory disturbances, and cognitive problems. About two-fifths exhibited multiple lesions, most frequently in the frontoparietal region (46.2%). Half of the patients showed an incomplete ring on post-contrast T1-weighted imaging, with peripheral diffusion-weighted imaging restriction in twenty-one patients. T2-hypointense rims were present in thirteen (56.5%) patients. Brain biopsy was performed in 12 cases (46.1%). Serum aquaporin-4 immunoglobulin was positive in 16.7% of tested (4/24) cases. Serum myelin oligodendrocyte glycoprotein immunoglobulin was negative in all thirteen patients tested. Twenty patients (76.9%) received intravenous corticosteroids for TDL attacks. After the median follow-up period of 48 months (range 6-300), 23.1% experienced CNS-IDD relapses. Median Expanded Disability Status Scale at TDL diagnosis was 4.3 (range 0.0-9.5), and improved to 3.0 (range 0.0-10.0) at the last follow-up. This study suggested that TDL were rare among Thai CNS-IDD patients, frequently presenting as a monophasic condition with a favorable outcome.
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Affiliation(s)
- Tatchaporn Ongphichetmetha
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok-noi, Bangkok, 10700, Thailand
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
- Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Saharat Aungsumart
- Neuroimmunology Unit, Department of Neurology, Neurological Institute of Thailand, Bangkok, 10400, Thailand
| | - Sasitorn Siritho
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok-noi, Bangkok, 10700, Thailand
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
- Bumrungrad International Hospital, Bangkok, 10110, Thailand
| | - Metha Apiwattanakul
- Neuroimmunology Unit, Department of Neurology, Neurological Institute of Thailand, Bangkok, 10400, Thailand
| | - Jantima Tanboon
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Natthapon Rattanathamsakul
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok-noi, Bangkok, 10700, Thailand
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Naraporn Prayoonwiwat
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok-noi, Bangkok, 10700, Thailand
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Jiraporn Jitprapaikulsan
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok-noi, Bangkok, 10700, Thailand.
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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219
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Ning F, Cao XQ, Wang QQ, Li ZY, Ruan Z, Chang T. Safety of SARS-CoV-2 vaccine in patients with autoimmune neurological conditions: A systematic review and meta-analysis. Heliyon 2024; 10:e23944. [PMID: 38261862 PMCID: PMC10796982 DOI: 10.1016/j.heliyon.2023.e23944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/06/2023] [Accepted: 12/16/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Risk of adverse effects and exacerbation in autoimmune neurological conditions (ANC)are frequently cited reasons for COVID-19 vaccine hesitancy. This study evaluates the ANC safety of COVID-19 vaccines in the real world. Methods Electronic databases were searched to identify studies reporting the use of the COVID-19 vaccine in ANC. We selected studies that provided data on adverse effects and worsening conditions related to ANC after vaccination. The pooled incidence rates for various adverse effects, stratified for the disease category, dosage, and type of vaccine, were estimated. Results Twenty-eight studies (31 vaccination cohorts) were included. The pooled incidence rate of general adverse events was 0.35 (95%CI, 0.27-0.43, I2 = 100 %). The pooled incidence rates of local injection reaction, fatigue, weakness, myalgia, fever, headache, and chills were 0.27 (0.18-0.36, I2 = 98 %), 0.16(0.11-0.21, I2 = 93 %), 0.15(0.00-0.31, I2 = 97 %), 0.13(0.08-0.19, I2 = 97 %), 0.11(0.07-0.15, I2 = 95 %), 0.11(0.07-0.16, I2 = 97 %), and 0.09 (0.03-0.16, I2 = 96 %), respectively. The pooled incidence rate of exacerbation adverse events was 0.05 (95%CI, 0.04-0.07, I2 = 84 %). Conclusion According to available evidence, the administration of COVID-19 vaccines in individuals with autoimmune neurological disorders seems well-tolerated, with few reports of adverse events. Furthermore, exacerbation of autoimmune neurological conditions following vaccination appears to be infrequent.
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Affiliation(s)
| | | | - Qing-qing Wang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhu-yi Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
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Block VJ, Koshal K, Wijangco J, Miller N, Sara N, Henderson K, Reihm J, Gopal A, Mohan SD, Gelfand JM, Guo CY, Oommen L, Nylander A, Rowson JA, Brown E, Sanders S, Rankin K, Lyles CR, Sim I, Bove R. A Closed-Loop Falls Monitoring and Prevention App for Multiple Sclerosis Clinical Practice: Human-Centered Design of the Multiple Sclerosis Falls InsightTrack. JMIR Hum Factors 2024; 11:e49331. [PMID: 38206662 PMCID: PMC10811573 DOI: 10.2196/49331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/14/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Falls are common in people with multiple sclerosis (MS), causing injuries, fear of falling, and loss of independence. Although targeted interventions (physical therapy) can help, patients underreport and clinicians undertreat this issue. Patient-generated data, combined with clinical data, can support the prediction of falls and lead to timely intervention (including referral to specialized physical therapy). To be actionable, such data must be efficiently delivered to clinicians, with care customized to the patient's specific context. OBJECTIVE This study aims to describe the iterative process of the design and development of Multiple Sclerosis Falls InsightTrack (MS-FIT), identifying the clinical and technological features of this closed-loop app designed to support streamlined falls reporting, timely falls evaluation, and comprehensive and sustained falls prevention efforts. METHODS Stakeholders were engaged in a double diamond process of human-centered design to ensure that technological features aligned with users' needs. Patient and clinician interviews were designed to elicit insight around ability blockers and boosters using the capability, opportunity, motivation, and behavior (COM-B) framework to facilitate subsequent mapping to the Behavior Change Wheel. To support generalizability, patients and experts from other clinical conditions associated with falls (geriatrics, orthopedics, and Parkinson disease) were also engaged. Designs were iterated based on each round of feedback, and final mock-ups were tested during routine clinical visits. RESULTS A sample of 30 patients and 14 clinicians provided at least 1 round of feedback. To support falls reporting, patients favored a simple biweekly survey built using REDCap (Research Electronic Data Capture; Vanderbilt University) to support bring-your-own-device accessibility-with optional additional context (the severity and location of falls). To support the evaluation and prevention of falls, clinicians favored a clinical dashboard featuring several key visualization widgets: a longitudinal falls display coded by the time of data capture, severity, and context; a comprehensive, multidisciplinary, and evidence-based checklist of actions intended to evaluate and prevent falls; and MS resources local to a patient's community. In-basket messaging alerts clinicians of severe falls. The tool scored highly for usability, likability, usefulness, and perceived effectiveness (based on the Health IT Usability Evaluation Model scoring). CONCLUSIONS To our knowledge, this is the first falls app designed using human-centered design to prioritize behavior change and, while being accessible at home for patients, to deliver actionable data to clinicians at the point of care. MS-FIT streamlines data delivery to clinicians via an electronic health record-embedded window, aligning with the 5 rights approach. Leveraging MS-FIT for data processing and algorithms minimizes clinician load while boosting care quality. Our innovation seamlessly integrates real-world patient-generated data as well as clinical and community-level factors, empowering self-care and addressing the impact of falls in people with MS. Preliminary findings indicate wider relevance, extending to other neurological conditions associated with falls and their consequences.
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Affiliation(s)
- Valerie J Block
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, United States
| | - Kanishka Koshal
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jaeleene Wijangco
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Nicolette Miller
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Narender Sara
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Kyra Henderson
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer Reihm
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Arpita Gopal
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, United States
| | - Sonam D Mohan
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jeffrey M Gelfand
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Chu-Yueh Guo
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Lauren Oommen
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Alyssa Nylander
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - James A Rowson
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Ethan Brown
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Stephen Sanders
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Katherine Rankin
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- University of California San Francisco Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| | - Ida Sim
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
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Longinetti E, Englund S, Burman J, Fink K, Fogdell-Hahn A, Gunnarsson M, Hillert J, Langer-Gould AM, Lycke J, Nilsson P, Salzer J, Svenningsson A, Mellergård J, Olsson T, Piehl F, Frisell T. Trajectories of cognitive processing speed and physical disability over 11 years following initiation of a first multiple sclerosis disease-modulating therapy. J Neurol Neurosurg Psychiatry 2024; 95:134-141. [PMID: 37558400 PMCID: PMC10850621 DOI: 10.1136/jnnp-2023-331784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND We analysed the COMparison Between All immunoTherapies for Multiple Sclerosis (NCT03193866), a Swedish nationwide observational study in relapsing-remitting multiple sclerosis (RRMS), to identify trajectories of processing speed and physical disability after disease-modulating therapy (DMT) start. METHODS Using a group-modelling approach, we assessed trajectories of processing speed with oral Symbol Digit Modalities Test (SDMT) and physical disability with Expanded Disability Status Scale, from first DMT start among 1645 patients with RRMS followed during 2011-2022. We investigated predictors of trajectories using group membership as a multinomial outcome and calculated conditional probabilities linking membership across the trajectories. RESULTS We identified 5 stable trajectories of processing speed: low SDMT scores (mean starting values=29.9; 5.4% of population), low/medium (44.3; 25.3%), medium (52.6; 37.9%), medium/high (63.1; 25.8%) and high (72.4; 5.6%). We identified 3 physical disability trajectories: no disability/stable (0.8; 26.8%), minimal disability/stable (1.6; 58.1%) and moderate disability (3.2; 15.1%), which increased to severe disability. Older patients starting interferons were more likely than younger patients starting rituximab to be on low processing speed trajectories. Older patients starting teriflunomide, with more than one comorbidity, and a history of pain treatment were more likely to belong to the moderate/severe physical disability trajectory, relative to the no disability one. There was a strong association between processing speed and physical disability trajectories. CONCLUSIONS In this cohort of actively treated RRMS, patients' processing speed remained stable over the years following DMT start, whereas patients with moderate physical disability deteriorated in physical function. Nevertheless, there was a strong link between processing speed and disability after DMT start.
