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Mohite R, Gharat S, Doshi G. Unraveling the Role of the Glycogen Synthase Kinase-3β, Bruton's Tyrosine Kinase, and Sphingosine 1 Phosphate Pathways in Multiple Sclerosis. Endocr Metab Immune Disord Drug Targets 2024; 24:1131-1145. [PMID: 38284723 DOI: 10.2174/0118715303261413231117113707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 01/30/2024]
Abstract
Inflammation, demyelination, and neurodegeneration are symptoms of the central nervous system (CNS) condition known as Multiple sclerosis (MS). Due to its crucial function in controlling immune cell activation and inflammation, the glycogen synthase kinase-3β (GSK- 3β), Bruton's tyrosine kinase (BTK), and Sphingosine 1 phosphate (S1P) signaling pathway have become a viable target for the therapy of MS. The GSK-3β signaling system, which controls several biological target processes, including cell survival, proliferation, and inflammation, depends on the GSK-3β enzyme. In MS animal models and human studies, GSK-3β inhibition has been demonstrated to lessen demyelination and inflammation. Clinical research on MS has demonstrated that BTK inhibitors decrease inflammation and disease activity by preventing B cell activation and the subsequent release of cytokines. Clinical investigations for MS have demonstrated that S1P modulators, such as fingolimod, lower disease activity and inflammation by limiting immune cell migration to the central nervous system and preventing cytokine production. The GSK-3β /BTK/S1P signaling pathway in MS is the subject of this paper's summary and discussion of prospective treatment targets.
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Affiliation(s)
- Rupali Mohite
- Department of Pharmacology, Toxicology and Therapeutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, V.M. Road, Vile Parle (W), Mumbai, India
| | - Sankalp Gharat
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, V.M. Road, Vile Parle (W), Mumbai, India
| | - Gaurav Doshi
- Department of Pharmacology, Toxicology and Therapeutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, V.M. Road, Vile Parle (W), Mumbai, India
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do Amaral LLF, Fragoso DC, Nunes RH, Littig IA, da Rocha AJ. Gadolinium-Enhanced Susceptibility-Weighted Imaging in Multiple Sclerosis: Optimizing the Recognition of Active Plaques for Different MR Imaging Sequences. AJNR Am J Neuroradiol 2019; 40:614-619. [PMID: 30846435 DOI: 10.3174/ajnr.a5997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/24/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Gadolinium SWI is MR imaging that has recently been reported to be effective in the evaluation of several neurologic disorders, including demyelinating diseases. Our aim was to analyze the accuracy of gadolinium SWI for detecting the imaging evidence of active inflammation on MS plaques when a BBB dysfunction is demonstrated by a focal gadolinium-enhanced lesion and to compare this technique with gadolinium-enhanced T1 spin-echo and T1 spin-echo with magnetization transfer contrast. MATERIALS AND METHODS MR imaging studies of 103 patients (170 examinations) were performed using a 1.5T scanner. Two neuroradiologists scrutinized signal abnormalities of the demyelinating plaques on gadolinium SWI and compared them with gadolinium T1 before and after an additional magnetization transfer pulse. Interrater agreement was evaluated among gadolinium T1 magnetization transfer contrast, gadolinium SWI, and gadolinium T1 spin-echo using the κ coefficient. The T1 magnetization transfer contrast sequence was adopted as the criterion standard in this cohort. Thus, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated for gadolinium T1 spin-echo and gadolinium SWI sequences. RESULTS Differences in BBB dysfunction were evident among gadolinium SWI, gadolinium T1 spin-echo, and gadolinium T1 magnetization transfer contrast. Gadolinium T1 magnetization transfer contrast demonstrated the highest number of active demyelinating plaques. Gadolinium SWI was highly correlated with gadolinium T1 magnetization transfer contrast in depicting acute demyelinating plaques (κ coefficient = 0.860; sensitivity = 0.837), and these techniques provided better performance compared with gadolinium T1 spin-echo (κ coefficient = 0.78; sensitivity = 0.645). CONCLUSIONS Gadolinium SWI was able to better detect BBB dysfunction in MS plaques and had a better performance than gadolinium T1 spin-echo. Increasing SWI sequence applications in clinical practice can improve our knowledge of MS, likely allowing the addition of BBB dysfunction analysis to the striking findings of the previously reported central vein sign.
