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Apetoh L. Chemoimmunotherapy combinations: translating basic knowledge into clinical successes. Genes Immun 2024; 25:99-101. [PMID: 38480829 DOI: 10.1038/s41435-024-00264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Lionel Apetoh
- Brown Center for Immunotherapy, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Beratto L, Bressy L, Agostino S, Malandrone F, Brichetto G, Ponzano M. The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis. Mult Scler Relat Disord 2024; 83:105473. [PMID: 38320418 DOI: 10.1016/j.msard.2024.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND A large body of evidence has tested the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with multiple sclerosis (PwMS). OBJECTIVE To determine the effect of exercise interventions on mental health and HRQoL in PwMS. METHODS We searched four databases up to April 2023, and included randomized controlled trials that: 1) involved PwMS ≥18 years old; 2) delivered an exercise intervention; 3) measured subjective well-being, psychological well-being, social well-being, or HRQoL as outcomes. We reported standardized differences in means (d) with a 95 % confidence interval (CI), for continuous outcomes and an incidence rate ratio (IRR) with a 95 % CI for dichotomous outcomes. RESULTS Forty-nine studies (n = 2,057 participants) were included. Exercise improved overall well-being (d = 0.78; 95 % CI 0.483, 1.077; moderate certainty evidence), subjective well-being (d = 0.666; 95 % CI 0.405, 0.928; moderate certainty evidence), social well-being (d = 1.046; 95 % CI 0.569, 1.523; low certainty evidence), and HRQoL (d = 0.568; 95 % CI 0.396, 0.74; moderate certainty evidence). CONCLUSION Exercise interventions can improve well-being and HRQoL in PwMS. Future studies should focus on PwMS ≥ 65 years or with higher level of impairments.
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Affiliation(s)
- Luca Beratto
- Department of Medical Sciences, University of Turin, Italy; School of Exercise and Sport Science, University of Turin, Italy
| | - Lara Bressy
- School of Exercise and Sport Science, University of Turin, Italy
| | - Samuel Agostino
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | | | | | - Matteo Ponzano
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), The University of British Columbia, Vancouver, BC, Canada.
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Bhattacharyya PK, Fox RJ, Sakaie KE, Bena J, Harvey T, Raska P, Lin J, Lowe MJ. Characterizing multiple sclerosis disease progression using a combined structural and functional connectivity metric. Magn Reson Imaging 2023; 103:185-191. [PMID: 37536637 PMCID: PMC10529682 DOI: 10.1016/j.mri.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE A combined resting state functional connectivity MRI (fcMRI) and diffusion tensor imaging (DTI) metric called structural and functional connectivity index (SFCI) was recently proposed for tracking disease status and progression in multiple sclerosis (MS). The metric combines fcMRI and transverse diffusivity (TD) along different functional pathways involved in principle symptomatic domains of MS. In a longitudinal study of patients with MS receiving the same MS therapy, initial worsening of transcallosal (TC) motor and frontoparietal (FP) cognitive networks, as measured by fcMRI and DTI over the first year was followed by stabilization in the second year of follow-up. In this study we have (i) probed relationships between individual and composite neurological measures of MS with SFCI and its individual components along TC motor and FP cognitive pathways and (ii) compared sensitivity of SFCI to treatment-induced longitudinal changes with each individual imaging measure. METHODS Twenty five patients with MS (15 female, age 42 ± 8 y) participated in this study and were scanned at 3 T whole body MRI scanner with diffusion tensor imaging (DTI) and resting-state functional connectivity MRI (fcMRI) scan protocol at baseline and 6, 12, 18 and 24 months after starting fingolimod. fcMRI and TD along TC and FP pathways were combined to form structural and functional connectivity index (SFCI) at each time point. Correlations between individual/combined neurological measures and individual imaging components/SFCI at baseline and were evaluated and compared. In addition, efficacies of individual and combined imaging metrics in tracking network integrity were compared. RESULTS Individual TD along the TC pathway was significantly inversely correlated with all individual/composite neurological scores. There were moderate correlations of TC and FP components of SFCI with most of the neurological scores, and the pathway-combined SFCI was significantly correlated with all neurological scores. Trend-level increases of both TC and FP fcMRI were observed during the second year of follow-up, both TC and FP TD increased significantly in the first year and then stabilized during the second year. A trend toward a decrease in combined imaging metrics along TC and FP were observed during the first year, followed by a trend toward an increase in these metrics during the second year, while a significant decrease in SFCI during the first year followed by a significant increase during the second year was observed. CONCLUSIONS SFCI was more effective in tracking network integrity/disease progression than individual pathway-specific components, which supports its use as an imaging marker for MS disease status and progression.