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Affiliation(s)
- Elisa Longinetti
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Simon Englund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Joachim Burman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan Lycke
- Department of Clinical Neuroscience, University of Gothenburg, Goteborg, Sweden
| | - Petra Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jonatan Salzer
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mellergård
- Department of Neurology, Linköping University, Linkoping, Östergötland, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Ghajarzadeh M, Waubant E, Nourbakhsh B. Design recommendations for studies that evaluate multiple sclerosis fatigue interventions. Front Psychiatry 2024; 14:1287344. [PMID: 38268567 PMCID: PMC10805898 DOI: 10.3389/fpsyt.2023.1287344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Affiliation(s)
- Mahsa Ghajarzadeh
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Bardia Nourbakhsh
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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223
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Du BQ, Lai QL, Li EC, Cai MT, Fang GL, Shen CH, Zhang YX, Ding MP. Myelin oligodendrocyte glycoprotein antibody and N-methyl-d-aspartate receptor antibody overlapping syndrome: insights from the recent case reports. Clin Exp Immunol 2024; 215:27-36. [PMID: 37724585 PMCID: PMC10776248 DOI: 10.1093/cei/uxad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/23/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
The overlapping of two or more types of neural autoantibodies in one patient has increasingly been documented in recent years. The coexistence of myelin oligodendrocyte glycoprotein (MOG) and N-methyl-d-aspartate receptor (NMDAR) antibodies is most common, which leads to a unique condition known as the MOG antibody and NMDAR antibody overlapping syndrome (MNOS). Here, we have reviewed the pathogenesis, clinical manifestations, paraclinical features, and treatment of MNOS. Forty-nine patients with MNOS were included in this study. They were young males with a median onset age of 23 years. No tumors were observed in the patients, and 24 of them reported prodromal symptoms. The most common clinical presentations were psychiatric symptoms (35/49) and seizures (25/49). Abnormalities on magnetic resonance imaging involved the brainstem (11/49), cerebellum (9/49), and parietal lobe (9/49). Most patients mostly responded to immunotherapy and had a good long-term prognosis. However, the overall recurrence rate of MNOS was higher than that of mono antibody-positive diseases. The existence of concurrent NMDAR antibodies should be suspected in patients with MOG antibody-associated disease having psychiatric symptoms, seizures, movement disorders, or autonomic dysfunction. Similarly, serum MOG antibody testing should be performed when patients with anti-NMDAR encephalitis present with atypical clinical manifestations, such as visual impairment and limb weakness, and neuroradiological findings, such as optic nerve, spinal cord, or infratentorial involvement or meningeal enhancement. Early detection of the syndrome and prompt treatment can be beneficial for these patients, and maintenance immunosuppressive therapy is recommended due to the high overall recurrence rate of the syndrome.
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Affiliation(s)
- Bing-Qing Du
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Er-Chuang Li
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meng-Ting Cai
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gao-Li Fang
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, China
| | - Chun-Hong Shen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mei-Ping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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224
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Saxby SM, Shemirani F, Crippes LJ, Ehlinger MA, Brooks L, Bisht B, Titcomb TJ, Rubenstein LM, Eyck PT, Hoth KF, Gill C, Kamholz J, Snetselaar LG, Wahls TL. Effects of a Remote Multimodal Intervention Involving Diet, Walking Program, and Breathing Exercise on Quality of Life Among Newly Diagnosed People with Multiple Sclerosis: A Quasi-Experimental Non-Inferiority Pilot Study. Degener Neurol Neuromuscul Dis 2024; 14:1-14. [PMID: 38222092 PMCID: PMC10787513 DOI: 10.2147/dnnd.s441738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Background Interventions involving diet, physical activity, and breathing exercises are shown to be beneficial in managing both fatigue and quality of life (QoL) related to MS; however, the impact of such interventions among people newly diagnosed with clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis (RRMS) who decline disease-modifying therapies (DMTs) is unknown. Methods A 12-month prospective quasi-experimental non-inferiority trial recruited people newly diagnosed with CIS or RRMS who voluntarily declined DMTs (health behavior group; HB, n = 29) or followed standard of care (SOC, n = 15). Participants in the HB group were remotely coached on the study diet, moderate-intensity walking, and breathing exercises. All participants completed questionnaires validated to assess MS symptoms, including perceived mental and physical QoL (MSQOL54); fatigue (Fatigue Severity Scale, FSS; and Modified Fatigue Impact Scale, MFIS); mood (Hospital Anxiety and Depression Scale, HADS); and cognitive function (Perceived Deficits Questionnaire, PDQ). Results During the 12 months, the HB group experienced improvement in scores for mental QoL (MSQOL54 - Mental, 0.24, 95% CI 0.01, 0.47; p = 0.04), fatigue (Total MFIS, -7.26, 95% CI -13.3,-1.18; p = 0.02), and perceived cognitive function (Total PDQ, PDQ-Attention, PDQ-Promemory, and PDQ-Planning, p ≤ 0.03 for all). A between-group difference was observed only for PDQ-Planning (p = 0.048). Non-inferiority analysis revealed that the 12-month changes in means for the HB group were not worse than those for the SOC group with respect to fatigue (FSS, p = 0.02), mood (HDS-Anxiety, p = 0.02; HADS-Depression, p < 0.0001), physical QoL (MSQOL54 - Physical, p = 0.02), or cognitive dysfunction (Total PDQ, p = 0.01). Conclusion The multimodal lifestyle intervention for individuals newly diagnosed with CIS or RRMS, who voluntarily decline DMTs, did not yield patient-reported outcomes worse than those observed in the SOC group regarding perceived mental quality of life, mood, fatigue, and cognitive function. Trial Registration clinicaltrials.gov identifier: NCT04009005.
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Affiliation(s)
- Solange M Saxby
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Landon J Crippes
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Mary A Ehlinger
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Lisa Brooks
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Babita Bisht
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Tyler J Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Karin F Hoth
- Department of Psychiatry and the Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Christine Gill
- Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - John Kamholz
- Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | | | - Terry L Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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225
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Arntzen EC, Braaten T, Fikke HK, Normann B. Feasibility of a new intervention addressing group-based balance and high-intensity training, physical activity, and employment in individuals with multiple sclerosis: a pilot randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1258737. [PMID: 38259873 PMCID: PMC10801079 DOI: 10.3389/fresc.2023.1258737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
Background and purpose Impaired sensorimotor function, reduced physical activity and unemployment are common challenges in persons with multiple sclerosis (pwMS), even when disability is low. CoreDISTparticipation is a new, multidisciplinary intervention delivered across healthcare levels systematically addressing these elements. This study primarily aimed to evaluate the feasibility of CoreDISTparticipation in terms of process, resources, management, and scientific outcomes. The secondary aim was to evaluate initial efficacy in terms of possible short-term effects compared with the usual care on barriers to employment, balance, walking, health-related quality of life (HRQoL), and physical activity. Methods This assessor-blinded prospective pilot randomized controlled trial included 29 pwMS [Expanded Disability Status Scale (EDSS): 0-3.5] randomly allocated to the intervention group (CoreDISTparticipation) (n = 15) or usual care (n = 14). CoreDISTparticipation consists of three phases: (1) hospital outpatient clinic: MS nurse work-focused session and physiotherapist exploring balance; (2) municipality: a digital meeting with pwMS, employer, MS nurse, and physiotherapist addressing employment and physical activity, 4 weeks indoor CoreDIST balance training (60 min × 2/week); and (3) 4 weeks outdoor CoreDIST balance training and high-intensity running/walking (60 min × 2/week). Assessments were undertaken at baseline and at weeks 6 and 11. Primary feasibility metric outcomes were the reporting of process, resources, management, and scientific outcomes. Efficacy measures included evaluation of the Multiple Sclerosis Work Difficulties Questionnaire-23 Norwegian Version (MSWDQ-23NV) and 6 Minute Walk-test as well as the Trunk Impairment Scale-modified Norwegian Version, Mini-Balance Evaluation Systems Test (Mini-BESTest), Multiple Sclerosis Walking Scale-12, Multiple Sclerosis Impact Scale-29 Norwegian Version (MSIS-29NV), ActiGraph wGT3x-BT monitors, and AccuGait Optimized force platform. The statistical analyses included repeated-measures mixed models performed in IBM SPSS Version 29. Results The primary feasibility metric outcomes demonstrated the need for minor adjustments in regard to the content of the intervention and increasing the number of staff. In regard to the efficacy measures, one person attended no postintervention assessments and was excluded, leaving 28 participants (mean EDSS: 1.8, SD: 1). The mean percentage employment was 46.3 (SD: 35.6) and 65.4 (SD: 39.3) in the CoreDISTparticipation and usual care group, respectively. No between-group differences were found. MSWDQ-23NV demonstrated a within-group difference of 5.7 points from baseline to Week 11 (P = 0.004; confidence interval: 2.2-9.3). Mini-BESTest and MSIS-29NV demonstrated within-group differences. The study is registered in ClinicalTrials.gov (Identifier: NCT05057338). Discussion The CoreDISTparticipation intervention is feasible to support pwMS when the identified feasibility metric outcomes in regard to process, resource, management, and scientific outcome metrics are adjusted to improve feasibility. Regarding efficacy measures, no between-group differences were detected; however, within-group differences in barriers to employment, balance, and HRQoL were detected for the CoreDISTparticipation group. A larger comparative trial is needed to explore between-group differences and should accurately and precisely define usual care and address the identified limitations of this study.
