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Peter J, Ferraioli F, Mathew D, George S, Chan C, Alalade T, Salcedo SA, Saed S, Tatti E, Quartarone A, Ghilardi MF. Movement-related beta ERD and ERS abnormalities in neuropsychiatric disorders. Front Neurosci 2022; 16:1045715. [PMID: 36507340 PMCID: PMC9726921 DOI: 10.3389/fnins.2022.1045715] [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: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Movement-related oscillations in the beta range (from 13 to 30 Hz) have been observed over sensorimotor areas with power decrease (i.e., event-related desynchronization, ERD) during motor planning and execution followed by an increase (i.e., event-related synchronization, ERS) after the movement's end. These phenomena occur during active, passive, imaged, and observed movements. Several electrophysiology studies have used beta ERD and ERS as functional indices of sensorimotor integrity, primarily in diseases affecting the motor system. Recent literature also highlights other characteristics of beta ERD and ERS, implying their role in processes not strictly related to motor function. Here we review studies about movement-related ERD and ERS in diseases characterized by motor dysfunction, including Parkinson's disease, dystonia, stroke, amyotrophic lateral sclerosis, cerebral palsy, and multiple sclerosis. We also review changes of beta ERD and ERS reported in physiological aging, Alzheimer's disease, and schizophrenia, three conditions without overt motor symptoms. The review of these works shows that ERD and ERS abnormalities are present across the spectrum of the examined pathologies as well as development and aging. They further suggest that cognition and movement are tightly related processes that may share common mechanisms regulated by beta modulation. Future studies with a multimodal approach are warranted to understand not only the specific topographical dynamics of movement-related beta modulation but also the general meaning of beta frequency changes occurring in relation to movement and cognitive processes at large. Such an approach will provide the foundation to devise and implement novel therapeutic approaches to neuropsychiatric disorders.
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Affiliation(s)
- Jaime Peter
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Francesca Ferraioli
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Dave Mathew
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shaina George
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Cameron Chan
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Tomisin Alalade
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Sheilla A. Salcedo
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shannon Saed
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Elisa Tatti
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,*Correspondence: Elisa Tatti,
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino Pulejo-Piemonte, Messina, Italy,Angelo Quartarone,
| | - M. Felice Ghilardi
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,M. Felice Ghilardi,
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2
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Kalincik T, Kister I, Bacon TE, Malpas CB, Sharmin S, Horakova D, Kubala-Havrdova E, Patti F, Izquierdo G, Eichau S, Ozakbas S, Onofrj M, Lugaresi A, Prat A, Girard M, Duquette P, Grammond P, Sola P, Ferraro D, Alroughani R, Terzi M, Boz C, Grand’Maison F, Bergamaschi R, Gerlach O, Sa MJ, Kappos L, Cartechini E, Lechner-Scott J, van Pesch V, Shaygannejad V, Granella F, Spitaleri D, Iuliano G, Maimone D, Prevost J, Soysal A, Turkoglu R, Ampapa R, Butzkueven H, Cutter G. Multiple Sclerosis Severity Score (MSSS) improves the accuracy of individualized prediction in MS. Mult Scler 2022; 28:1752-1761. [DOI: 10.1177/13524585221084577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The MSBase prediction model of treatment response leverages multiple demographic and clinical characteristics to estimate hazards of relapses, confirmed disability accumulation (CDA), and confirmed disability improvement (CDI). The model did not include Multiple Sclerosis Severity Score (MSSS), a disease duration-adjusted ranked score of disability. Objective: To incorporate MSSS into the MSBase prediction model and compare model accuracy with and without MSSS. Methods: The associations between MSSS and relapse, CDA, and CDI were evaluated with marginal proportional hazards models adjusted for three principal components representative of patients’ demographic and clinical characteristics. The model fit with and without MSSS was assessed with penalized r2 and Harrell C. Results: A total of 5866 MS patients were started on disease-modifying therapy during prospective follow-up (age 38.4 ± 10.6 years; 72% female; disease duration 8.5 ± 7.7 years). Including MSSS into the model improved the accuracy of individual prediction of relapses by 31%, of CDA by 23%, and of CDI by 24% (Harrell C) and increased the amount of variance explained for relapses by 49%, for CDI by 11%, and for CDA by 10% as compared with the original model. Conclusion: Addition of a single, readily available metric, MSSS, to the comprehensive MSBase prediction model considerably improved the individual accuracy of prognostics in MS.