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Affiliation(s)
- P K Bhattacharyya
- Imaging Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - R J Fox
- Neurological Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - K E Sakaie
- Imaging Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - J Bena
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - T Harvey
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - P Raska
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - J Lin
- Imaging Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - M J Lowe
- Imaging Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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Sorensen PS, Magyari M, Sellebjerg F. An update on combination therapies for multiple sclerosis: where are we now? Expert Rev Neurother 2023; 23:1173-1187. [PMID: 38058171 DOI: 10.1080/14737175.2023.2289572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION In theory, combination of two agents, which are suboptimal when given individually, may result in a significant increase in therapeutic effect. Combination therapies have proven particularly effective against infections such as HIV, cancer, and also chronic autoimmune diseases such as rheumatoid arthritis. AREAS COVERED The authors review the literature, searching for randomized placebo-controlled or comparative, double-blind or investigator-blinded clinical trials, not including open label clinical trials, of treatment of multiple sclerosis (MS) with combination therapy or add-on therapy, including trials of induction therapy, trials for prevention of disease activity or worsening, amelioration of adverse effects, and treatment of relapses, and trials to increase remyelination. EXPERT OPINION Combination of two platform therapies (Interferon-beta or glatiramer acetate) was without additional effect. Clinical trials with add-on, often applying repurposed drugs (e.g. simvastatin, atorvastatin, minocycline, estriol, cyclophosphamide, azathioprine, albuterol, vitamin D), have been negative, apart from monthly methylprednisolone that, however, had low tolerability. Combination therapy for neuroprotection/remyelination showed some interesting results, though we are still awaiting results of phase III trials. The results of combination of anti-inflammatory therapies have in general been disappointing. In the future, combination of new effective neuroprotective/remyelinating drugs and highly effective anti-inflammatory treatments may benefit people with MS.
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Affiliation(s)
- Per Soelberg Sorensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Glostrup, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Teixeira-Vaz A, Rocha JA, Oliveira M, Simões-Moreira T, Reis DAE, Silva AI, Paiva JA. Surviving critical COVID-19: How functionality, physical, mental and cognitive outcomes evolve? PLoS One 2023; 18:e0284597. [PMID: 37352178 PMCID: PMC10289386 DOI: 10.1371/journal.pone.0284597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/03/2023] [Indexed: 06/25/2023] Open
Abstract
PURPOSE To analyze the long-term consequences of critical COVID-19, regarding physical, mental, cognitive and functional impairments, and to describe its evolution through time. METHODS Prospective cohort study, with consecutive inclusion of patients admitted due to SARS-CoV-2 to intensive care units(ICU) of a tertiary-care center, between May/2020 and September/2021. All included patients were included in Physical and Rehabilitation Medicine(PRM) inpatient programs during ICU stay. Eligible patients were evaluated on PRM appointments 6 and 12 months after ICU discharge. In each visit, physical examination and a predefined set of scales were applied, aiming to comprehensively evaluate the three domains (physical, mental and cognitive) of post-intensive care syndrome and the patients' functionality. Statistical analysis encompassed descriptive and univariate analysis. RESULTS A total of 42 patients were included: 66.7% males, mean age of 62 yo. In the physical domain, 6 months after ICU discharge, there was a significant reduction in quality of life (p-value = 0.034), muscle strength (p-value = 0.002), gait ability (p-value<0.001) and balance (p-values<0.001) and increased fatigue levels (p-value = 0.009), in comparison with reference values. Yet, a significative positive evolution was observed in all referred subdomains (p-values<0.05). Nevertheless, 12 months after discharge, muscle strength (p-value = 0.001), gait (p-value<0.001) and balance (p-value<0.001) were still significantly compromised. Regarding the mental domain, both at 6 and 12 months after discharge, the levels of anxiety and depression were significantly increased (p-values<0.001). Nonetheless, a positive evolution was also found (p-values<0.02). Cognitive performance was significantly impaired in comparison with reference values, both at 6 and 12 months (p-value<0.001). Yet, a global improvement was also depicted (p-value = 0.003). Six months after ICU discharge, 54.8% were autonomous in activities of daily living, a value that improved to 74.0% in the subsequent 6 months (p-value = 0.002). CONCLUSION Critical COVID-19 survivors present significant physical, mental and cognitive impairments 6 and 12 months after ICU discharge, despite their positive evolution through time.