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Affiliation(s)
- Ellen Christin Arntzen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Physiotherapy, Kongsgården Physiotherapy, Bodø, Norway
| | - Tonje Braaten
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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226
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Bock K, Peltzer J, Liu W, Colgrove Y, Smirnova I, Siengsukon C. Sleep quality and lymphedema in breast cancer survivors: a mixed method analysis. J Cancer Surviv 2024:10.1007/s11764-023-01516-9. [PMID: 38183577 DOI: 10.1007/s11764-023-01516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE The purpose of this convergent mixed methods study was to assess the perceptions and characteristics of sleep in breast cancer survivors (BCSs) and elucidate perceptions of sleep among BCS with lymphedema. METHODS Participants were BCS with and without lymphedema. Both groups completed the Pittsburgh Sleep Quality Index (PSQI), PROMIS® Sleep Disturbance (8a short form), and wore an actigraph on their wrist to capture sleep/wake cycles for 7 days/nights while logging their sleep using a sleep diary. The coefficient of variation of sleep efficiency was calculated from the sleep diary to assess intraindividual variability. In addition, a subsample of BCS with lymphedema participated in a semi-structured qualitative interview. The qualitative data was analyzed separately, and the themes were applied to provide a more nuanced explanation of the quantitative outcomes. RESULTS The BCS with lymphedema (n=23) had a significant difference in PSQI (p=0.002), PROMIS® Sleep Disturbance (p=0.084), and sleep efficiency coefficient of variation (p=0.014) compared to BCS without lymphedema (n=23). There were no statistically significant differences between groups in the actigraphy results. BCS with lymphedema perceived that lymphedema management contributed to their sleep disturbance, further exacerbating their mind/body fatigue. CONCLUSION This study provides the foundation for future research to investigate the integration of sleep interventions with lymphedema management for holistic survivorship care for BCS with lymphedema. IMPLICATIONS FOR CANCER SURVIVORS An innovative sleep health intervention designed to consider the unique factors contributing to sleep disturbance in BCS with lymphedema will fill a gap in their post-cancer treatment quality of life.
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Affiliation(s)
- Karen Bock
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Jill Peltzer
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Wen Liu
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Yvonne Colgrove
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Irina Smirnova
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Catherine Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Gonzalez-Lorenzo M, Ridley B, Minozzi S, Del Giovane C, Peryer G, Piggott T, Foschi M, Filippini G, Tramacere I, Baldin E, Nonino F. Immunomodulators and immunosuppressants for relapsing-remitting multiple sclerosis: a network meta-analysis. Cochrane Database Syst Rev 2024; 1:CD011381. [PMID: 38174776 PMCID: PMC10765473 DOI: 10.1002/14651858.cd011381.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Different therapeutic strategies are available for the treatment of people with relapsing-remitting multiple sclerosis (RRMS), including immunomodulators, immunosuppressants and biological agents. Although each one of these therapies reduces relapse frequency and slows disability accumulation compared to no treatment, their relative benefit remains unclear. This is an update of a Cochrane review published in 2015. OBJECTIVES To compare the efficacy and safety, through network meta-analysis, of interferon beta-1b, interferon beta-1a, glatiramer acetate, natalizumab, mitoxantrone, fingolimod, teriflunomide, dimethyl fumarate, alemtuzumab, pegylated interferon beta-1a, daclizumab, laquinimod, azathioprine, immunoglobulins, cladribine, cyclophosphamide, diroximel fumarate, fludarabine, interferon beta 1-a and beta 1-b, leflunomide, methotrexate, minocycline, mycophenolate mofetil, ofatumumab, ozanimod, ponesimod, rituximab, siponimod and steroids for the treatment of people with RRMS. SEARCH METHODS CENTRAL, MEDLINE, Embase, and two trials registers were searched on 21 September 2021 together with reference checking, citation searching and contact with study authors to identify additional studies. A top-up search was conducted on 8 August 2022. SELECTION CRITERIA Randomised controlled trials (RCTs) that studied one or more of the available immunomodulators and immunosuppressants as monotherapy in comparison to placebo or to another active agent, in adults with RRMS. DATA COLLECTION AND ANALYSIS Two authors independently selected studies and extracted data. We considered both direct and indirect evidence and performed data synthesis by pairwise and network meta-analysis. Certainty of the evidence was assessed by the GRADE approach. MAIN RESULTS We included 50 studies involving 36,541 participants (68.6% female and 31.4% male). Median treatment duration was 24 months, and 25 (50%) studies were placebo-controlled. Considering the risk of bias, the most frequent concern was related to the role of the sponsor in the authorship of the study report or in data management and analysis, for which we judged 68% of the studies were at high risk of other bias. The other frequent concerns were performance bias (34% judged as having high risk) and attrition bias (32% judged as having high risk). Placebo was used as the common comparator for network analysis. Relapses over 12 months: data were provided in 18 studies (9310 participants). Natalizumab results in a large reduction of people with relapses at 12 months (RR 0.52, 95% CI 0.43 to 0.63; high-certainty evidence). Fingolimod (RR 0.48, 95% CI 0.39 to 0.57; moderate-certainty evidence), daclizumab (RR 0.55, 95% CI 0.42 to 0.73; moderate-certainty evidence), and immunoglobulins (RR 0.60, 95% CI 0.47 to 0.79; moderate-certainty evidence) probably result in a large reduction of people with relapses at 12 months. Relapses over 24 months: data were reported in 28 studies (19,869 participants). Cladribine (RR 0.53, 95% CI 0.44 to 0.64; high-certainty evidence), alemtuzumab (RR 0.57, 95% CI 0.47 to 0.68; high-certainty evidence) and natalizumab (RR 0.56, 95% CI 0.48 to 0.65; high-certainty evidence) result in a large decrease of people with relapses at 24 months. Fingolimod (RR 0.54, 95% CI 0.48 to 0.60; moderate-certainty evidence), dimethyl fumarate (RR 0.62, 95% CI 0.55 to 0.70; moderate-certainty evidence), and ponesimod (RR 0.58, 95% CI 0.48 to 0.70; moderate-certainty evidence) probably result in a large decrease of people with relapses at 24 months. Glatiramer acetate (RR 0.84, 95%, CI 0.76 to 0.93; moderate-certainty evidence) and interferon beta-1a (Avonex, Rebif) (RR 0.84, 95% CI 0.78 to 0.91; moderate-certainty evidence) probably moderately decrease people with relapses at 24 months. Relapses over 36 months findings were available from five studies (3087 participants). None of the treatments assessed showed moderate- or high-certainty evidence compared to placebo. Disability worsening over 24 months was assessed in 31 studies (24,303 participants). Natalizumab probably results in a large reduction of disability worsening (RR 0.59, 95% CI 0.46 to 0.75; moderate-certainty evidence) at 24 months. Disability worsening over 36 months was assessed in three studies (2684 participants) but none of the studies used placebo as the comparator. Treatment discontinuation due to adverse events data were available from 43 studies (35,410 participants). Alemtuzumab probably results in a slight reduction of treatment discontinuation due to adverse events (OR 0.39, 95% CI 0.19 to 0.79; moderate-certainty evidence). Daclizumab (OR 2.55, 95% CI 1.40 to 4.63; moderate-certainty evidence), fingolimod (OR 1.84, 95% CI 1.31 to 2.57; moderate-certainty evidence), teriflunomide (OR 1.82, 95% CI 1.19 to 2.79; moderate-certainty evidence), interferon beta-1a (OR 1.48, 95% CI 0.99 to 2.20; moderate-certainty evidence), laquinimod (OR 1.49, 95 % CI 1.00 to 2.15; moderate-certainty evidence), natalizumab (OR 1.57, 95% CI 0.81 to 3.05), and glatiramer acetate (OR 1.48, 95% CI 1.01 to 2.14; moderate-certainty evidence) probably result in a slight increase in the number of people who discontinue treatment due to adverse events. Serious adverse events (SAEs) were reported in 35 studies (33,998 participants). There was probably a trivial reduction in SAEs amongst people with RRMS treated with interferon beta-1b as compared to placebo (OR 0.92, 95% CI 0.55 to 1.54; moderate-certainty evidence). AUTHORS' CONCLUSIONS We are highly confident that, compared to placebo, two-year treatment with natalizumab, cladribine, or alemtuzumab decreases relapses more than with other DMTs. We are moderately confident that a two-year treatment with natalizumab may slow disability progression. Compared to those on placebo, people with RRMS treated with most of the assessed DMTs showed a higher frequency of treatment discontinuation due to AEs: we are moderately confident that this could happen with fingolimod, teriflunomide, interferon beta-1a, laquinimod, natalizumab and daclizumab, while our certainty with other DMTs is lower. We are also moderately certain that treatment with alemtuzumab is associated with fewer discontinuations due to adverse events than placebo, and moderately certain that interferon beta-1b probably results in a slight reduction in people who experience serious adverse events, but our certainty with regard to other DMTs is lower. Insufficient evidence is available to evaluate the efficacy and safety of DMTs in a longer term than two years, and this is a relevant issue for a chronic condition like MS that develops over decades. More than half of the included studies were sponsored by pharmaceutical companies and this may have influenced their results. Further studies should focus on direct comparison between active agents, with follow-up of at least three years, and assess other patient-relevant outcomes, such as quality of life and cognitive status, with particular focus on the impact of sex/gender on treatment effects.
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Affiliation(s)
- Marien Gonzalez-Lorenzo
- Laboratorio di Metodologia delle revisioni sistematiche e produzione di Linee Guida, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ben Ridley
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Cochrane Italy, Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Guy Peryer
- School of Health Sciences, University of East Anglia (UEA), Norwich, UK
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Queens University, Kingston, Ontario, Canada
| | - Matteo Foschi
- Department of Neuroscience, Multiple Sclerosis Center - Neurology Unit, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Graziella Filippini
- Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Baldin
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Pravatà E, Diociasi A, Navarra R, Carmisciano L, Sormani MP, Roccatagliata L, Chincarini A, Ossola A, Cardia A, Cianfoni A, Kaelin-Lang A, Gobbi C, Zecca C. Biometry extraction and probabilistic anatomical atlas of the anterior Visual Pathway using dedicated high-resolution 3-D MRI. Sci Rep 2024; 14:453. [PMID: 38172589 PMCID: PMC10764933 DOI: 10.1038/s41598-023-50980-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
Anterior Visual Pathway (aVP) damage may be linked to diverse inflammatory, degenerative and/or vascular conditions. Currently however, a standardized methodological framework for extracting MRI biomarkers of the aVP is not available. We used high-resolution, 3-D MRI data to generate a probabilistic anatomical atlas of the normal aVP and its intraorbital (iOrb), intracanalicular (iCan), intracranial (iCran), optic chiasm (OC), and tract (OT) subdivisions. We acquired 0.6 mm3 steady-state free-precession images from 24 healthy participants using a 3 T scanner. aVP masks were obtained by manual segmentation of each aVP subdivision. Mask straightening and normalization with cross-sectional area (CSA) preservation were obtained using scripts developed in-house. A probabilistic atlas ("aVP-24") was generated by averaging left and right sides of all subjects. Leave-one-out cross-validation with respect to interindividual variability was performed employing the Dice Similarity Index (DSI). Spatially normalized representations of the aVP subdivisions were generated. Overlapping CSA values before and after normalization demonstrate preservation of the aVP cross-section. Volume, length, CSA, and ellipticity index (ε) biometrics were extracted. The aVP-24 morphology followed previous descriptions from the gross anatomy. Atlas spatial validation DSI scores of 0.85 in 50% and 0.77 in 95% of participants indicated good generalizability across the subjects. The proposed MRI standardization framework allows for previously unavailable, geometrically unbiased biometric data of the entire aVP and provides the base for future spatial-resolved, group-level investigations.