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Affiliation(s)
- Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ilya Kister
- Neurology, NYU School of Medicine, New York, NY, USA
| | - Tamar E Bacon
- Neurology, NYU School of Medicine, New York, NY, USA
| | - Charles B Malpas
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Dana Horakova
- Department of Neurology, Charles University in Prague, Prague, Czech Republic
| | - Eva Kubala-Havrdova
- Department of Neurology, Charles University in Prague, Prague, Czech Republic
| | - Francesco Patti
- GF Ingrassia Department, University of Catania, Catania, Italy
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio, Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy/Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | - Marc Girard
- Universite de Montreal and CHUM, Montreal, QC, Canada
| | | | | | - Patrizia Sola
- Neurology Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Neurology Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy/Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | | | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands/School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maria J Sa
- Hospital S. João, Porto, Portugal; University Fernando Pessoa, Porto, Portugal
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience(RC2NB) and MS Center, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Jeannette Lechner-Scott
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | | | - Vahid Shaygannejad
- Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | | | - Davide Maimone
- Neurology Unit, Piazza S. Maria di Gesù 5, Catania, Italy
| | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | | | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Gary Cutter
- Department of Biostatistics, UAB School of Public Health, Birmingham, AL, USA
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3
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Roxburgh R, Willoughby E, Seaman S. Regarding the publication The Multiple Sclerosis Severity Score: Fluctuations and prognostic ability in a longitudinal cohort of patients with MS authored by RH Gross et al. Mult Scler J Exp Transl Clin 2020; 6:2055217320927421. [PMID: 32547777 PMCID: PMC7249563 DOI: 10.1177/2055217320927421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Shaun Seaman
- MRC Biostatistics Unit, University of Cambridge, UK
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4
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Abstract
Severity score represents disease duration-adjusted mean rank of disability in multiple sclerosis (MS) patients from the reference population. This measure allows one to compare the relative rates of disease progression among patients, patient subgroups, and across epochs, which opens up new question of what accounts for the observed differences in severity, and can be used to assess correlation between disease severity and clinical, radiologic, immunologic, genetic, and environmental variables of interest. Severity score can also prove useful for developing prognostic tools in MS. This article discusses the diverse applications of severity score concept in MS research, and (re)introduces Herbert's proposal of severity-based MS classification in the context of variability of MS severity.
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Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Orhun H Kantarci
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
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5
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The effect of galanin gene polymorphism rs948854 on the severity of multiple sclerosis: A significant association with the age of onset. Mult Scler Relat Disord 2020; 37:101439. [DOI: 10.1016/j.msard.2019.101439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/04/2019] [Accepted: 10/08/2019] [Indexed: 01/15/2023]
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6
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Braakhuis HEM, Berger MAM, van der Stok GA, van Meeteren J, de Groot V, Beckerman H, Bussmann JBJ. Three distinct physical behavior types in fatigued patients with multiple sclerosis. J Neuroeng Rehabil 2019; 16:105. [PMID: 31443714 PMCID: PMC6708224 DOI: 10.1186/s12984-019-0573-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/29/2019] [Indexed: 01/16/2023] Open
Abstract
Background Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation. Trial registration Clinical trial registration no ISRCTN 82353628, ISRCTN 69520623 and ISRCTN 58583714. Electronic supplementary material The online version of this article (10.1186/s12984-019-0573-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H E M Braakhuis
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands. .,Faculty of Health Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands.
| | - M A M Berger
- Faculty of Health Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - G A van der Stok
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J van Meeteren
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,MS Center Amsterdam, Amsterdam, The Netherlands
| | - H Beckerman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,MS Center Amsterdam, Amsterdam, The Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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7
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Swart EC, Neilson LM, Good CB, Shrank WH, Henderson R, Manolis C, Parekh N. Determination of Multiple Sclerosis Indicators for Value-Based Contracting Using the Delphi Method. J Manag Care Spec Pharm 2019; 25:753-760. [PMID: 31232201 PMCID: PMC10397620 DOI: 10.18553/jmcp.2019.25.7.753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Value-based contracts link medication payments to performance measures with the ultimate goal of lowering costs while improving patient outcomes. Previous multiple sclerosis (MS) value-based contracts have focused on indicators easily collected from claims or electronic health record data as their value-based outcomes, even though numerous other MS clinical indicators of interest exist. Uncertainty remains regarding which MS indicators are most meaningful to all stakeholders affected by a value-based contract. OBJECTIVE To identify meaningful MS indicators among key stakeholders for the purpose of informing a value-based contract for MS medications. METHODS Using a modified Delphi method, we surveyed 26 diverse stakeholders, including 8 patients and caregivers; 9 providers (neurologists, nurses, physician assistants, and specialty pharmacists); 2 pharmaceutical company representatives; 5 payers; and 2 pharmacy benefits managers. A list of 12 MS indicators was created from subject matter expert consultation and a literature review. All stakeholders reported on the meaningfulness and value of these 12 indicators through a 5-point Likert scale and forced selection of the 3 most meaningful indicators. All nonpatient stakeholders were additionally surveyed on collection feasibility of the same 12 indicators using a 5-point Likert scale. We defined consensus as ≥ 75% agreement on the meaningfulness and feasibility of an indicator (Likert scores 4 or 5). We performed a Fisher's exact test to assess differences between nonpatient and patient stakeholder rankings of indicators. RESULTS Consensus was reached for at least 1 indicator for all questions after 2 rounds. "Worsening physical disability" and "functional impairment" achieved 92% agreement on a Likert-scale question assessing indicator value, and 100% of participants selected "worsening physical disability" when asked to choose the 3 most meaningful indicators. "MS flares requiring an emergency department visit" and "MS flares requiring inpatient admission" were rated as the 2 most feasibly collected indicators (both received 89% agreement). CONCLUSIONS Using the Delphi method, we identified that disability and functional impairment are meaningful MS indicators to diverse stakeholders. These findings support the incorporation of important patient-reported outcomes into value-based contracts for MS medications. DISCLOSURES This study was supported by a grant from Express Scripts Holding Company, which provided research funding to the UPMC Center for Value-Based Pharmacy Initiatives for work on this study. Swart, Neilson, Good, and Parekh are employed by the UPMC Center for Value-Based Pharmacy Initiatives. Manolis is the Chief Pharmacy Officer of UPMC Health Plan, and Shrank was the Chief Medical Officer of UPMC Insurance Services Division at the time of this study. Henderson is employed by Express Scripts Holding Company.