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Affiliation(s)
- L L F do Amaral
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil .,Neuroradiology Department (L.L.F.A.), BP Medicina Diagnóstica, Hospital BP e BP Mirante da Beneficěncia Portuguesa de São Paulo, São Paulo, Brazil
| | - D C Fragoso
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil.,Division of Neuroradiology (D.C.F.), Fleury S.A., São Paulo, Brazil
| | - R H Nunes
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil
| | - I A Littig
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - A J da Rocha
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil
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Caldito NG, Saidha S, Sotirchos ES, Dewey BE, Cowley NJ, Glaister J, Fitzgerald KC, Al-Louzi O, Nguyen J, Rothman A, Ogbuokiri E, Fioravante N, Feldman S, Kwakyi O, Risher H, Kimbrough D, Frohman TC, Frohman E, Balcer L, Crainiceanu C, Van Zijl PCM, Mowry EM, Reich DS, Oh J, Pham DL, Prince J, Calabresi PA. Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: a longitudinal study. Brain 2018; 141:3115-3129. [PMID: 30312381 PMCID: PMC6202573 DOI: 10.1093/brain/awy245] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/03/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023] Open
Abstract
On average, African Americans with multiple sclerosis demonstrate higher inflammatory disease activity, faster disability accumulation, greater visual dysfunction, more pronounced brain tissue damage and higher lesion volume loads compared to Caucasian Americans with multiple sclerosis. Neurodegeneration is an important component of multiple sclerosis, which in part accounts for the clinical heterogeneity of the disease. Brain atrophy appears to be widespread, although it is becoming increasingly recognized that regional substructure atrophy may be of greater clinical relevance. Patient race (within the limitations of self-identified ancestry) is regarded as an important contributing factor. However, there is a paucity of studies examining differences in neurodegeneration and brain substructure volumes over time in African Americans relative to Caucasian American patients. Optical coherence tomography is a non-invasive and reliable tool for measuring structural retinal changes. Recent studies support its utility for tracking neurodegeneration and disease progression in vivo in multiple sclerosis. Relative to Caucasian Americans, African American patients have been found to have greater retinal structural injury in the inner retinal layers. Increased thickness of the inner nuclear layer and the presence of microcystoid macular pathology at baseline predict clinical and radiological inflammatory activity, although whether race plays a role in these changes has not been investigated. Similarly, assessment of outer retinal changes according to race in multiple sclerosis remains incompletely characterized. Twenty-two African Americans and 60 matched Caucasian Americans with multiple sclerosis were evaluated with brain MRI, and 116 African Americans and 116 matched Caucasian Americans with multiple sclerosis were monitored with optical coherence tomography over a mean duration of 4.5 years. Mixed-effects linear regression models were used in statistical analyses. Grey matter (-0.9%/year versus -0.5%: P =0.02), white matter (-0.7%/year versus -0.3%: P =0.04) and nuclear thalamic (-1.5%/year versus -0.7%/year: P =0.02) atrophy rates were approximately twice as fast in African Americans. African Americans also exhibited higher proportions of microcystoid macular pathology (12.1% versus 0.9%, P =0.001). Retinal nerve fibre layer (-1.1% versus -0.8%: P =0.02) and ganglion cell+ inner plexiform layer (-0.7%/year versus -0.4%/year: P =0.01) atrophy rates were faster in African versus Caucasian Americans. African Americans on average exhibited more rapid neurodegeneration than Caucasian Americans and had significantly faster brain and retinal tissue loss. These results corroborate the more rapid clinical progression reported to occur, in general, in African Americans with multiple sclerosis and support the need for future studies involving African Americans in order to identify individual differences in treatment responses in multiple sclerosis.