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Affiliation(s)
- Emanuele Pravatà
- Neurocenter of Southern Switzerland, EOC, Neuroradiology, Lugano, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland.
| | - Andrea Diociasi
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Riccardo Navarra
- Institute for Advanced Biomedical Technology (I.T.A.B.), Chieti, Italy
| | - Luca Carmisciano
- Department of Health Sciences, University of Genova, Genova, Italy
| | | | | | | | - Alessandra Ossola
- Neurocenter of Southern Switzerland, EOC, Ophthalmology, Lugano, Switzerland
- Neurocenter of Southern Switzerland, EOC, Neurosurgery, Lugano, Switzerland
| | - Andrea Cardia
- Neurocenter of Southern Switzerland, EOC, Neurosurgery, Lugano, Switzerland
| | - Alessandro Cianfoni
- Neurocenter of Southern Switzerland, EOC, Neuroradiology, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Alain Kaelin-Lang
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
- Neurocenter of Southern Switzerland, EOC, Neurology, Lugano, Switzerland
| | - Claudio Gobbi
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
- Neurocenter of Southern Switzerland, EOC, Neurology, Lugano, Switzerland
| | - Chiara Zecca
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
- Neurocenter of Southern Switzerland, EOC, Neurology, Lugano, Switzerland
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229
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Ong S, Kibbler J, Maxwell G, Steer J. Disseminated tuberculosis associated with fingolimod treatment in a patient with multiple sclerosis. BMJ Case Rep 2024; 17:e255011. [PMID: 38171639 PMCID: PMC10773306 DOI: 10.1136/bcr-2023-255011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Fingolimod is a sphingosine-1-phosphate receptor modulator approved as a disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (MS). A woman in her 30s was treated with fingolimod for relapsing-remitting MS. After 7 years of treatment, she presented with non-productive cough, night sweats, breathlessness and unintentional weight loss. She had a negative interferon-gamma release assay (IGRA). A high-resolution CT thorax showed innumerable miliary opacities in both lungs. Bronchoalveolar lavage was positive for Mycobacterium tuberculosis complex PCR. An MRI head showed multiple small punctate contrast-enhancing lesions most typical for tuberculomas. We describe the first reported case of disseminated tuberculosis (TB) associated with fingolimod treatment. Patients who are receiving DMT must be closely observed for the development of opportunistic infections, and IGRA results should be interpreted with caution. Screening for latent TB prior to commencing fingolimod should be considered on an individual basis. The management of TB in MS patients on DMT requires an interdisciplinary approach.
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Affiliation(s)
- Stephanie Ong
- Neurology, Sunderland Royal Hospital, Sunderland, UK
| | - Joseph Kibbler
- Newcastle University, Newcastle upon Tyne, UK
- Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Gemma Maxwell
- Neurology, Sunderland Royal Hospital, Sunderland, UK
| | - John Steer
- Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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230
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Wu CY, Yu K, Arnold SE, Das S, Dodge HH. Who Benefited Most from the Internet-Based Conversational Engagement RCT (I-CONECT)? Application of the Personalized Medicine Approach to a Behavioral Intervention Study. J Prev Alzheimers Dis 2024; 11:639-648. [PMID: 38706280 PMCID: PMC11061034 DOI: 10.14283/jpad.2024.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/09/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Many Alzheimer's Disease (AD) clinical trials have failed to demonstrate treatment efficacy on cognition. It is conceivable that a complex disease like AD may not have the same treatment effect due to many heterogeneities of disease processes and individual traits. OBJECTIVES We employed an individual-level treatment response (ITR) approach to determine the characteristics of treatment responders and estimated time saved in cognitive decline using the Internet-based Conversational Engagement Clinical Trial (I-CONECT) behavioral intervention study as a model. DESIGN AND SETTING I-CONECT is a multi-site, single-blind, randomized controlled trial aimed to improve cognitive functions through frequent conversational interactions via internet/webcam. The experimental group engaged in video chats with study staff 4 times/week for 6 months; the control group received weekly 10-minute check-in phone calls. PARTICIPANTS Out of 186 randomized participants, current study used 139 participants with complete information on both baseline and 6-month follow-up (73 with mild cognitive impairment (MCI), 66 with normal cognition; 64 in the experimental group, and 75 in the control group). MEASUREMENTS ITR scores were generated for the Montreal Cognitive Assessment (MoCA) (global cognition, primary outcome) and Category Fluency Animals (CFA) (semantic fluency, secondary outcome) that showed significant efficacy in the trial. ITR scores were generated through 300 iterations of 3-fold cross-validated random forest models. The average treatment difference (ATD) curve and the area between the curves (ABC) were estimated to measure the heterogeneity of treatment responses. Responder traits were identified using SHapley Additive exPlanations (SHAP) and decision tree models. The time saved in cognitive decline was explored to gauge clinical meaningfulness. RESULTS ABC statistics showed substantial heterogeneity in treatment response with MoCA but modest heterogeneity in treatment response with CFA. Age, cognitive status, time spent with family and friends, education, and personality were important characteristics that influenced treatment responses. Intervention group participants in the upper 30% of ITR scores demonstrated potential delays of 3 months in semantic fluency (CFA) and 6 months in global cognition (MoCA), assuming a 5-fold faster natural cognitive decline compared to the control group during the post-treatment period. CONCLUSIONS ITR-based analyses are valuable in profiling treatment responders for features that can inform future trial design and clinical practice. Reliably measuring time saved in cognitive decline is an area of ongoing research to gain insight into the clinical meaningfulness of treatment.
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Affiliation(s)
- C-Y Wu
- Chao-Yi Wu, 149 13th floor, 10-003C, Boston, MA, USA, , 02129; 617-724-2428
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231
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Dejbakht M, Akhzari M, Jalili S, Faraji F, Barazesh M. Multiple Sclerosis: New Insights into Molecular Pathogenesis and Novel Platforms for Disease Treatment. Curr Drug Res Rev 2024; 16:175-197. [PMID: 37724675 DOI: 10.2174/2589977516666230915103730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Multiple sclerosis (MS), a chronic inflammatory disorder, affects the central nervous system via myelin degradation. The cause of MS is not fully known, but during recent years, our knowledge has deepened significantly regarding the different aspects of MS, including etiology, molecular pathophysiology, diagnosis and therapeutic options. Myelin basic protein (MBP) is the main myelin protein that accounts for maintaining the stability of the myelin sheath. Recent evidence has revealed that MBP citrullination or deamination, which is catalyzed by Ca2+ dependent peptidyl arginine deiminase (PAD) enzyme leads to the reduction of positive charge, and subsequently proteolytic cleavage of MBP. The overexpression of PAD2 in the brains of MS patients plays an essential role in new epitope formation and progression of the autoimmune disorder. Some drugs have recently entered phase III clinical trials with promising efficacy and will probably obtain approval in the near future. As different therapeutic platforms develop, finding an optimal treatment for each individual patient will be more challenging. AIMS This review provides a comprehensive insight into MS with a focus on its pathogenesis and recent advances in diagnostic methods and its present and upcoming treatment modalities. CONCLUSION MS therapy alters quickly as research findings and therapeutic options surrounding MS expand. McDonald's guidelines have created different criteria for MS diagnosis. In recent years, ever-growing interest in the development of PAD inhibitors has led to the generation of many reversible and irreversible PAD inhibitors against the disease with satisfactory therapeutic outcomes.
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Affiliation(s)
- Majid Dejbakht
- Department of Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Morteza Akhzari
- School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Sajad Jalili
- Department of Orthopedics, School of Medicine, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
| | - Fouziyeh Faraji
- Department of Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Mahdi Barazesh
- Department of Biotechnology, Cellular and Molecular Research Center, School of Paramedical, Gerash University of Medical Sciences, Gerash, Iran
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Turkowitch D, Donkers SJ, Costa SL, Vaduvathiriyan P, Williams J, Siengsukon C. Behavioral Interventions to Improve Sleep Outcomes in Individuals With Multiple Sclerosis: A Systematic Review. Int J MS Care 2024; 26:22-29. [PMID: 38213676 PMCID: PMC10779715 DOI: 10.7224/1537-2073.2022-110] [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: 01/13/2024]
Abstract
BACKGROUND Sleep disturbances are common in individuals with multiple sclerosis. The objective of this systematic review was to determine effective behavioral interventions to improve their sleep. METHODS Literature searches were performed in December 2021 in Ovid MEDLINE, Elsevier Embase, and Web of Science, along with hand searching for grey literature and cited references. Four reviewers independently reviewed titles and abstracts (2 reviewers for each article; n = 830) and the full-text articles (n = 81). Consensus for inclusion was achieved by a fifth reviewer. Thirty-seven articles were eligible for inclusion. Four reviewers extracted relevant data from each study (2 reviewers for each article) using a standard data extraction table. Consensus was achieved for completeness and accuracy of the data extraction table by a fifth reviewer. The same 4 reviewers conducted a quality appraisal of each article to assess the risk of bias and quality of the articles, and consensus was achieved by a fifth reviewer as needed. Descriptive data were used for types of interventions, sleep outcomes, results, and key components across interventions. RESULTS Overall, the cognitive behavioral therapy for insomnia, cognitive behavioral therapy/psychotherapy, and education/self-management support interventions reported positive improvements in sleep outcomes. Quality appraisal scores ranged from low to high, indicating potential for bias. CONCLUSIONS Variability in the intervention type, intervention dose, outcomes used, training/expertise of interventionist, specific sample, and study quality made it difficult to compare and synthesize results. Further research is necessary to demonstrate the efficacy of most of the interventions.