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Affiliation(s)
- Elizabeth C.S. Swart
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Lynn M. Neilson
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Chester B. Good
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, Pennsylvania, and Division of General Internal Medicine, University of Pittsburgh
| | - William H. Shrank
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, Pennsylvania
| | | | - Chronis Manolis
- Center for Value-Based Pharmacy Initiatives and Pharmacy Division, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Natasha Parekh
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, Pennsylvania, and Division of General Internal Medicine, University of Pittsburgh
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8
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Ďurfinová M, Procházková Ľ, Petrleničová D, Bystrická Z, Orešanská K, Kuračka Ľ, Líška B. Cholesterol level correlate with disability score in patients with relapsing-remitting form of multiple sclerosis. Neurosci Lett 2018; 687:304-307. [PMID: 30339921 DOI: 10.1016/j.neulet.2018.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune disease characterised by demyelination. There are many environmental factors that can affect the progression of this disease. It is necessary to better understand the impact of these factors in MS pathogenesis and progression. OBJECTIVE Present study investigates the relationship of total cholesterol serum levels and other parameters contributing to cardiovascular risk - homocysteine and serum lipid parameters (triglycerides, HDL, LDL) - with the progression of MS (EDSS score). METHODS The study involved 169 patients diagnosed with MS. Total homocysteine levels were measured by high-performance liquid chromatography. Serum lipid parameters were measured with enzymatic kits. RESULTS There was no difference observed between homocysteine levels in MS patients and controls. Dyslipidaemia seems to be associated with MS progression, particularly in women with relapsing-remitting form of MS. CONCLUSION Positive correlation of total and LDL cholesterol with disability score in patients with relapsing-remitting form of MS suggests that lipid parameters could have a negative effect on the disease progression.
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Affiliation(s)
- M Ďurfinová
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinkova 2, SK-81108 Bratislava, Slovakia.
| | - Ľ Procházková
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Limbová 5, SK-83305 Bratislava, Slovakia
| | - D Petrleničová
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Limbová 5, SK-83305 Bratislava, Slovakia
| | - Z Bystrická
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinkova 2, SK-81108 Bratislava, Slovakia
| | - K Orešanská
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinkova 2, SK-81108 Bratislava, Slovakia
| | - Ľ Kuračka
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinkova 2, SK-81108 Bratislava, Slovakia
| | - B Líška
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinkova 2, SK-81108 Bratislava, Slovakia
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9
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DeMarshall C, Goldwaser EL, Sarkar A, Godsey GA, Acharya NK, Thayasivam U, Belinka BA, Nagele RG. Autoantibodies as diagnostic biomarkers for the detection and subtyping of multiple sclerosis. J Neuroimmunol 2017; 309:51-57. [PMID: 28601288 DOI: 10.1016/j.jneuroim.2017.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 12/19/2022]
Abstract
The goal of this preliminary proof-of-concept study was to use human protein microarrays to identify blood-based autoantibody biomarkers capable of diagnosing multiple sclerosis (MS). Using sera from 112 subjects, including 51 MS subjects, autoantibody biomarkers effectively differentiated MS subjects from age- and gender-matched normal and breast cancer controls with 95.0% and 100% overall accuracy, but not from subjects with Parkinson's disease. Autoantibody biomarkers were also useful in distinguishing subjects with the relapsing-remitting form of MS from those with the secondary progressive subtype. These results demonstrate that autoantibodies can be used as noninvasive blood-based biomarkers for the detection and subtyping of MS.
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Affiliation(s)
- Cassandra DeMarshall
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Department of Geriatrics and Gerontology, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Eric L Goldwaser
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Department of Geriatrics and Gerontology, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Abhirup Sarkar
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Department of Geriatrics and Gerontology, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Graduate School of Biomedical Sciences, Rowan University, Stratford, NJ, USA
| | - George A Godsey
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Department of Geriatrics and Gerontology, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Graduate School of Biomedical Sciences, Rowan University, Stratford, NJ, USA
| | - Nimish K Acharya
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Robert G Nagele
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA; Graduate School of Biomedical Sciences, Rowan University, Stratford, NJ, USA; Durin Technologies, Inc., New Brunswick, NJ, USA.