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Affiliation(s)
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Blake E Dewey
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Norah J Cowley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Glaister
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Omar Al-Louzi
- Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James Nguyen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alissa Rothman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther Ogbuokiri
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Fioravante
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sydney Feldman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ohemaa Kwakyi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hunter Risher
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorlan Kimbrough
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Austin Dell Medical School, Austin TX, USA
| | - Elliot Frohman
- Department of Neurology, University of Texas Austin Dell Medical School, Austin TX, USA
| | - Laura Balcer
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | | | - Peter C M Van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins University, Baltimore MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, MD, USA
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Neurology, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada
| | - Dzung L Pham
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
- Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jerry Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Oreja-Guevara C. Overview of magnetic resonance imaging for management of relapsing−remitting multiple sclerosis in everyday practice. Eur J Neurol 2015; 22 Suppl 2:22-7. [DOI: 10.1111/ene.12800] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. Oreja-Guevara
- Neurology Department; Hospital Clínico Universitario San Carlos; Madrid Spain
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5
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Dula AN, Pawate S, Dortch RD, Barry RL, George-Durrett KM, Lyttle BD, Dethrage LM, Gore JC, Smith SA. Magnetic resonance imaging of the cervical spinal cord in multiple sclerosis at 7T. Mult Scler 2015. [PMID: 26209591 DOI: 10.1177/1352458515591070] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The clinical course of multiple sclerosis (MS) is mainly attributable to cervical and upper thoracic spinal cord dysfunction. High-resolution, 7T anatomical imaging of the cervical spinal cord is presented. Image contrast between gray/white matter and lesions surpasses conventional, clinical T1- and T2-weighted sequences at lower field strengths. OBJECTIVE To study the spinal cord of healthy controls and patients with MS using magnetic resonance imaging at 7T. METHODS Axial (C2-C5) T1- and T2*-weighted and sagittal T2*-/spin-density-weighted images were acquired at 7T in 13 healthy volunteers (age 22-40 years), and 15 clinically diagnosed MS patients (age 19-53 years, Extended Disability Status Scale, (EDSS) 0-3) in addition to clinical 3T scans. In healthy volunteers, a high-resolution multi-echo gradient echo scan was obtained over the same geometry at 3T. Evaluation included signal and contrast to noise ratios and lesion counts for healthy and patient volunteers, respectively. RESULTS/CONCLUSION High-resolution images at 7T exceeded resolutions reported at lower field strengths. Gray and white matter were sharply demarcated and MS lesions were more readily visualized at 7T compared to clinical acquisitions, with lesions apparent at both fields. Nerve roots were clearly visualized. White matter lesion counts averaged 4.7 vs 3.1 (52% increase) per patient at 7T vs 3T, respectively (p=0.05).
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Affiliation(s)
- Adrienne N Dula
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA
| | - Siddharama Pawate
- Department of Neuroscience, Vanderbilt University Medical Center, USA
| | - Richard D Dortch
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA
| | - Robert L Barry
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA
| | | | - Bailey D Lyttle
- Department of Neuroscience, Vanderbilt University Medical Center, USA
| | - Lindsey M Dethrage
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA
| | - John C Gore
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA/Department of Biomedical Engineering, Vanderbilt University Medical Center, USA
| | - Seth A Smith
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA/Department of Biomedical Engineering, Vanderbilt University Medical Center, USA
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6
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Davis MF, Haines JL. The intelligent use and clinical benefits of electronic medical records in multiple sclerosis. Expert Rev Clin Immunol 2014; 11:205-11. [PMID: 25495075 DOI: 10.1586/1744666x.2015.991314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Electronic medical records (EMRs) are being quickly adopted in clinics around the world. This advancement can greatly enhance the clinical care of patients with multiple sclerosis (MS) by providing formats that allow easier review of medical documents and more structured avenues to store relevant information. MS clinicians should be involved with implementing and updating EMRs at their institutions to ensure EMR formats that benefit MS clinics. EMRs also provide opportunities for research studies of MS to access detailed, longitudinal data of MS disease course that would otherwise be difficult to collect.
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Affiliation(s)
- Mary F Davis
- Brigham Young University, Microbiology and Molecular Biology, 4007 LSB, Provo, UT 84602, USA
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Nakamura M, Morris M, Cerghet M, Schultz L, Elias S. Longitudinal Follow-up of a Cohort of Patients with Incidental Abnormal Magnetic Resonance Imaging Findings at Presentation and Their Risk of Developing Multiple Sclerosis. Int J MS Care 2014; 16:111-5. [PMID: 25337052 DOI: 10.7224/1537-2073.2013-016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is widely used in clinical practice, and "abnormal brain MRI" findings often prompt assessment for multiple sclerosis (MS), even when there are no symptoms suggestive of the disease. Despite several studies involving individuals with "radiologically isolated syndrome" (RIS), little is known about what factors might predict future development of MS. The objective of this study was to longitudinally evaluate clinical and MRI characteristics of people who presented to an MS clinic because of incidental abnormal MRI findings but did not have typical symptoms of MS, in order to assess risk factors for developing MS. METHODS Thirty consecutive patients presenting to an MS clinic for evaluation of abnormal MRI findings were enrolled in the study. Clinical and paraclinical data, including MRI results, were reviewed. Magnetic resonance imaging findings of T2 hyperintensities measuring more than 3 mm in diameter and fulfilling at least three out of four Barkhof criteria, with or without gadolinium-enhancing lesions, were considered to be suggestive of MS. RESULTS The median follow-up time was 5.5 years. No participants without MRI findings suggestive of MS were diagnosed with MS (P = .005). Fifteen participants had MRI findings suggestive of MS. Seven of the 15 (47%) were diagnosed with MS on follow-up. Cerebrospinal fluid (CSF) testing results were available for 15 participants. Abnormal results were found in six participants, of whom five (83%) also had MRI findings suggestive of MS. Only two of the nine (22%) participants with normal CSF results (P = .04) had MRI findings suggestive of MS. CONCLUSIONS In our cohort, none of the participants without MRI findings suggestive of MS developed MS. The participants with MRI findings suggestive of MS were more likely to develop symptoms and MRI changes typical of MS on follow-up.