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Affiliation(s)
- Ana Teixeira-Vaz
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Afonso Rocha
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Mafalda Oliveira
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Tiago Simões-Moreira
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - David Almeida e Reis
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Isabel Silva
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Pittock SJ, Barnett M, Bennett JL, Berthele A, de Sèze J, Levy M, Nakashima I, Oreja-Guevara C, Palace J, Paul F, Pozzilli C, Yountz M, Allen K, Mashhoon Y, Kim HJ. Ravulizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder. Ann Neurol 2023; 93:1053-1068. [PMID: 36866852 DOI: 10.1002/ana.26626] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE CHAMPION-NMOSD (NCT04201262) is a phase 3, open-label, externally controlled interventional study evaluating the efficacy and safety of the terminal complement inhibitor ravulizumab in adult patients with anti-aquaporin-4 antibody-positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD). Ravulizumab binds the same complement component 5 epitope as the approved therapeutic eculizumab but has a longer half-life, enabling an extended dosing interval (8 vs 2 weeks). METHODS The availability of eculizumab precluded the use of a concurrent placebo control in CHAMPION-NMOSD; consequently, the placebo group of the eculizumab phase 3 trial PREVENT (n = 47) was used as an external comparator. Patients received weight-based intravenous ravulizumab on day 1 and maintenance doses on day 15, then once every 8 weeks. The primary endpoint was time to first adjudicated on-trial relapse. RESULTS The primary endpoint was met; no patients taking ravulizumab (n = 58) had an adjudicated relapse (during 84.0 patient-years of treatment) versus 20 patients with adjudicated relapses in the placebo group of PREVENT (during 46.9 patient-years; relapse risk reduction = 98.6%, 95% confidence interval = 89.7%-100.0%, p < 0.0001). Median (range) study period follow-up time was 73.5 (11.0-117.7) weeks for ravulizumab. Most treatment-emergent adverse events were mild/moderate; no deaths were reported. Two patients taking ravulizumab experienced meningococcal infections. Both recovered with no sequelae; one continued ravulizumab treatment. INTERPRETATION Ravulizumab significantly reduced relapse risk in patients with AQP4+ NMOSD, with a safety profile consistent with those of eculizumab and ravulizumab across all approved indications. ANN NEUROL 2023;93:1053-1068.
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Affiliation(s)
- Sean J Pittock
- Department of Neurology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado, Aurora, CO, USA
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jérôme de Sèze
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital Center, Strasbourg, France
| | - Michael Levy
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ichiro Nakashima
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Celia Oreja-Guevara
- Department of Neurology, San Carlos Clinical Hospital, Madrid, Spain
- Department of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
- Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | | | | | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, South Korea
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Osen A, Stefoski D, Shoemaker T, Kaplan T, Morales FS. Cyclophosphamide for severe acute forms of central nervous system inflammatory disorders. J Neurol Sci 2023; 451:120693. [PMID: 37300950 DOI: 10.1016/j.jns.2023.120693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
Cyclophosphamide (CYC) may be an effective treatment in patients who fail first line therapy for severe central nervous system (CNS) inflammatory disorders including CNS vasculitis, neuromyelitis optica, autoimmune encephalitis, tumefactive and aggressive multiple sclerosis (MS). We performed a retrospective analysis of 46 patients treated with CYC after failing first line therapy for severe CNS inflammatory conditions. Primary outcomes included modified Rankin Scale (mRS) for patients classified into a non-MS group, Expanded Disability Status Score (EDSS) for MS patients, and Targeted Neurological Deficit score (TND) for all patients. Secondary outcome included neuroimaging studies following CYC treatment. By the second follow up period (average of 7 months) mRS in the non-MS group improved from 3.7 to 2.2 and EDSS in the MS group improved from 5.6 to 3.8. Average TND score at 7 months was 2.8 (mild-marked improvement). At first follow up (average 5.6 months), 76.2% (32/42) patients had either stable or improving imaging, and 83.3% (30/36) patients had stable or improving imaging at second follow up (average 13.6 months). Adverse events were reported by 31.9% of patients with most common being nausea and vomiting, headache, alopecia, and hyponatremia. Treatment with CYC can result in disease stabilization of severe CNS inflammatory diseases and is generally well tolerated.