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10
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Choi IY, Lee P, Hughes AJ, Denney DR, Lynch SG. Longitudinal changes of cerebral glutathione (GSH) levels associated with the clinical course of disease progression in patients with secondary progressive multiple sclerosis. Mult Scler 2016; 23:956-962. [PMID: 27620894 DOI: 10.1177/1352458516669441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increased oxidative stress leads to loss of glutathione (GSH). We have reported lower cerebral GSH in patients with secondary progressive multiple sclerosis (SPMS), indicating the involvement of oxidative stress in multiple sclerosis (MS) pathophysiology. OBJECTIVE This study expanded upon our earlier work by examining longitudinal changes in cerebral GSH in patients with SPMS in relation to their clinical status. METHODS A total of 13 patients with SPMS (Expanded Disability Status Scale (EDSS) = 4.0-6.5; MS duration = 21.2 ± 8.7 years) and 12 controls were studied over 3-5 years. GSH mapping was acquired from frontal and parietal regions using a multiple quantum chemical shift imaging technique at 3 T. Clinical assessments of the patient's disability included EDSS, gait, motor strength, ataxia, tremor, brainstem function and vision changes. RESULTS Brain GSH concentrations in patients were lower than those in controls for both baseline and 3- to 5-year follow-ups. Longitudinal GSH changes of patients were associated with their neurologist's blinded appraisal of their clinical progression. Patients judged to have worsening clinical status had significantly greater declines in frontal GSH concentrations than those with stable clinical status. CONCLUSION GSH provides a distinct measure associated with the disease progression in SPMS, possibly due to its dynamic alignment with pathogenic processes of MS related to oxidative stress.
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Affiliation(s)
- In-Young Choi
- Hoglund Brain Imaging Center and Departments of Molecular & Integrative Physiology and Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Phil Lee
- Hoglund Brain Imaging Center and Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abbey J Hughes
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Douglas R Denney
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Sharon G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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11
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Ziemssen T, Kern R, Cornelissen C. Study design of PANGAEA 2.0, a non-interventional study on RRMS patients to be switched to fingolimod. BMC Neurol 2016; 16:129. [PMID: 27502119 PMCID: PMC4977700 DOI: 10.1186/s12883-016-0648-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/26/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The therapeutic options for patients with Multiple Sclerosis (MS) have steadily increased due to the approval of new substances that now supplement traditional first-line agents, demanding a paradigm shift in the assessment of disease activity and treatment response in clinical routine. Here, we report the study design of PANGAEA 2.0 (Post-Authorization Non-interventional GermAn treatment benefit study of GilEnyA in MS patients), a non-interventional study in patients with relapsing-remitting MS (RRMS) identify patients with disease activity and monitor their disease course after treatment switch to fingolimod (Gilenya®), an oral medication approved for patients with highly active RRMS. METHOD/DESIGN In the first phase of the PANGAEA 2.0 study the disease activity status of patients receiving a disease-modifying therapy (DMT) is evaluated in order to identify patients at risk of disease progression. This evaluation is based on outcome parameters for both clinical disease activity and magnetic resonance imaging (MRI), and subclinical measures, describing disease activity from the physician's and the patient's perspective. In the second phase of the study, 1500 RRMS patients identified as being non-responders and switched to fingolimod (oral, 0.5 mg/daily) are followed-up for 3 years. Data on relapse activity, disability progression, MRI lesions, and brain volume loss will be assessed in accordance to 'no evidence of disease activity-4' (NEDA-4). The modified Rio score, currently validated for the evaluation of treatment response to interferons, will be used to evaluate the treatment response to fingolimod. The MS management software MSDS3D will guide physicians through the complex processes of diagnosis and treatment. A sub-study further analyzes the benefits of a standardized quantitative evaluation of routine MRI scans by a central reading facility. PANGAEA 2.0 is being conducted between June 2015 and December 2019 in 350 neurological practices and centers in Germany, including 100 centers participating in the sub-study. DISCUSSION PANGAEA 2.0 will not only evaluate the long-term benefit of a treatment change to fingolimod but also the applicability of new concepts of data acquisition, assessment of MS disease activity and evaluation of treatment response for the in clinical routine. TRIAL REGISTRATION BfArM6532; Trial Registration Date: 20/05/2015.