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Affiliation(s)
- Mio Nakamura
- Department of Neurology (MN, MM, MC, LS, SE) and Department of Public Health Sciences (LS), Henry Ford Hospital, Detroit, MI, USA; and Wayne State University, School of Medicine, Detroit, MI, USA (MN, MM)
| | - Mark Morris
- Department of Neurology (MN, MM, MC, LS, SE) and Department of Public Health Sciences (LS), Henry Ford Hospital, Detroit, MI, USA; and Wayne State University, School of Medicine, Detroit, MI, USA (MN, MM)
| | - Mirela Cerghet
- Department of Neurology (MN, MM, MC, LS, SE) and Department of Public Health Sciences (LS), Henry Ford Hospital, Detroit, MI, USA; and Wayne State University, School of Medicine, Detroit, MI, USA (MN, MM)
| | - Lonni Schultz
- Department of Neurology (MN, MM, MC, LS, SE) and Department of Public Health Sciences (LS), Henry Ford Hospital, Detroit, MI, USA; and Wayne State University, School of Medicine, Detroit, MI, USA (MN, MM)
| | - Stanton Elias
- Department of Neurology (MN, MM, MC, LS, SE) and Department of Public Health Sciences (LS), Henry Ford Hospital, Detroit, MI, USA; and Wayne State University, School of Medicine, Detroit, MI, USA (MN, MM)
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8
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Impact of delayed diagnosis and treatment in clinically isolated syndrome and multiple sclerosis. J Neurosci Nurs 2014; 45:S3-13. [PMID: 24217189 DOI: 10.1097/jnn.0000000000000021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multiple sclerosis (MS) is a progressive inflammatory disease with several possible clinical courses; before the development of definite MS, some patients may have clinically isolated syndrome (CIS), which is a single attack of neurological symptoms caused by inflammation or demyelination. Disease-modifying treatments (DMTs) have been extensively used for the management of MS, resulting in improvements in the clinical presentation and decreases in MS-associated neurological damage. Earlier initiation of DMT in the course of MS is associated with better outcomes. For patients with CIS, initiation of interferon-beta or glatiramer acetate treatment after an initial clinical event indicative of MS has been associated with delays in the progression to clinically definite MS as well as improvements in measures of neurological damage via magnetic resonance imaging. The initiation of treatment for patients with CIS should be considered, and nurses play a vital role in educating patients about the risks of conversion to MS and the benefits of early DMT.
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Giannetti P, Politis M, Su P, Turkheimer F, Malik O, Keihaninejad S, Wu K, Reynolds R, Nicholas R, Piccini P. Microglia activation in multiple sclerosis black holes predicts outcome in progressive patients: an in vivo [(11)C](R)-PK11195-PET pilot study. Neurobiol Dis 2014; 65:203-10. [PMID: 24508617 DOI: 10.1016/j.nbd.2014.01.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 01/08/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022] Open
Abstract
The pathophysiological correlates and the contribution to persisting disability of hypointense T1-weighted MRI lesions, black holes (BH), in multiple sclerosis (MS) are still unclear. In order to study the in vivo functional correlates of this MRI finding, we used 11C-PK11195 PET (PK-PET) to investigate changes in microglial activity. Ten relapsing and 9 progressive MS subjects had a PK-PET scan and a MRI scan alongside a full clinical assessment, including the expanded disability status scale (EDSS) for evaluation of disability. We studied the PK binding potential of the specifically bound radioligand relative to the non-displaceable radioligand in tissue (BPND) in T1 BHs. Out of a total of 1242 BHs identified, 947 were PK enhancing. The PKBPND was correlated with the EDSS (r=0.818; p<0.05) only in the progressive group. In the relapsing patients there was an inverse correlation between PKBPND and BH total lesion volume in whole brain (r=-0.781; p<0.05). When progressive patients were grouped according to the disability outcome at 2years from the PK-PET scan, the total PKBPND in BHs was found to be a significant outcome predictor of disability (p<0.01). Our findings show that relapsing and progressive patients have heterogeneous patterns of PKBPND in T1 BHs and indicate that BHs are not just "holes" representing loss of axons and myelin, but display inflammatory activity in the form of activated microglia. The significant association between PKBPND, neurological impairment and outcome in progressive subjects supports a role for activated microglia in disability progression.