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Affiliation(s)
- Allison Osen
- Department of Neurology, Division of Multiple Sclerosis, Rush University Medical Center, 1625 W. Harrison St, Chicago, IL 60612, United States of America
| | - Dusan Stefoski
- Department of Neurology, Division of Multiple Sclerosis, Rush University Medical Center, 1625 W. Harrison St, Chicago, IL 60612, United States of America
| | - Thomas Shoemaker
- Department of Neurology, Division of Multiple Sclerosis, Rush University Medical Center, 1625 W. Harrison St, Chicago, IL 60612, United States of America
| | - Tyler Kaplan
- Department of Neurology, Division of Multiple Sclerosis, Rush University Medical Center, 1625 W. Harrison St, Chicago, IL 60612, United States of America
| | - Fabian Sierra Morales
- Department of Neurology, Division of Multiple Sclerosis, Rush University Medical Center, 1625 W. Harrison St, Chicago, IL 60612, United States of America.
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Chang EH, Carnevale D, Chavan SS. Editorial: Understanding and targeting neuro-immune interactions within disease and inflammation. Front Immunol 2023; 14:1201669. [PMID: 37153559 PMCID: PMC10154784 DOI: 10.3389/fimmu.2023.1201669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Eric H. Chang
- Laboratory for Biomedical Sciences, Institute of Biolectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
| | - Daniela Carnevale
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Pozzilli, Italy
| | - Sangeeta S. Chavan
- Laboratory for Biomedical Sciences, Institute of Biolectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
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Beloribi-Djefaflia S, Attarian S. Treatment of Charcot-Marie-Tooth neuropathies. Rev Neurol (Paris) 2023; 179:35-48. [PMID: 36588067 DOI: 10.1016/j.neurol.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/31/2022]
Abstract
Charcot-Marie-Tooth (CMT) is a heterogeneous group of inherited neuropathies that affect the peripheral nerves and slowly cause progressive disability. Currently, there is no effective therapy. Patients' management is based on rehabilitation and occupational therapy, fatigue, and pain treatment with regular follow-up according to the severity of the disease. In the last three decades, much progress has been made to identify mutations involved in the different types of CMT, decipher the pathophysiology of the disease, and identify key genes and pathways that could be targeted to propose new therapeutic strategies. Genetic therapy is one of the fields of interest to silence genes such as PMP22 in CMT1A or to express GJB1 in CMT1X. Among the most promising molecules, inhibitors of the NRG-1 axis and modulators of UPR or the HDACs enzyme family could be used in different types of CMT.
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Affiliation(s)
- S Beloribi-Djefaflia
- Reference center for neuromuscular disorders and ALS, AP-HM, CHU La Timone, Marseille, France
| | - S Attarian
- Reference center for neuromuscular disorders and ALS, AP-HM, CHU La Timone, Marseille, France; FILNEMUS, European Reference Network for Rare Diseases (ERN), Marseille, France; Medical Genetics, Aix Marseille Université-Inserm UMR_1251, 13005 Marseille, France.
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Berthele A, Levy M, Wingerchuk DM, Pittock SJ, Shang S, Kielhorn A, Royston M, Sabatella G, Palace J. A single relapse induces worsening of disability and health-related quality of life in patients with neuromyelitis optica spectrum disorder. Front Neurol 2023; 14:1099376. [PMID: 37114235 PMCID: PMC10126826 DOI: 10.3389/fneur.2023.1099376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
Background Cumulative damage from multiple relapses in neuromyelitis optica spectrum disorder (NMOSD) is associated with poor health-related quality of life (HRQoL) and long-term disability in patients positive for anti-aquaporin 4 antibodies (AQP4+). This study assessed the effect of an individual relapse on HRQoL and disability outcomes in AQP4+ NMOSD. Methods Post hoc analyses of data pooled from the PREVENT study and its open-label extension, which evaluated the efficacy and safety of eculizumab in AQP4+ NMOSD, examined the effect of a single relapse on 3 disability and 4 HRQoL outcome measures. Assuming the effect of 1 relapse extends to multiple relapses, an extrapolation was done to assess the effect of 2 relapses on these outcomes. Results In 27 patients (placebo: n = 20; eculizumab: n = 7) experiencing an independently adjudicated relapse, 1 relapse led to significantly worse disability (modified Rankin Scale and Expanded Disability Status Scale [EDSS]) and HRQoL (36-item Short-Form Health Survey mental and physical component summaries; European Quality of Life 5-Dimension questionnaire 3-Level visual analogue scale and utility index) scores. In 4 of 7 outcomes, clinically meaningful worsening was more likely for relapsing versus non-relapsing patients (n = 116). Extrapolating the effect of 2 relapses predicted that clinically meaningful worsening was more likely in 6 out of 7 outcomes, including EDSS, for patients experiencing multiple relapses versus patients experiencing no relapses. Conclusion Findings from these clinical trial data demonstrate that a single NMOSD relapse can worsen disability and HRQoL, underscoring the role of relapse prevention in improving long-term outcomes in patients with AQP4+ NMOSD.