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Affiliation(s)
- Tjalf Ziemssen
- Zentrum für klinische Neurowissenschaften, Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 43, D-01307, Dresden, Germany.
| | - Raimar Kern
- Zentrum für klinische Neurowissenschaften, Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 43, D-01307, Dresden, Germany
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12
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Ziemssen T, Kern R, Thomas K. Multiple sclerosis: clinical profiling and data collection as prerequisite for personalized medicine approach. BMC Neurol 2016; 16:124. [PMID: 27484848 PMCID: PMC4971685 DOI: 10.1186/s12883-016-0639-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a highly heterogeneous disease as it can present inter-individually as well as intra-individually, with different disease phenotypes emerging during different stages in the long-term disease course. In addition to advanced immunological, genetic and magnetic resonance imaging (MRI) profiling of the patient, the clinical profiling of MS patients needs to be widely implemented in clinical practice and improved by including a greater range of relevant parameters as patient-reported outcomes. It is crucial to implement a high standard of clinical characterization of individual patients as this is key to effective long-term observation and evaluation. To generate reliable real-world data, individual clinical data should be collected in specific MS registries and/or using intelligent software instruments as the Multiple Sclerosis Documentation System 3D. Computational analysis of biological processes will play a key role in the transition to personalized MS treatment. Major breakthroughs in the areas of bioinformatics and computational systems biology will be required to process this complex information to enable improved personalization of treatment for MS patients.
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Affiliation(s)
- Tjalf Ziemssen
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany.
| | - Raimar Kern
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany
| | - Katja Thomas
- MS Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr 74, 01307, Dresden, Germany
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Li HF, Hong Y, Xie Y, Hao HJ, Sun RC. Precision medicine in myasthenia graves: begin from the data precision. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:106. [PMID: 27127759 DOI: 10.21037/atm.2016.02.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myasthenia gravis (MG) is a prototypic autoimmune disease with overt clinical and immunological heterogeneity. The data of MG is far from individually precise now, partially due to the rarity and heterogeneity of this disease. In this review, we provide the basic insights of MG data precision, including onset age, presenting symptoms, generalization, thymus status, pathogenic autoantibodies, muscle involvement, severity and response to treatment based on references and our previous studies. Subgroups and quantitative traits of MG are discussed in the sense of data precision. The role of disease registries and scientific bases of precise analysis are also discussed to ensure better collection and analysis of MG data.
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Affiliation(s)
- Hai-Feng Li
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Yu Hong
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Yanchen Xie
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Hong-Jun Hao
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Ren-Cheng Sun
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
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Goodwin SJ. Multiple sclerosis: integration of modeling with biology, clinical and imaging measures to provide better monitoring of disease progression and prediction of outcome. Neural Regen Res 2016; 11:1900-1903. [PMID: 28197176 PMCID: PMC5270418 DOI: 10.4103/1673-5374.195274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Multiple Sclerosis (MS) is a major cause of neurological disability in adults and has an annual cost of approximately $28 billion in the United States. MS is a very complex disorder as demyelination can happen in a variety of locations throughout the brain; therefore, this disease is never the same in two patients making it very hard to predict disease progression. A modeling approach which combines clinical, biological and imaging measures to help treat and fight this disorder is needed. In this paper, I will outline MS as a very heterogeneous disorder, review some potential solutions from the literature, demonstrate the need for a biomarker and will discuss how computational modeling combined with biological, clinical and imaging data can help link disparate observations and decipher complex mechanisms whose solutions are not amenable to simple reductionism.
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Affiliation(s)
- Shikha Jain Goodwin
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA; Brain Sciences Center, VA Medical Center, Minneapolis, MN, USA
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Patterns of Objective and Subjective Burden of Informal Caregivers in Multiple Sclerosis. Behav Neurol 2015; 2015:648415. [PMID: 26078487 PMCID: PMC4452831 DOI: 10.1155/2015/648415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/30/2015] [Indexed: 01/24/2023] Open
Abstract
Background. Home
care for patients with Multiple Sclerosis (MS)
relies largely on informal caregivers (ICs).
Methods. We assessed ICs
objective burden (Resource Utilization in
Dementia measuring informal care time (ICT)) and
ICs subjective burden (Zarit Burden Inventory (ZBI)). Results. ICs
(N = 99)
were spouses (70%), mean age 52 years,
assisting disabled patients with a mean EDSS
(Expanded Disability Status Scale) of 5.5, with
executive dysfunction (mean DEX (Dysexecutive questionnaire) of 25) and a duration of MS
ranging from 1 to 44 years. Objective burden was
high (mean ICT = 6.5 hours/day), mostly
consisting of supervision time. Subjective
burden was moderate (mean ZBI = 27.3).
Multivariate analyses showed that both burdens
were positively correlated with higher levels of
EDSS and DEX, whereas coresidency and IC's
female gender correlated with objective burden
only and IC's poor mental health status with
subjective burden only. When considering MS
aggressiveness, it appeared that both burdens
were not correlated with a higher duration of MS
but rather increased for patients with severe
and early dysexecutive function and for patients
classified as fast progressors according to the
Multiple Sclerosis Severity Score.
Conclusion. Evaluation of MS
disability course and IC's personal
situation is crucial to understand the burden
process and to implement adequate interventions
in MS.