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Affiliation(s)
- David Turkowitch
- From the Department of Physical Therapy, Rehabilitation Science, and Athletic Training (DT, CS) and AR Dykes Library (PV), University of Kansas Medical Center, Kansas City, KS, USA
| | - Sarah J. Donkers
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada (SJD)
| | - Silvana L. Costa
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, USA (SLC)
- Department of Physical Medicine and Rehabilitation, Rutgers–New Jersey Medical School, Newark, NJ, USA (SLC)
| | - Prasanna Vaduvathiriyan
- From the Department of Physical Therapy, Rehabilitation Science, and Athletic Training (DT, CS) and AR Dykes Library (PV), University of Kansas Medical Center, Kansas City, KS, USA
| | - Joy Williams
- Rehabilitation Services, Kaiser Permanente Sacramento, Sacramento, CA, USA (JW)
| | - Catherine Siengsukon
- From the Department of Physical Therapy, Rehabilitation Science, and Athletic Training (DT, CS) and AR Dykes Library (PV), University of Kansas Medical Center, Kansas City, KS, USA
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Albarraq RH, Alhujaili NA, Alshehri ZI, Alqarni AM, Bawareth RM. Anticipated Stigma among Patients with Multiple Sclerosis in Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:54-59. [PMID: 38362097 PMCID: PMC10866384 DOI: 10.4103/sjmms.sjmms_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/06/2023] [Accepted: 08/09/2023] [Indexed: 02/17/2024]
Abstract
Background Social stigma is a major problem among patients with multiple sclerosis (MS), which can affect their quality of life. There is limited research from Saudi Arabia on the anticipated stigma among patients with MS. Objectives To determine the levels of anticipated stigma and its predictors in patients with MS in Saudi Arabia. Methods This cross-sectional study included adult patients with MS across Saudi Arabia. Sociodemographic and medical information, including age, gender, marital status, educational level, duration of disease, number of MS episodes in the past 12 months, previous diagnosis of mental illness, and performing activities of daily living without assistance, were collected. Anticipated stigma was measured using an Arabic version of the Chronic Illness Anticipated Stigma Scale. Results A total of 222 patients with MS were included. Moderate to severe anticipated stigma was found among 70.4% of the patients. The highest anticipated stigma mean score was from work colleagues (2.96/5). Predictors of stigma were age (P = 0.049), gender (P = 0.016), marital status (P = 0.015), education level (P = 0.003), number of MS episodes in the previous year (P < 0.001), and previous diagnosis of a mental disorder (P = 0.001). Conclusions The findings of this study indicate the need for developing programs that reduce the anticipated stigma among patients with MS in Saudi Arabia.
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Affiliation(s)
| | - Naseem Abdulmohi Alhujaili
- Department of Medicine, Division of Psychiatry, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
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Jagadish A, Shankaranarayana AM, Natarajan M, Solomon JM. Transcranial direct current stimulation for fatigue in neurological conditions: A systematic scoping review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2054. [PMID: 37838979 DOI: 10.1002/pri.2054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND AND PURPOSE Fatigue following neurological conditions negatively impacts daily activities, reducing overall quality of life. Transcranial direct current stimulation (tDCS) for fatigue management is still underexplored. This scoping review explores its use in managing fatigue among various neurological conditions. METHODS A thorough literature search was carried out using PubMed, Scopus, CINAHL, Web of Science, Embase, ProQuest, and the Cochrane Library. Google Scholar and clinicaltrials.gov were manually searched for gray literature and ongoing trials, respectively. Regardless of the study design, all studies utilizing tDCS for the management of fatigue in various neurological conditions were considered. Two reviewers independently screened all the studies, following which the data were retrieved. RESULTS Studies employing tDCS for fatigue management across neurological conditions is as follows: Multiple sclerosis (MS) (n = 28, 66%), stroke (n = 5, 12%), Parkinson's disease (PD) (n = 4, 10%), post-polio syndrome (PPS) (n = 2, 5%), traumatic brain injury (TBI) (n = 2, 5%), and amyotrophic lateral sclerosis (n = 1, 2%). All the studies used anodal stimulation, with the common stimulation site being the left dorsolateral prefrontal cortex for MS, stroke, and PD. A stimulation intensity of 1.0-4.0 mA with a duration ranging from 15 to 30 min in 1 to 24 sessions were commonly reported. The Fatigue Severity Scale (n = 21) and Modified Fatigue Impact Scale (n = 17) were frequently implemented outcome measures. Regardless of the study design, 36/42 (85.7%) studies reported an improvement in fatigue scores in the tDCS group. The common adverse events noted were tingling (n = 8, 35%), headache (n = 6, 26%), and itching (n = 6, 26%). DISCUSSION Application of tDCS for fatigue was explored in individuals with stroke, PD, PPS, and TBI after MS. Even though a wide range of treatment parameters and outcome measures were adopted to assess and target fatigue, tDCS proves to have a promising role in alleviating this symptom.
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Affiliation(s)
- Akhila Jagadish
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Apoorva M Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Han K, Wang Y, Li S, Ye T, Li M, Wang J. Ophthalmoplegia with a focal lesion in the interpeduncular fossa as the initial symptoms of multiple sclerosis: 3-year follow-up. J Int Med Res 2024; 52:3000605231208570. [PMID: 38190846 PMCID: PMC10775742 DOI: 10.1177/03000605231208570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/02/2023] [Indexed: 01/10/2024] Open
Abstract
The differential diagnosis of isolated ophthalmoplegia includes a range of pathologies. In this case, a 26-year-old man of Han nationality presented with ophthalmoplegia. Neuroimaging revealed an atypical focal lesion in the interpeduncular fossa. Initial systemic workup indicated intracranial Mycobacterium tuberculosis infection, but there was no evidence to support a diagnosis of other autoimmune diseases (e.g., myasthenia gravis or multiple sclerosis). Neuroimaging follow-up over the next 3 years revealed progression from atypical solitary lesions to multifocal lesions in the white matter of the brain. Key immunological markers were observed in cerebrospinal fluid during follow-up, suggesting the evolution of multiple sclerosis. Ophthalmoplegia with a focal lesion in the interpeduncular fossa was an unusual set of symptoms indicating multiple sclerosis onset. The findings in this case suggest that M. tuberculosis infection is an important but overlooked factor involved in the pathogenesis of multiple sclerosis. Upon initial detection, atypical lesions should receive sufficient attention and patients should undergo systematic screening to identify M. tuberculosis infection and its associated immunological abnormalities.
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Affiliation(s)
- Kai Han
- Department of Neurology, The China-Japan Union Hospital, Jilin University, Changchun, China
| | - Yixuan Wang
- Department of Neurology, The China-Japan Union Hospital, Jilin University, Changchun, China
| | - Shasha Li
- Department of Neurology, The China-Japan Union Hospital, Jilin University, Changchun, China
| | - Tianshu Ye
- Department of Neurology, The China-Japan Union Hospital, Jilin University, Changchun, China
| | - Miao Li
- Department of Neurosurgery, The China-Japan Union Hospital, Jilin University, Changchun, China
| | - Jie Wang
- Department of Neurology, The China-Japan Union Hospital, Jilin University, Changchun, China
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Arena S, Chisari CG, Toscano S, Bucello S, Grimaldi LM, Ragonese P, Realmuto S, Cottone S, Maimone D, Finocchiaro C, Reitano P, Patti F. Real-World Effectiveness of Cladribine for Patients with Multiple Sclerosis: A Sicilian Multicentric Experience (Rewind Study). Curr Neuropharmacol 2024; 22:1271-1283. [PMID: 36946484 PMCID: PMC10964096 DOI: 10.2174/1570159x21666230322140711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/29/2022] [Accepted: 10/27/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Cladribine tablets are a highly effective option for the treatment of relapsingremitting multiple sclerosis (RRMS). OBJECTIVE The study aims to evaluate the effectiveness of cladribine in a real-world setting. METHODS This prospective real-world study consecutively screened all RRMS patients from seven different MS centers in Sicily (Italy) who completed the 2-year treatment course of cladribine tablets in the period between 11th March 2019 and 31st October 2021. Data about Expanded Disability Status Scale (EDSS), relapses, previous treatments, adverse events (AEs) and magnetic resonance imaging (MRI) were collected. Patients who were previously treated with other DMTs were further stratified into moderately active treatment (MAT) and highly active treatment (HAT) patients. RESULTS A total of 217 patients (70% women, with a mean age of 38.4 ± 11.3 years) were enrolled. Fifty patients (23.0%) were naïve to treatment and 167 (77%) switched from other disease modifying therapies. After the second year of treatment, about 80% were EDSS progression free, 88% remained relapse-free at T24, and 48% of patients were MRI activity-free. Kaplan Meier analyses showed significant differences between MT and HAT in terms of time to first clinical relapse (HR: 2.43, IC 1.02- 5.76; p = 0.04), time to the first new T1-gadolinium enhancing lesion (HR: 3.43, IC 1.35-8.70; p = 0.009) and time to MRI worsening (HR: 2.42, IC 1.15-5.09; p = 0.02). CONCLUSION This study confirmed that cladribine is an effective treatment for MS, particularly in naïve patients and those who have switched from MATs.