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Affiliation(s)
- Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, München, Germany
- *Correspondence: Achim Berthele,
| | - Michael Levy
- Massachusetts General Hospital and Harvard Medical School, Mass General Neurology, Boston, MA, United States
| | | | | | - Shulian Shang
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Adrian Kielhorn
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Minying Royston
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Guido Sabatella
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, United Kingdom
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Giovannini S, Iacovelli C, Brau F, Loreti C, Fusco A, Caliandro P, Biscotti L, Padua L, Bernabei R, Castelli L. RObotic-Assisted Rehabilitation for balance and gait in Stroke patients (ROAR-S): study protocol for a preliminary randomized controlled trial. Trials 2022; 23:872. [PMID: 36224575 PMCID: PMC9558956 DOI: 10.1186/s13063-022-06812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
Background Stroke, the incidence of which increases with age, has a negative impact on motor and cognitive performance, quality of life, and the independence of the person and his or her family, leading to a number of direct and indirect costs. Motor recovery is essential, especially in elderly patients, to enable the patient to be independent in activities of daily living and to prevent falls. Several studies have shown how robotic training associated with physical therapy influenced functional and motor outcomes of walking after stroke by improving endurance and walking strategies. Considering data from previous studies and patients’ needs in gait and balance control, we hypothesized that robot-assisted balance treatment associated with physical therapy may be more effective than usual therapy performed by a physical therapist in terms of improving static, dynamic balance and gait, on fatigue and cognitive performance. Methods This is an interventional, single-blinded, preliminary randomized control trial. Twenty-four patients of both sexes will be recruited, evaluated, and treated at the UOC Rehabilitation and Physical Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome from January to December 2022. Patients will be randomized into two groups: the experimental group will perform specific rehabilitation for balance disorder using the Hunova® robotic platform (Movendo Technology srl, Genoa, IT) for 3 times a week, for 4 weeks (12 total sessions), and for 45 min of treatment, in addition to conventional treatment, while the conventional group (GC) will perform only conventional treatment as per daily routine. All patients will undergo clinical and instrumental evaluation at the beginning and end of the 4 weeks of treatment. Conclusions The study aims to evaluate the improvement in balance, fatigue, quality of life, and motor and cognitive performance after combined conventional and robotic balance treatment with Hunova® (Movendo Technology srl, Genoa, IT) compared with conventional therapy alone. Robotic assessment to identify the most appropriate and individualized rehabilitation treatment may allow reducing disability and improving quality of life in the frail population. This would reduce direct and indirect social costs of care and treatment for the National Health Service and caregivers. Trial registration ClinicalTrials.gov NCT05280587. Registered on March 15, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06812-w.
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Affiliation(s)
- Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 8, 00168, Rome, Italy. .,UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy.
| | - Chiara Iacovelli
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Fabrizio Brau
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy.,Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Augusto Fusco
- UOC Neuroriabilitazione Ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Pietro Caliandro
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Lorenzo Biscotti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy.,Geriatric Care Promotion and Development Centre (C.E.P.S.A.G), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 8, 00168, Rome, Italy.,UOC Neuroriabilitazione Ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 8, 00168, Rome, Italy.,Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Letizia Castelli
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
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Chedid T, Moisset X, Clavelou P. Rationale for off-label treatments use in primary progressive multiple sclerosis: A review of the literature. Rev Neurol (Paris) 2022; 178:932-938. [PMID: 35851485 DOI: 10.1016/j.neurol.2022.02.461] [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: 07/29/2021] [Revised: 12/18/2021] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Until recently, few therapeutic options, other than symptomatic treatment, were available for patients with primary progressive multiple sclerosis (PPMS). Ocrelizumab is the only approved treatment in this indication, and only since 2017. However, many patients in France are receiving off-label treatments for PPMS, mainly rituximab, mycophenolate mofetil, methotrexate, cyclophosphamide, and azathioprine. OBJECTIVE To evaluate published data concerning the efficacy of these five treatments frequently used as off-label disease-modifying therapies. METHODS We reviewed and summarized the studies published in Pubmed since the inception of the database. RESULTS Evidence from randomized controlled trials is lacking to support the use of these treatments as disease-modifying therapies in PPMS. CONCLUSION The literature lacks dedicated studies to support the off-label use of these disease-modifying therapies in PPMS. However, some limited data are available in the literature suggesting that the use of rituximab and cyclophosphamide could potentially be of some interest in specific subpopulations.