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Integrating the tools for an individualized prognosis in multiple sclerosis. J Neurol Sci 2013; 331:10-3. [DOI: 10.1016/j.jns.2013.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 04/23/2013] [Indexed: 01/24/2023]
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Horakova D, Kalincik T, Dolezal O, Krasensky J, Vaneckova M, Seidl Z, Havrdova E. Early predictors of non-response to interferon in multiple sclerosis. Acta Neurol Scand 2012; 126:390-7. [PMID: 22428845 DOI: 10.1111/j.1600-0404.2012.01662.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify early clinical and MRI predictors of non-response to interferon (IFN) treatment in multiple sclerosis (MS). METHODS In 172 patients with relapsing-remitting MS treated with IFNβ, we evaluated prediction of future treatment non-response. Candidate predictors comprised disability and its sustained progression, relapse score (combining frequency and severity of relapses), brain volume change, brain parenchymal fraction, number of new T2 lesions, and T2 and T1 lesion volume within the initial year of treatment. Treatment non-response was evaluated as confirmed disability progression or overall average annual relapse score exceeding 1 over the following 5 years. Logistic regression model was adjusted for patient age, gender, disease duration and changes in treatment. RESULTS Ninety patients (52%) reached the status of IFN non-responders in years 2-6. Patients with ≥1 new T2 lesion and relapse score ≥2 (odds ratio ≥5.7) or those with ≥3 new T2 lesions regardless of the relapse score (odds ratio = 3) were in a significantly higher risk of future treatment non-response. CONCLUSIONS In patients with MS treated with IFNβ for 1 year, number of new T2 lesions and annualized relapse score predict individual risk of treatment non-response over the following 5 years.
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Affiliation(s)
- D. Horakova
- Department of Neurology and Center of Clinical Neuroscience; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - T. Kalincik
- Department of Neurology and Center of Clinical Neuroscience; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - O. Dolezal
- Department of Neurology and Center of Clinical Neuroscience; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - J. Krasensky
- Department of Radiology; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - M. Vaneckova
- Department of Radiology; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - Z. Seidl
- Department of Radiology; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - E. Havrdova
- Department of Neurology and Center of Clinical Neuroscience; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
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Considerations in the design of clinical trials for relapsing multiple sclerosis. ACTA ACUST UNITED AC 2012. [DOI: 10.4155/cli.12.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Preston J, Haslam S, Lamont L. What Do People with Multiple Sclerosis Want from an Occupational Therapy Service? Br J Occup Ther 2012. [DOI: 10.4276/030802212x13383757345102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim: This study aimed to understand how people with multiple sclerosis (MS) experienced a local occupational therapy service and to identify what they would want from future services. Method: The data from this qualitative programme evaluation were generated through nine focus groups, including 30 people with a clinically definite diagnosis of MS, 10 partners/carers of people with MS and six occupational therapy staff. Findings: The findings evolved within four key themes: comprehension of occupational therapy; assessment and interventions; home visits; and levels of support. Although occupational therapy was not initially well understood, comprehension developed with greater use of the service. Nevertheless, significant challenges exist in providing therapeutic programmes that offer meaning and purpose within the lives of people with MS while ensuring flexibility and choice. Conclusion: This study suggests that there is a possible distinction between what occupational therapists believe people with MS want and what they and their partners/carers do want. People with MS and their partners/carers, therefore, have a meaningful contribution to make and should be involved in the future development of occupational therapy services.
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Affiliation(s)
- Jenny Preston
- Formerly Head Occupational Therapist and now Consultant Occupational Therapist, NHS Ayrshire and Arran, Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, Irvine
| | | | - Lynn Lamont
- MS Specialist Occupational Therapist, NHS Ayrshire and Arran, Irvine
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Keller JL, Wang JI, Kang JY, Hanson JA, Kamath P, Swain JO, Raymond GV, Zackowski KM. Strength: a relevant link to functional performance in the neurodegenerative disease of adrenomyeloneuropathy. Neurorehabil Neural Repair 2012; 26:1080-8. [PMID: 22544816 DOI: 10.1177/1545968312441682] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND With progressive abnormalities in leg strength, tone, and sensation, adrenomyeloneuropathy (AMN) is a differential diagnosis for multiple sclerosis and hereditary spastic paraparesis. AMN pathology has been linked to weakness, making it a relevant model to evaluate the relationship between neurodegeneration and disability. Quantifying symptom severity in AMN is essential for treatment development in rehabilitative management. OBJECTIVE To identify deficits in body functions, activity, and participation of people with AMN and provide a practical framework for evaluating the severity of disability. METHODS Cohort analysis of 142 participants with AMN. MEASURES of body functions (leg strength, vibration sensation, range of motion, and spasticity), activity (walk velocity, standing balance, Timed Up and Go, and Sit-to-Stand Time), and participation (6-Minute Walk) are evaluated. Regression analyses identify relationships between the measures. A staging framework (mild, moderate, and severe) reflects the continuum of disability. Finally, an analysis of variance/Kruskal-Wallis was used for between-stage and sex differences among the variables. RESULTS Strength is the strongest correlate for the 5 measures of activity and participation. Staging based on weakness distinguishes 3 levels of severity along a continuum of disability. Differences between the sexes are more prevalent earlier in the continuum but show equally severe deficits in the last stage. CONCLUSIONS In AMN, staging based on degrees of weakness provides a practical means to characterize the severity of common deficits in body functions as well as activity and participation at each stage, to direct the evaluation. Such information could help clinicians develop more effective rehabilitative techniques.