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Affiliation(s)
- Sebastiano Arena
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Clara Grazia Chisari
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Simona Toscano
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Sebastiano Bucello
- Multiple Sclerosis
Center- PO Muscatello di Augusta, ASP Siracusa, Siracusa, Italy
| | - Luigi Maria Grimaldi
- Institute Foundation “G. Giglio”, Multiple Sclerosis Centre, Cefalù-Palermo, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Sabrina Realmuto
- Multiple Sclerosis Centre, Neurology Unit and Stroke Unit, AOOR “Villa Sofia-Cervello”, United Hospitals, Palermo, Italy
| | - Salvatore Cottone
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione
“Civico Di Cristina e Benfratelli”, Palermo, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, ARNAS Garibaldi,
Catania, Italy
| | - Chiara Finocchiaro
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Paola Reitano
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Francesco Patti
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
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Tisavipat N, Juan HY, Chen JJ. Monoclonal antibody therapies for aquaporin-4-immunoglobulin G-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Saudi J Ophthalmol 2024; 38:2-12. [PMID: 38628414 PMCID: PMC11017007 DOI: 10.4103/sjopt.sjopt_102_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/20/2023] [Indexed: 04/19/2024] Open
Abstract
Monoclonal antibody therapies mark the new era of targeted treatment for relapse prevention in aquaporin-4 (AQP4)-immunoglobulin G (IgG)-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD). For over a decade, rituximab, an anti-CD20 B-cell-depleting agent, had been the most effectiveness treatment for AQP4-IgG+NMOSD. Tocilizumab, an anti-interleukin-6 receptor, was also observed to be effective. In 2019, several randomized, placebo-controlled trials were completed that demonstrated the remarkable efficacy of eculizumab (anti-C5 complement inhibitor), inebilizumab (anti-CD19 B-cell-depleting agent), and satralizumab (anti-interleukin-6 receptor), leading to the Food and Drug Administration (FDA) approval of specific treatments for AQP4-IgG+NMOSD for the first time. Most recently, ravulizumab (anti-C5 complement inhibitor) was also shown to be highly efficacious in an open-label, external-controlled trial. Although only some patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) warrant immunotherapy, there is currently no FDA-approved treatment for relapse prevention in MOGAD. Observational studies showed that tocilizumab was associated with a decrease in relapses, whereas rituximab seemed to have less robust effectiveness in MOGAD compared to AQP4-IgG+NMOSD. Herein, we review the evidence on the efficacy and safety of each monoclonal antibody therapy used in AQP4-IgG+NMOSD and MOGAD, including special considerations in children and women of childbearing potential.
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Affiliation(s)
| | - Hui Y. Juan
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - John J. Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
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238
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Li L, Etminan M, Kaplan GG, Tremlett H, Xie H, Aviña-Zubieta JA. Multiple Sclerosis Risk Among Anti-tumor Necrosis Factor Alpha Users: A Methodological Review of Observational Studies Based on Real-world Data. Curr Drug Saf 2024; 19:200-207. [PMID: 37496244 DOI: 10.2174/1574886318666230726162245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023]
Abstract
Epidemiologic studies on the risk of multiple sclerosis (MS) or demyelinating events associated with anti-tumor necrosis factor alpha (TNFα) use among patients with rheumatic diseases or inflammatory bowel diseases have shown conflicting results. Causal directed acyclic graphs (cDAGs) are useful tools for understanding the differing results and identifying the structure of potential contributing biases. Most of the available literature on cDAGs uses language that might be unfamiliar to clinicians. This article demonstrates how cDAGs can be used to determine whether there is a confounder, a mediator or collider-stratification bias and when to adjust for them appropriately. We also use a case study to show how to control for potential biases by drawing a cDAG depicting anti-TNFα use and its potential to contribute to MS onset. Finally, we describe potential biases that might have led to contradictory results in previous studies that examined the effect of anti-TNFα and MS, including confounding, confounding by contraindication, and bias due to measurement error. Clinicians and researchers should be cognizant of confounding, confounding by contraindication, and bias due to measurement error when reviewing future studies on the risk of MS or demyelinating events associated with anti-TNFα use. cDAGs are a useful tool for selecting variables and identifying the structure of different biases that can affect the validity of observational studies.
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Affiliation(s)
- Lingyi Li
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Mahyar Etminan
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Ophthalmology and Visual Sciences, Medicine and Pharmacology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Helen Tremlett
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- The Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - J Antonio Aviña-Zubieta
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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239
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Kennedy PGE, George W, Yu X. The elusive nature of the oligoclonal bands in multiple sclerosis. J Neurol 2024; 271:116-124. [PMID: 37945762 DOI: 10.1007/s00415-023-12081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Intrathecal immunoglobulin G (IgG) and oligoclonal bands (OCBs) detected in both the brain and cerebrospinal fluid (CSF) are seminal features of multiple sclerosis (MS). The presence of OCBs correlates with elevated disease burden and severity and supports the diagnosis of MS. Despite numerous investigations into the potential viral and autoantigen targets, the precise antigenic specificity of OCBs has remained elusive. We have little knowledge of the nature regarding these oligoclonal IgG bands. Here, we present compelling evidence highlighting the key findings that both OCBs and intrathecal IgG antibodies are under genetic control and that OCBs originate from clonal B-cells in both the periphery and CNS. We propose that MS OCBs are IgG immune complexes composed of IgG1 and IgG3 antibodies and that the pathological role of OCB stems from the IgG effector functions of these complexes, leading to demyelination and axonal injuries. We present additional evidence regarding the nature of MS OCBs: (1) disease-modifying therapies have been shown to affect CSF OCB; (2) OCBs have also been detected in several neuroinfectious diseases; (3) Epstein-Barr virus (EBV) has been particularly linked with MS pathogenesis, and its association with OCB is an important area of study. Although OCBs are closely associated with MS, more meticulously planned research is necessary to clarify the precise role of OCB in MS, both in terms of disease pathogenesis and diagnosis.
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Affiliation(s)
- Peter G E Kennedy
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, G61 1QH, Scotland, UK
| | - Woro George
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Xiaoli Yu
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
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240
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Valdivia-Tangarife ER, Cortés-Enríquez F, Morlett-Paredes A, Villaseñor-Cabrera T, Gámez-Nava JI, Mireles-Ramírez MA, González-López L, Macías-Islas MÁ. Frequency of cognitive impairment in patients with neuromyelitis optica spectrum disorder in Mexico. Mult Scler J Exp Transl Clin 2024; 10:20552173241231678. [PMID: 38410681 PMCID: PMC10896058 DOI: 10.1177/20552173241231678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Background Between 29% and 67% of neuromyelitis optica spectrum disorder patients have cognitive alterations. Objective To assess the frequency of cognitive impairment in patients with neuromyelitis optica spectrum disorder in Mexico using the Brief International Cognitive Assessment for Multiple Sclerosis. Methods We evaluated 40 neuromyelitis optica spectrum disorder patients and 40 healthy controls from Mexico. Results 28 (70.0%) patients with neuromyelitis optica spectrum disorder had cognitive impairment in two or more cognitive domains. Student´s T test showed statistically poor performance by neuromyelitis optica spectrum disorder patients compared to healthy controls on all three neuropsychological test scores. This significant difference was observed on the Symbols Digit Modalities Test (t = 8.875; p ≤ 0.001); California Verbal Learning Test-II memory (t = 10.418; p ≤ 0.001); and Brief Visuospatial Memory Test Revised (t = 6.123; p ≤ 0.001). Conclusions This study showed that 70% of neuromyelitis optica spectrum disorder patients exhibited cognitive impairment in two or more cognitive domains. Determining the frequency of cognitive impairment will guide the decision of Neuropsychologists in planning cognitive rehabilitation across various domains.
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Affiliation(s)
- Edgar R Valdivia-Tangarife
- Departamento de Neurociecias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Fernando Cortés-Enríquez
- Departamento de Neurología, Hospital General, No 14 del Instituto Mexicano del Seguro Social, Guadalajara, México
| | | | - Teresita Villaseñor-Cabrera
- Departamento de Neurociecias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
- O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, México
| | - Jorge I Gámez-Nava
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Mario A Mireles-Ramírez
- Departamento de Neurología, Unidad de Alta Especialidad Médica, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Laura González-López
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Miguel Á Macías-Islas
- Departamento de Neurociecias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
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Chaumont H, Bérard N, Karam JP, Lobjois Q, Tressieres B, Signate A, Lannuzel A, Cabre P. Mitoxantrone in NMO Spectrum Disorder in a Large Multicenter Cohort in French Caribbean. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200175. [PMID: 37949668 PMCID: PMC10691227 DOI: 10.1212/nxi.0000000000200175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Preventing relapses in neuromyelitis Optica spectrum disorder (NMOSD) is a primary goal. New effective molecules are often expensive and not readily available in regions with fragile health systems. Assessing the efficacy and safety of less costly therapeutic alternatives is necessary. We aim to evaluate the efficacy and safety of mitoxantrone (MiTX) in NMOSD. METHODS This is an observational, multicenter, open study of 86 NMOSD-treated patients with prospective follow-up over 30 years. The first endpoint was the first relapse at the 96-week follow-up. The secondary endpoints were to evaluate the median delay to relapse, the annualized relapse rate (ARR), and the Expanded Disability Status Scale (EDSS) at 96 weeks of follow-up and to assess risk factors of relapse and the occurrence of severe adverse effects. RESULTS At 96-week follow-up, 71% of our patients were relapse-free, and it was 87% when patients were treated with MiTX from the first attack. The ARR dropped from 0.85 (±0.55) to 0.32 (±0.63) (p < 0.001) and EDSS from 4.9 (±2.4) to 4.2 (±2.6) (p < 0.001). AQP4-IgG seropositivity (hazard ratio [HR] 12.3, 95% CI 1.64-91.6, p = 0.015), a delay between the first attack and MiTX ≥24 months (HR 2.76, 95% CI 1.23-6.17, p = 0.014), and a pretreatment ARR ≥1 (HR 2.38, 95% CI 1.05-5.39, p = 0.037) were predictors of relapse. During the entire follow-up, severe secondary adverse events occurred in 3 patients (3.5%). DISCUSSION MiTX is an effective and safe treatment for most of our patients, drastically less expensive than new molecules, and could be allowed in NMOSD Afro-descendant patients in geographical areas where access to care is difficult.