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Affiliation(s)
- T Chedid
- Hospital Center of Périgueux, 80, avenue Georges Pompidou, 24000 Périgueux, France.
| | - X Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France
| | - P Clavelou
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France
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13
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Plati D, Tripoliti E, Zelilidou S, Vlachos K, Konitsiotis S, Fotiadis DI. Multiple Sclerosis Severity Estimation and Progression Prediction Based on Machine Learning Techniques. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1109-1112. [PMID: 36085783 DOI: 10.1109/embc48229.2022.9871213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of the study is to address the Multiple Sclerosis (MS) severity estimation problem based on EDSS score and the prediction of the disease's progression with the application of Machine Learning (ML) approaches. Several ML techniques are implemented. The data are provided by the Neurology Clinic of the University Hospital of Ioannina and were collected in the framework of the ProMiSi project. The features recorded are grouped into: general demographic information, MS clinical related data, results of special tests, treatment, and comorbidities. The records from 30 patients are utilized and are recorded in three time points. The ML methods provided quite high results with 94.87% accuracy for the MS severity estimation and 83.33% for the disease's progression prediction.
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Ford CC, Cohen JA, Goodman AD, Lindsey JW, Lisak RP, Luzzio C, Pruitt A, Rose J, Rus H, Wolinsky JS, Kadosh SE, Bernstein-Hanlon E, Stark Y, Alexander JK. Early versus delayed treatment with glatiramer acetate: Analysis of up to 27 years of continuous follow-up in a US open-label extension study. Mult Scler 2022; 28:1729-1743. [PMID: 35768939 PMCID: PMC9442630 DOI: 10.1177/13524585221094239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Glatiramer acetate (GA) is US-approved for relapsing multiple sclerosis. Objectives: To describe GA long-term clinical profile. To compare effectiveness of early start (ES) versus delayed start (DS; up to 3 years) with GA. Methods: Phase 3 trial participants entered a randomized placebo-controlled period then an open-label extension (OLE) with GA. Results: Overall, 208 out of 251 (82.9%) randomized participants entered the OLE; 24 out of 101 (23.8%, ES) and 28 out of 107 (26.2%, DS) participants completed the OLE. Median GA treatment was 9.8 (0.1–26.3) years. Annualized change in Expanded Disability Status Scale (EDSS) score was lower with ES versus DS (p = 0.0858: full study; p = 0.002; Year 5). Participants with improved/stable EDSS was consistently higher with ES versus DS: 40.3% versus 31.6% (p = 0.1590; full study); 70.8% versus 55.6% (p = 0.015; Year 5). ES prolonged time-to-6-month confirmed disease worsening (CDW) versus DS (9.8 vs 6.7 years), time-to-12-month CDW (18.9 vs 11.6 years), and significantly reduced time-to-second-6-month CDW (p = 0.0441). No new safety concerns arose. Conclusion: GA long-term treatment maintained clinical benefit with a similar safety profile to phase 3 results; a key limitation was that only 25% of participants completed the OLE. Early initiation of GA had sustained benefits versus delayed treatment.
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Affiliation(s)
- Corey C Ford
- Department of Neurology, University of New Mexico Health Sciences Center, The University of New Mexico, Albuquerque, NM, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew D Goodman
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - John W Lindsey
- Department of Neurology, University of Texas Health Science Center at Houston (UTHouston), Houston, TX, USA
| | - Robert P Lisak
- Department of Neurology and Department of Biochemistry, Microbiology and Immunology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Christopher Luzzio
- Departments of Neurology and Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy Pruitt
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - John Rose
- Imaging and Neuroscience Center, School of Medicine, The University of Utah, Salt Lake City, UT, USA
| | - Horea Rus
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Jerry S Wolinsky
- Department of Neurology, University of Texas Health Science Center at Houston (UTHouston), Houston, TX, USA
| | - Shaul E Kadosh
- Innovative Research and Development, Teva Pharmaceuticals, Netanya, Israel
| | | | - Yafit Stark
- Global Clinical Development, Teva Pharmaceuticals, Netanya, Israel
| | - Jessica K Alexander
- Global Medical Affairs, Teva Pharmaceuticals, West Chester, PA, USA/Jazz Pharmaceuticals, Palo Alto, CA, USA
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Prada V, Zuccarino R, Schenone C, Mennella G, Grandis M, Shy ME, Schenone A. Charcot-Marie-Tooth neuropathy score and ambulation index are both predictors of orthotic need for patients with CMT. Neurol Sci 2022; 43:2759-2764. [PMID: 34613504 PMCID: PMC8918134 DOI: 10.1007/s10072-021-05646-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022]
Abstract
Charcot-Marie-Tooth (CMT) disease is the most common hereditary neuropathy with an estimated prevalence of 1 person affected on 2500. Frequent symptoms include distal weakness and muscle wasting, sensory loss, reduced deep tendon reflexes, and skeletal deformities, such as hammer toes and pes cavus. CMT is a progressive disease and patients' needs change over their lifetime. In particular, ambulation aids are increasingly needed to maintain ambulation and reduce the risk of falls. We performed a retrospective analysis of medical records from 149 patients with confirmed CMT to evaluate patients ambulation needs related to the severity of their CMT as measured by the CMT Neuropathy Score (CMTNS) and Ambulation Index (AI). Most patients required some form of orthotics (86.6%). The CMTNS and AI scores both differed significantly between patients with no orthotics compared to those who wore insoles/inserts. The CMTNS and AI also differed significantly between patients wearing insoles and those with ankle foot orthotics (AFOs). CMTNS and the AI were valid predictors of the type and choice of the orthotics. Both the CMTNS and AI can be effective tools to aid in the correct choice of orthotics in patients affected by CMT.