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Horakova D, Kalincik T, Dusankova JB, Dolezal O. Clinical correlates of grey matter pathology in multiple sclerosis. BMC Neurol 2012; 12:10. [PMID: 22397707 PMCID: PMC3311149 DOI: 10.1186/1471-2377-12-10] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 03/07/2012] [Indexed: 12/26/2022] Open
Abstract
Traditionally, multiple sclerosis has been viewed as a disease predominantly affecting white matter. However, this view has lately been subject to numerous changes, as new evidence of anatomical and histological changes as well as of molecular targets within the grey matter has arisen. This advance was driven mainly by novel imaging techniques, however, these have not yet been implemented in routine clinical practice. The changes in the grey matter are related to physical and cognitive disability seen in individuals with multiple sclerosis. Furthermore, damage to several grey matter structures can be associated with impairment of specific functions. Therefore, we conclude that grey matter damage - global and regional - has the potential to become a marker of disease activity, complementary to the currently used magnetic resonance markers (global brain atrophy and T2 hyperintense lesions). Furthermore, it may improve the prediction of the future disease course and response to therapy in individual patients and may also become a reliable additional surrogate marker of treatment effect.
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Affiliation(s)
- Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
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22
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Motl RW, Weikert M, Suh Y, Sosnoff JJ, Pula J, Soaz C, Schimpl M, Lederer C, Daumer M. Accuracy of the actibelt(®) accelerometer for measuring walking speed in a controlled environment among persons with multiple sclerosis. Gait Posture 2012; 35:192-6. [PMID: 21945386 DOI: 10.1016/j.gaitpost.2011.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/08/2011] [Accepted: 09/04/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Advances in portable sensor technology have opened an era for objective, real-life monitoring of walking speed in persons with multiple sclerosis (MS). PURPOSE The present study examined the accuracy of the actibelt(®) accelerometer for measuring walking speed during a standard 6-min walk (6MW) and the possibility that disability status influenced the degree of accuracy among persons with MS. METHODS On a single testing session, 51 persons with MS and Expanded Disability Status Scale scores between 2.0 and 6.5 performed a 6MW while wearing an actibelt(®) in the body's sagittal symmetry plane and close to the body's centre of mass. RESULTS All 51 participants completed the 6MW without stopping, falling, or any adverse events, and the actibelt(®) provided walking speed data for each of the participants. The actibelt(®) significantly overestimated walking speed (actual minus actibelt(®)) by a mean±standard deviation of -0.12±0.17 m/s for the overall sample (p<0.0001). There was no significant overestimation in the sample with mild disability (-0.02±0.11 m/s), but there was in the samples with moderate (-0.10±0.16 m/s) and severe (-0.26±0.12 m/s) disability. CONCLUSION The actibelt(®) is ready for real-life monitoring of walking speed in persons with mild MS, but caution is necessary when interpreting the accuracy of the walking speed data for those with MS who have moderate and severe disability.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 350 Freer Hall, Urbana, IL 61801, USA.
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24
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De Jager PL. Genome-wide association study of severity in multiple sclerosis. Genes Immun 2011; 12:615-25. [PMID: 21654844 PMCID: PMC3640650 DOI: 10.1038/gene.2011.34] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/11/2011] [Indexed: 01/20/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system with a strong genetic component. Several lines of evidence support a strong role for genetic factors influencing both disease susceptibility and clinical outcome in MS. Identification of genetic variants that distinguish particular disease subgroups and/or predict a severe clinical outcome is critical to further our understanding of disease mechanisms and guide development of effective therapeutic approaches. We studied 1470 MS cases and performed a genome-wide association study of more than 2.5 million single-nucleotide polymorphisms to identify loci influencing disease severity, measured using the MS severity score (MSSS), a measure of clinical disability. Of note, no single result achieved genome-wide significance. Furthermore, variants within previously confirmed MS susceptibility loci do not appear to influence severity. Although bioinformatic analyses highlight certain pathways that are over-represented in our results, we conclude that the genetic architecture of disease severity is likely polygenic and comprised of modest effects, similar to what has been described for MS susceptibility, to date. However, a role for major effects of rare variants cannot be excluded. Importantly, our results also show the MSSS, when considered as a binary or continuous phenotype variable is by comparison a stable outcome.