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Affiliation(s)
- Hugo Chaumont
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France.
| | - Nicolas Bérard
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Jean-Pierre Karam
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Quentin Lobjois
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Benoit Tressieres
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Aissatou Signate
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Annie Lannuzel
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Philippe Cabre
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
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Zarghami A, Fuh-Ngwa V, Claflin SB, van der Mei I, Ponsonby AL, Broadley S, Simpson-Yap S, Taylor BV. Changes in employment status over time in multiple sclerosis following a first episode of central nervous system demyelination, a Markov multistate model study. Eur J Neurol 2024; 31:e16016. [PMID: 37525323 DOI: 10.1111/ene.16016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND PURPOSE Understanding predictors of changes in employment status among people living with multiple sclerosis (MS) can assist health care providers to develop appropriate work retention/rehabilitation programs. We aimed to model longitudinal transitions of employment status in MS and estimate the probabilities of retaining employment status or losing or gaining employment over time in individuals with a first clinical diagnosis of central nervous system demyelination (FCD). METHODS This prospective cohort study comprised adults (aged 18-59 years) diagnosed with FCD (n = 237) who were followed for more than 11 years. At each review, participants were assigned to one of three states: unemployed, part-time, or full-time employed. A Markov multistate model was used to examine the rate of state-to-state transitions. RESULTS At the time of FCD, participants with full-time employment had an 89% chance of being in the same state over a 1-year period, but this decreased to 42% over the 10-year follow-up period. For unemployed participants, there was a 92% likelihood of remaining unemployed after 1 year, but this probability decreased to 53% over 10 years. Females, those who progressed to clinically definite MS, those with a higher relapse count, and those with a greater level of disability were at increased risk of transitioning to a deteriorated employment state. In addition, those who experienced clinically significant fatigue over the follow-up period were less likely to gain employment after being unemployed. CONCLUSIONS In our FCD cohort, we found a considerable rate of employment transition during the early years post-diagnosis. Over more than a decade of follow-up post-FCD, we found that females and individuals with a greater disability and a higher relapse count are at higher risk of losing employment.
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Affiliation(s)
- Amin Zarghami
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Valery Fuh-Ngwa
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Simon Broadley
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Binshalan T, Buckley E, Nair S, Mcneill A. Variability of Multiple Sclerosis Walking Scale and Multiple Sclerosis Impact Scale Scores in People Without Multiple Sclerosis. Cureus 2024; 16:e51811. [PMID: 38322083 PMCID: PMC10846872 DOI: 10.7759/cureus.51811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Many people with multiple sclerosis (pwMS) experience problems with mobility at some point in their disease course. The Multiple Sclerosis Impact Scale (MSIS) and Multiple Sclerosis Walking Scale (MSWS) are validated patient-reported outcome measures of physical impairment in pwMS. The range of scores on MSIS and MSWS in people without MS (pwoMS) are not well understood. Methods People over the age of 16 who did not have a diagnosis of multiple sclerosis (MS) were invited to complete an online survey consisting of a general health questionnaire, MSIS and the MSWS. Scores for MSIS and MSWS from pwoMS were compared to those from a cohort of 35 pwMS from a previous study. Scores for MSIS and MSWS were correlated with age, sex and comorbidities in pwoMS. Results One hundred eighty-nine ambulant pwoMS were recruited (52.5% female), aged over 16 years of age. Ninety-nine percent reported no difficulty with walking, 89.4% were non-smokers, and 14% had a physical co-morbidity. None used a walking aid. For pwoMS, the MSIS score was a mean of 39.14±13.75 (range 29-127), compared to a mean of 77.2±24.94 (range 40-126) for pwMS. For pwoMS, the mean MSWS score was 8.46±16.2 (0-87) compared to a mean of 56.9±28.9 (4-100) for pwMS. There was no significant effect of sex or smoking on MSIS or MSWS scores in pwoMS. Presence of a physical co-morbidity was associated with significantly higher MSIS and MSWS scores in pwoMS. There was a significant correlation of increasing age with increasing MSWS score in pwoMS but no correlation of age with MSIS score. Conclusion There is a wide range of MSWS and MSIS scores in pwoMS. The age and presence of comorbidities influence both MSWS and MSIS scores. Our findings have implications for the selection of control groups for clinical studies in pwMS.
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Affiliation(s)
| | - Ellen Buckley
- Neuroscience, The University of Sheffield, Sheffield, GBR
| | - Siva Nair
- Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
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Amerio A, Magnani L, Arduino G, Fesce F, de Filippis R, Parise A, Costanza A, Nguyen KD, Saverino D, De Berardis D, Aguglia A, Escelsior A, Serafini G, De Fazio P, Amore M. Immunomodulatory Effects of Clozapine: More Than Just a Side Effect in Schizophrenia. Curr Neuropharmacol 2024; 22:1233-1247. [PMID: 38031778 PMCID: PMC10964093 DOI: 10.2174/1570159x22666231128101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 12/01/2023] Open
Abstract
Recent evidence suggests a possible relationship between the immune system and schizophrenia spectrum disorders (SSDs), as neuroinflammation appears to play a role in major psychiatric conditions. Neuroinflammation is as a broad concept representing a physiological protective response to infection or injury, but in some cases, especially if chronic, it may represent an expression of maladaptive processes, potentially driving to clinical dysfunction and neurodegeneration. Several studies are concurrently highlighting the importance of microglia, the resident immune cells of the central nervous system, in a huge number of neurodegenerative diseases, including multiple sclerosis, Alzheimer's and Parkinson's diseases, as well as SSDs. A more fundamental phenomenon of maladaptive coupling of microglia may contribute to the genesis of dysfunctional brain inflammation involved in SSDs, from the onset of their neurophenomenological evolution. Clozapine and other antipsychotic drugs seem to express a provable immunomodulant effect and a more specific action on microglia, while neuroactive steroids and nonsteroidal anti-inflammatory drugs may reduce some SSDs symptoms in add-on therapy. Given these theoretical premises, this article aims to summarize and interpret the available scientific evidence about psychotropic and anti-inflammatory drugs that could express an immunomodulant activity on microglia.
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Magnani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Gabriele Arduino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Fabio Fesce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Alberto Parise
- Department of Geriatric-Rehabilitation,, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI) Lugano, Switzerland
| | - Khoa D. Nguyen
- Department of Microbiology and Immunology, Stanford University, Palo Alto, CA, USA
- Tranquis Therapeutics, Palo Alto, CA, USA
| | - Daniele Saverino
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Experimental Medicine (DiMeS), Section of Human Anatomy, University of Genoa, Genoa, Italy
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital “G. Mazzini”, Teramo, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Rodríguez de Vera Gómez P, Méndez Muros M, Torres Cuadro A, Toyos Sáenz de Miera FJ, López Ruiz R, Guerrero Vázquez R, García González JJ, Garrido Hermosilla AM, Martín Hernández T. Alemtuzumab induces severe orbitopathy in relapsing-remitting multiple sclerosis. J Neurol 2024; 271:486-496. [PMID: 37773417 DOI: 10.1007/s00415-023-11995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023]
Abstract
CONTEXT Treatment with Alemtuzumab (ALZ) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) is associated with the development of ALZ-induced Graves' disease (GD-ALZ). Some cases may develop associated Graves´ Orbitopathy (GO-ALZ), with possible visual compromise. AIM The aim of this study was to describe the main clinical and biochemical characteristics of GD-ALZ, as well as the clinical course of a case series of GO-ALZ METHODS: This study is a retrospective observational study, carried out in a reference hospital for the care of patients with RRMS in Spain. Cases treated with ALZ in the period 2014-2022 were included. GO-ALZ cases were identified among those with clinical symptoms compatible with thyroid eye disease after initiating ALZ treatment. RESULTS A total of 135 cases, with a mean follow-up of 69.6 months after the first ALZ cycle, were included. The incidence of GD-ALZ was 32.6% (44/135), with a predominance of women (77.3%) and mean age of 41.9 years. The presence of first-degree relatives with hypothyroidism was identified as risk factor for the development of GD-ALZ (adjusted P-value: 0.02). GO-ALZ was diagnosed in 6 cases (incidence: 13.6%), of which 3 had severe clinical forms of GO, requiring anti-IL-6 treatment. A favorable response was reported in all of them, with a significant decrease in disease activity and improvement in proptosis. CONCLUSIONS We report one of the largest cohorts of GD-ALZ and GO-ALZ cases. The diagnosis of these entities should be taken into account in patients treated with Alemtuzumab, given the risk of developing severe clinical forms. In moderate-severe forms of GO-ALZ, drugs with anti-IL-6 activity are a safe and effective option.
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Affiliation(s)
- Pablo Rodríguez de Vera Gómez
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain.
| | - Mariola Méndez Muros
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain.