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Affiliation(s)
- Valeria Prada
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, Genova, Italy.
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242-1009, USA.
| | - Riccardo Zuccarino
- Neuromuscular Omnicentre (NeMO) Trento-Fondazione Serena Onlus, Pergine Valsugana, TN, Italy
| | - Cristina Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, Genova, Italy
| | - Giulia Mennella
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, Genova, Italy
| | - Marina Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, Genova, Italy
- Ospedale Policlinico IRCCS San Martino, Genova, Italy
| | - Michael E Shy
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242-1009, USA
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, Genova, Italy
- Ospedale Policlinico IRCCS San Martino, Genova, Italy
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16
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de Leeuw MJ, Oppewal A, Elbers RG, Knulst MWEJ, van Maurik MC, van Bruggen MC, Hilgenkamp TIM, Bindels PJE, Maes-Festen DAM. Healthy Ageing and Intellectual Disability study: summary of findings and the protocol for the 10-year follow-up study. BMJ Open 2022; 12:e053499. [PMID: 35193910 PMCID: PMC8867312 DOI: 10.1136/bmjopen-2021-053499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The Healthy Ageing and Intellectual Disability (HA-ID) study is a prospective multicentre cohort study in the Netherlands that started in 2008, including 1050 older adults (aged ≥50) with intellectual disabilities (ID). The study is designed to learn more about the health and health risks of this group as they age. Compared with the amount of research in the general population, epidemiological research into the health of older adults with ID is still in its infancy. Longitudinal data about the health of this vulnerable and relatively unhealthy group are needed so that policy and care can be prioritised and for guiding clinical decision making about screening, prevention and treatment to improve healthy ageing. METHODS AND ANALYSIS This article presents a summary of the previous findings of the HA-ID study and describes the design of the 10-year follow-up in which a wide range of health data will be collected within five research themes: (1) cardiovascular disease; (2) physical activity, fitness and musculoskeletal disorders; (3) psychological problems and psychiatric disorders; (4) nutrition and nutritional state; and (5) frailty. ETHICS AND DISSEMINATION Ethical approval for the 10-year follow-up measurements of the HA-ID study has been obtained from the Medical Ethics Review Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2019-0562). TRIAL REGISTRATION NUMBER This cohort study is registered in the Dutch Trial Register (NTR number NL8564) and has been conducted according to the principles of the Declaration of Helsinki.
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Affiliation(s)
- Marleen J de Leeuw
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Alyt Oppewal
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Roy G Elbers
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Mireille W E J Knulst
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Marco C van Maurik
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Marjoleine C van Bruggen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Thessa I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Dederieke A M Maes-Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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Efficiency of Leg Exoskeleton Use in Rehabilitation of Cerebral Stroke Patients. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2021-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
The study aimed to evaluate the effectiveness of functional and motor activity restoration, including the walking function, in patients after an ischemic stroke using the ExoAtlet lower limb exoskeleton.
Patients and methods. A clinical study was carried out on 42 patients who had undergone a cerebral infarction in the mid cerebral artery system with a post-stroke paresis of the leg, and who had undergone a rehabilitation course in a round-theclock hospital during the early recovery period. Patients were randomized into two equal groups comparable in terms of the stroke severity: the patients in group 1 were receiving a standard rehabilitation program (control group), the patients in group 2 were additionally receiving a course of gait rehabilitation using the ExoAtlet exoskeleton - 10 sessions, 5 sessions per week for 14 days.