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Affiliation(s)
- Paolo Giannetti
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Marios Politis
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK; Neurodegeneration Imaging Group, Department of Clinical Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.
| | - Paul Su
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Federico Turkheimer
- Centre for Neuroimaging, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
| | - Omar Malik
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Shiva Keihaninejad
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Kit Wu
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Richard Reynolds
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Richard Nicholas
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Paola Piccini
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
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Erbayat Altay E, Fisher E, Jones SE, Hara-Cleaver C, Lee JC, Rudick RA. Reliability of classifying multiple sclerosis disease activity using magnetic resonance imaging in a multiple sclerosis clinic. JAMA Neurol 2013; 70:338-44. [PMID: 23599930 DOI: 10.1001/2013.jamaneurol.211] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the reliability of new magnetic resonance imaging (MRI) lesion counts by clinicians in a multiple sclerosis specialty clinic. DESIGN An observational study. SETTING A multiple sclerosis specialty clinic. PATIENTS Eighty-five patients with multiple sclerosis participating in a National Institutes of Health–supported longitudinal study were included. INTERVENTION Each patient had a brain MRI scan at entry and 6 months later using a standardized protocol. MAIN OUTCOME MEASURES The number of new T2 lesions, newly enlarging T2 lesions, and gadolinium-enhancing lesions were measured on the 6-month MRI using a computer-based image analysis program for the original study. For this study, images were reanalyzed by an expert neuroradiologist and 3 clinician raters. The neuroradiologist evaluated the original image pairs; the clinicians evaluated image pairs that were modified to simulate clinical practice. New lesion counts were compared across raters, as was classification of patients as MRI active or inactive. RESULTS Agreement on lesion counts was highest for gadolinium-enhancing lesions, intermediate for new T2 lesions, and poor for enlarging T2 lesions. In 18% to 25% of the cases, MRI activity was classified differently by the clinician raters compared with the neuroradiologist or computer program. Variability among the clinical raters for estimates of new T2 lesions was affected most strongly by the image modifications that simulated low image quality and different head position. CONCLUSIONS Between-rater variability in new T2 lesion counts may be reduced by improved standardization of image acquisitions, but this approach may not be practical in most clinical environments. Ultimately, more reliable, robust, and accessible image analysis methods are needed for accurate multiple sclerosis disease-modifying drug monitoring and decision making in the routine clinic setting.
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Affiliation(s)
- Edru Erbayat Altay
- Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research, 9500 Euclid Ave, Cleveland, OH 44195-5244, USA.
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Katsenos C, Androulaki D, Lyra S, Tsoutsouras T, Mandragos C. A 17 year-old girl with a demyelinating disease requiring mechanical ventilation: a case report. BMC Res Notes 2013; 6:22. [PMID: 23331922 PMCID: PMC3579686 DOI: 10.1186/1756-0500-6-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 01/02/2013] [Indexed: 12/05/2022] Open
Abstract
Background Demyelinating diseases cause destruction of the myelin sheath, while axons are relatively spared. Pathologically, demyelination can be the result of an inflammatory process, viral infection, acquired metabolic derangement and ischemic insult. Three diseases that can cause inflammatory demyelination of the CNS are: Multiple sclerosis (MS), Acute disseminated encephalomyelitis (ADEM) and Acute hemorrhagic leucoencephalitis. Differentiation is not always easy and there is considerable overlaping. Data about adults with acute demyelination requiring ICU admission is limited. Case presentation A 17 year old Greek female was hospitalised in the ICU because of acute respiratory failure requiring mechanical ventilation. She had a history of febrile disease one month before, acute onset of paraplegia, diplopia, progressive arm weakness and dyspnea. Her consciousness was not impaired. A demyelinating central nervous system (CNS) disease, possibly post infectious encephalomyelitis (ADEM) was the underlying condition. The MRI of the brain disclosed diffused expanded cerebral lesions involving the optic nerve, basal ganglia cerebellum, pons and medulla oblongata. There was also extended involvement of the cervical and thoracic part of the spinal cord. CSF leukocyte count was elevated with lymphocyte predominance. The patient required mechanical ventilation for two months. Then she was transferred to a rehabilitation centre. Three years later she remains paraplegic. Since then she has not suffered any other demyelination attack. Conclusions Demyelinating diseases can cause acute respiratory failure when the spinal cord is affected. Severe forms of these diseases, making necessary ICU admission, is less frequently reported. Intensivists should be aware of the features of these rare diseases.
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Affiliation(s)
- Chrysostomos Katsenos
- Korgialenio-Benakio Red Cross Hospital of Athens, ICU, Athanasaki 1 str, Ampelokipoi, 11526, Athens, Greece.
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