- Andalusian Reference Unit for Graves' Orbitopathy (UPRA) Endocrinology, Seville, Spain.
| | - Alberto Torres Cuadro
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain
| | | | - Rocío López Ruiz
- Neurology Department, University Hospital Virgen de la Macarena, Seville, Spain
| | - Raquel Guerrero Vázquez
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain
| | | | - Antonio Manuel Garrido Hermosilla
- Ophthalmology Department, University Hospital Virgen de la Macarena, Seville, Spain
- Andalusian Reference Unit for Graves' Orbitopathy (UPRA) Endocrinology, Seville, Spain
| | - Tomás Martín Hernández
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain
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Özden F, Özkeskin M, Ekici E, Yüceyar N. Agreement between video-based clinician-rated tools and patient-reported outcomes on gait assessment in individuals with multiple sclerosis. Neurol Sci 2024; 45:241-248. [PMID: 37535127 DOI: 10.1007/s10072-023-06983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/22/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To our knowledge, no studies compared the video-clinician-based tools and patient-reported questionnaires in assessing gait and balance in people with MS (pwMS). The present study investigated the correlation and agreement between video-clinician-based objective measurement tools and patient-reported outcome measures (PROMs) in gait and balance evaluation. METHODS A prospective cross-sectional study was conducted with 55 pwMS. Video analysis-based gait was evaluated by the Tinetti Gait Assessment (TGA), Gait Assessment and Intervention Tool (GAIT), and Functional Ambulation Classification Scale (FACS) by the clinician. Participants' self-reported gait and balance were assessed with the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Activity-Specific Balance Confidence Scale (ABC). RESULTS There was a moderate positive correlation between ABC with TGA and FACS (r1: 0.552, r2: 0.510, p < 0.001). ABC was strongly correlated with GAIT (r: - 0.652, p < 0.001). A moderate positive correlation was observed between MSWS-12 with TGA and FACS (r1: - 0.575, r2: - 0.524, p < 0.001). In addition, there was a strong positive correlation between MSWS-12 and GAIT (r: - 0.652, p < 0.001). Clinician-rated tools and PROMs were within the agreement limits regarding the unstandardized beta values p < 0.001). CONCLUSIONS Clinician-based gait and balance tools demonstrate consistent results with PROMs in pwMS. Considering the low cost and practical use of PROMs, in cases where video-based clinician-based measurements cannot be provided (time, space, and technical inadequacies), questionnaires can provide concordant results at moderate and severe levels compared with objective tools.
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Affiliation(s)
- Fatih Özden
- Department of Health Care Services, Köyceğiz Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Mehmet Özkeskin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ege University, İzmir, Turkey
| | - Ece Ekici
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Ege University, İzmir, Turkey
| | - Nur Yüceyar
- Department of Neurology, Faculty of Medicine, Ege University, İzmir, Turkey
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Kümpfel T, Giglhuber K, Aktas O, Ayzenberg I, Bellmann-Strobl J, Häußler V, Havla J, Hellwig K, Hümmert MW, Jarius S, Kleiter I, Klotz L, Krumbholz M, Paul F, Ringelstein M, Ruprecht K, Senel M, Stellmann JP, Bergh FT, Trebst C, Tumani H, Warnke C, Wildemann B, Berthele A. Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management. J Neurol 2024; 271:141-176. [PMID: 37676297 PMCID: PMC10770020 DOI: 10.1007/s00415-023-11910-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023]
Abstract
This manuscript presents practical recommendations for managing acute attacks and implementing preventive immunotherapies for neuromyelitis optica spectrum disorders (NMOSD), a rare autoimmune disease that causes severe inflammation in the central nervous system (CNS), primarily affecting the optic nerves, spinal cord, and brainstem. The pillars of NMOSD therapy are attack treatment and attack prevention to minimize the accrual of neurological disability. Aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) are a diagnostic marker of the disease and play a significant role in its pathogenicity. Recent advances in understanding NMOSD have led to the development of new therapies and the completion of randomized controlled trials. Four preventive immunotherapies have now been approved for AQP4-IgG-positive NMOSD in many regions of the world: eculizumab, ravulizumab - most recently-, inebilizumab, and satralizumab. These new drugs may potentially substitute rituximab and classical immunosuppressive therapies, which were as yet the mainstay of treatment for both, AQP4-IgG-positive and -negative NMOSD. Here, the Neuromyelitis Optica Study Group (NEMOS) provides an overview of the current state of knowledge on NMOSD treatments and offers statements and practical recommendations on the therapy management and use of all available immunotherapies for this disease. Unmet needs and AQP4-IgG-negative NMOSD are also discussed. The recommendations were developed using a Delphi-based consensus method among the core author group and at expert discussions at NEMOS meetings.
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Affiliation(s)
- Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Judith Bellmann-Strobl
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Markus Krumbholz
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
| | - Friedemann Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille University, CNRS, CRMBM, Marseille, France
| | | | - Corinna Trebst
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | - Clemens Warnke
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Brigitte Wildemann
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany.
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Hardy TA, Aouad P, Barnett MH, Blum S, Broadley S, Carroll WM, Crimmins D, Griffiths D, Hodgkinson S, Lechner-Scott J, Lee A, Malhotra R, McCombe P, Parratt J, Plummer C, Van der Walt A, Martel K, Walker RA. Onboarding of siponimod in secondary progressive multiple sclerosis patients in Australia: Novel, real-world evidence from the MSGo digital support programme. Mult Scler J Exp Transl Clin 2024; 10:20552173231226106. [PMID: 38222025 PMCID: PMC10787529 DOI: 10.1177/20552173231226106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Background Siponimod is approved for use in people with secondary progressive multiple sclerosis (pwSPMS). An integrated digital platform, MSGo, was developed for pwSPMS and clinicians to help navigate the multiple steps of the pre-siponimod work-up. Objective To explore real-world onboarding experiences of siponimod amongst pwSPMS in Australia. Methods Retrospective, non-interventional, longitudinal, secondary analysis of data extracted from MSGo (20 April 2022). The primary endpoint was the average time for siponimod onboarding; secondary endpoints were adherence and sub-group analyses of variables influencing onboarding. Results Mixed-cure modelling estimated that 58% of participants (N = 368, females 71%, median age of 59 years) registered in MSGo would ever initiate siponimod. The median time to initiation was 56 days (95% CI [47-59] days). Half of the participants cited 'waiting for vaccination' as the reason for initiation delay. Cox regression analyses found participants with a nominated care partner had faster onboarding (HR 2.1, 95% CI [1.5-3.0]) and were more likely to continue self-reporting daily siponimod dosing than were those without a care partner (HR 2.2, 95% CI [1.3-3.7]). Conclusions Despite the limitations of self-reported data and the challenges of the COVID-19 pandemic, this study provides insights into siponimod onboarding in Australia and demonstrates the positive impact of care partner support.
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Affiliation(s)
- TA Hardy
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - P Aouad
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - MH Barnett
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Blum
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Broadley
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - WM Carroll
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - D Crimmins
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - D Griffiths
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Hodgkinson
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - J Lechner-Scott
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - A Lee
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - R Malhotra
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - P McCombe
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - J Parratt
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - C Plummer
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - A Van der Walt
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - K Martel
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - RA Walker
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
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Pakenham KI, Landi G, Grandi S, Tossani E. The mediating role of psychological flexibility in the relationship between resilience and distress and quality of life in people with multiple sclerosis. J Health Psychol 2024; 29:65-80. [PMID: 37387365 DOI: 10.1177/13591053231182364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
The purpose of this study is to investigate the role of psychological flexibility in mediating the beneficial effects of resilience on distress and quality of life (QoL) in people with MS (PwMS). The psychological flexibility framework underpinning acceptance and commitment therapy (ACT) was used to conceptualise psychological flexibility. A total of 56 PwMS completed an online survey that assessed global psychological flexibility and each of its six core sub-processes, resilience, distress, mental and physical health QoL, socio-demographics, and illness variables. Mediation analyses showed that, as hypothesised, higher levels of global psychological flexibility and its sub-processes were associated with increases in the positive impacts of resilience on distress and mental and physical health QoL via a mediational mechanism. These findings suggest that psychological flexibility skills build resilience capacities in PwMS. The psychological flexibility framework offers an ACT-based intervention pathway to build resilience and enhance mental health and QoL in PwMS.
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Verbout NG, Su W, Pham P, Jordan KR, Kohs TCL, Tucker EI, McCarty OJT, Sherman LS. Cytoprotective E-WE thrombin reduces disease severity in a murine model of relapsing-remitting multiple sclerosis. Am J Physiol Cell Physiol 2024; 326:C40-C49. [PMID: 37955120 PMCID: PMC11192471 DOI: 10.1152/ajpcell.00377.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
The blood-brain barrier is composed of microvascular endothelial cells, immune cells, and astrocytes that work in concert with the coagulation cascade to control inflammation and immune cell infiltration into the central nervous system. Endothelial cell dysfunction leading to increased permeability and compromised barrier function are hallmarks of neuroinflammatory and autoimmune disorders, including multiple sclerosis (MS). Therapeutic strategies that improve or protect endothelial barrier function may be beneficial in the treatment or prevention of neuroinflammatory diseases. We therefore tested the hypothesis that biasing thrombin toward anticoagulant and cytoprotective activities would provide equivalent or even additive benefit compared with standard-of-care therapeutic strategies, including corticosteroids. In a mouse model of relapsing-remitting MS, treatment with the thrombin mutant, E-WE thrombin, an engineered thrombin mutant with cytoprotective activities that is biased toward anticoagulant and cytoprotective activity, reduced neuroinflammation and extracellular fibrin formation in SJL mice inoculated with proteolipid protein (PLP) peptide. When administered at the onset of detectable disease, E-WE thrombin significantly improved the disease severity of the initial attack as well as the relapse and delayed the onset of relapse to a similar extent as observed with methylprednisolone. Both methylprednisolone and E-WE thrombin reduced demyelination and immune cell recruitment. These results provide rationale for considering engineered forms of thrombin biased toward anticoagulant and cytoprotective activity as a therapeutic strategy and perhaps an effective alternative to high-dose methylprednisolone for the management of acute relapsing MS attacks.NEW & NOTEWORTHY There are limited treatment options for mitigating acute relapsing attacks for patients with multiple sclerosis. We tested the hypothesis that harnessing the cytoprotective activity of the blood coagulation enzyme, thrombin, would provide benefit and protection against relapsing disease in a mouse model of MS. Our results provide rationale for considering engineered forms of thrombin biased toward cytoprotective activity as a therapeutic strategy and perhaps an alternative to steroids for the management of relapsing MS attacks.
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Affiliation(s)
- Norah G Verbout
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
- Aronora, Inc, Portland, Oregon, United States
| | - Weiping Su
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
| | - Peter Pham
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
| | - Kelley R Jordan
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Tia C L Kohs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Erik I Tucker
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
- Aronora, Inc, Portland, Oregon, United States
| | - Owen J T McCarty
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Larry S Sherman
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
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