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Affiliation(s)
- PL De Jager
- Program in Translational NeuroPsychiatric Genomics, Department of Neurology, Brigham & Women’s Hospital and Harvard Medical School, and Program in Medical & Population Genetics, Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Association of IL1A, IL1B, ILRN, IL6, IL10 and TNF-α polymorphisms with risk and clinical course of multiple sclerosis in a Polish population. J Neuroimmunol 2011; 236:87-92. [DOI: 10.1016/j.jneuroim.2011.04.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/02/2011] [Accepted: 04/28/2011] [Indexed: 12/11/2022]
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Khademi M, Kockum I, Andersson ML, Iacobaeus E, Brundin L, Sellebjerg F, Hillert J, Piehl F, Olsson T. Cerebrospinal fluid CXCL13 in multiple sclerosis: a suggestive prognostic marker for the disease course. Mult Scler 2010; 17:335-43. [DOI: 10.1177/1352458510389102] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Levels of CXCL13, a potent B-cell chemoattractant, are elevated in the cerebrospinal fluid (CSF) during multiple sclerosis (MS) and are associated with markers of MS activity. Levels decrease upon effective treatments. Objective: Here we validate the potential role of CSF CXCL13 as a biomarker for aspects of MS in a large amount of clinical material, the majority collected at early diagnostic work-up. Methods: CXCL13 was measured by ELISA in 837 subjects: relapsing–remitting MS (RRMS; n = 323), secondary progressive MS (SPMS; n = 40), primary progressive MS (PPMS; n = 24), clinically isolated syndrome (CIS; n = 79), other neurological diseases (ONDs; n = 181), ONDs with signs of inflammation or viral/bacterial infections (iONDs; n = 176) and healthy controls ( n = 14). Results: Subjects with viral/bacterial infections had extremely high CXCL13 levels compared to all included groups ( p < 0.0001). CXCL13 was otherwise significantly higher in MS compared to the remaining controls ( p < 0.0001), and CIS ( p < 0.01). A significant and positive correlation between CXCL13 and relapse rate, the results obtained for the Expanded Disability Status Scale (EDSS) and the number of lesions detected by MRI was demonstrated. CXCL13 was increased in CIS conversion to clinically definite MS ( p < 0.001). Oligoclonal immunoglobulin band (OCB)-positive CIS or MS had significantly increased CXCL13 levels compared to OCB-negative CIS or MS ( p < 0.001 and p < 0.0001, respectively). Conclusion: CXCL13 was associated with disease exacerbations and unfavourable prognosis in RRMS. Increased CXCL13 was not specific for MS since subjects with viral/bacterial infections exhibited even higher levels. High levels predicted CIS conversion to MS. We suggest that measurement of CSF CXCL13 can be part of the armamentarium in the diagnostic and prognostic work-up in MS and be of help in future treatment decisions.
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Affiliation(s)
- Mohsen Khademi
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus L Andersson
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Lou Brundin
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Finn Sellebjerg
- Department of Neurology, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Hillert
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Werneck LC, Lorenzoni PJ, Radünz VA, Utiumi MA, Kay CSK, Scola RH. Influence of treatment in multiple sclerosis dysability: an open, retrospective, non-randomized long-term analysis. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:511-21. [DOI: 10.1590/s0004-282x2010000400008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 03/02/2010] [Indexed: 11/22/2022]
Abstract
The efficacies of immunosuppressive (IMS) and immunomodulatory (IMM) drugs for multiple sclerosis (MS) have been reported in several studies. These agents can reduce relapse rates and lesions observed by magnetic resonance imaging studies. However, the effect of these medications in disability progression over 4 years is rarely examined. OBJECTIVE: To study the disabilities associated with MS patients after a long time period and to analyze the therapeutic influence of different types of treatments in patient disease progression. METHOD: This is an open, uncontrolled, non-randomized, retrospective study of the disease progression using the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS) in 155 cases of MS, which were 76% female with a mean age of onset of 30.21±9.70. The follow-up period was 115.39±88.08 months (median 92, 3 to 447 months). These cases were submitted to the following 277 different therapeutic procedures: 62 without IMS or IMM therapy (SYT) (just corticosteroids), 53 with azathioprine (AZA), 53 interferon-β (IFNβ)-1b 250 µg (BET), 55 IFNβ-1a 22 µg (R22), 19 IFNβ-1a 30 µg (AVO), 15 IFNβ-1a 44 µg (R44), 15 glatiramer acetate (COP) 20 mg, and 5 cases with mitoxantrone (MIT). RESULTS: The median EDSS group was 2.00 (0 to 5.5, mean 1.89±1.52) at the onset of each treatment and 2.50 (0 to 9, mean 3.06±2.18) at the end. The median initial MSSS was 3.34 (0.25 to 9.50, mean 3.94±2.91) and the final medial was 3.90 (0.05 to 9.88, mean 4.02±2.78). The EDSS between initial and final score for the whole group had statistically significant progression, as well as for the sub-groups SYT, AZA, BET and R22. No statistically significance difference was found in the MSSS between initial and final scores in the whole group or treatment sub-groups. The variation between the initial and final EDSS and MSSS among the types of treatments found no statistical significance for any group. CONCLUSION: In this study series, no statistical difference was found in the long-term progression of disability among the IMS and IMM treated cases, nor in the cases treated only with corticosteroids.
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