Results. The study demonstrated the effectiveness of the ExoAtlet exoskeleton used in the rehabilitation of stroke patients over the standard course of rehabilitation. The advantages include a decrease in the hemiparesis degree, an increase in the muscle strength of the paretic limb, an improvement in balance, an improvement and acceleration of the walking process. The obtained results of the instrumental study confirmed the benefits of physical training on the Exoskeleton, which was demonstrated through an increase in stability and balance, as well as through a decrease in the energy consumption index for maintaining the stable verticalization.
Conclusion. The usage of the ExoAtlet exoskeleton increases the effectiveness of rehabilitation measures and improves motor and functional activities of patients who have suffered a cerebral stroke.
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Okamura M, Konishi M, Sagara A, Shimizu Y, Nakamura T. Impact of early mobilization on discharge disposition and functional status in patients with subarachnoid hemorrhage: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e28171. [PMID: 34941070 PMCID: PMC8701947 DOI: 10.1097/md.0000000000028171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Whereas early rehabilitation improves the patients' physical function in patients with cerebral infarction and hemorrhage, complications in the early stage are the main barriers in patients with subarachnoid hemorrhage (SAH). Therefore, the clinical impact of early rehabilitation in patients with SAH is not well documented. We sought to investigate whether early mobilization is associated with favorable discharge disposition and functional status in patients with SAH.Hospitalization data of 35 patients (65.7 ± 13.7 years, 37.1% men) were retrospectively reviewed. The early and delayed mobilization groups were defined as those who had and had not participated in walking rehabilitation on day 14, respectively. We investigated whether patients were discharged or transferred to another hospital and assessed their functional status using the Functional Ambulation Categories, Ambulation Index, Glasgow Outcome Scale, and modified Rankin Scale scores.Nine patients (69.2%) in the early mobilization group and one patient (4.5%) in the delayed mobilization group were discharged home directly (P < .001). In multivariate logistic regression analysis, early mobilization was independently associated with home discharge after adjustment using the World Federation of Neurosurgical Societies grade (adjusted odds ratio = 30.20, 95% CI = 2.77-329.00, P < .01). Early mobilization was associated with favorable functional status at discharge through multivariate linear regression analysis (standardized beta = 0.64 with P < .001 for the Functional Ambulation Category and beta = -0.62 with P < .001 for the modified Rankin Scale, respectively).Early mobilization was associated with home discharge and favorable functional status at discharge. Larger prospective studies are warranted.
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Affiliation(s)
- Masatsugu Okamura
- Department of Rehabilitation, Yokohama City University Hospital, Yokohama, Japan
- Department of Rehabilitation Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaaki Konishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akiko Sagara
- Department of Rehabilitation Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Yasuo Shimizu
- Department of Rehabilitation Medicine, Kyoto City Hospital, Kyoto, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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19
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Targeted walking training of patients in the early recovery period of cerebral stroke (preliminary research). КЛИНИЧЕСКАЯ ПРАКТИКА 2021. [DOI: 10.17816/clinpract77334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Currently, training of the gait function for patients with cerebral stroke using the biofeedback technology is an independent, effective, and promising method. The most common training and exposure parameters are the gait speed, cycle length, and cadence. However, the application of basic and more complex types of selective training using wearable sensor technology is rare due to the technological complexity of their use for biofeedback.
Aims: To study the possibility of using the biofeedback training technology with a targeted effect on one of the basic parameters characterizing the symmetry of walking, the duration of the support period, in patients in the early recovery period of cerebral stroke.
Methods: We examined 12 patients who underwent a course of biofeedback training to harmonize the period of support during the early recovery period of hemispheric cerebral stroke in the middle cerebral artery basin. The biomechanics of voluntary walking was investigated before and after the training. The spatio-temporal parameters of walking, kinematics of movements in the hip, knee, and ankle joints, and the maximum EMG amplitudes of the main muscle groups responsible for walking were recorded. The classical clinical scales were also used. The biofeedback training on a treadmill consisted of 10 sessions; the duration of the support period was the training parameter.
Results. As a result of the treatment, a significant improvement was noted according to the UpGo clinical scale and Hausers walking index. The differences in the trained support phase after the treatment are not significant and demonstrate positive changes. The kinematics of movements in the joints also demonstrates relatively small, but significant changes for the knee joint. For the hip joint, no dynamics in the parameters values is observed; the joint function does not change significantly, and the amplitude asymmetry remains unchanged. For the knee joint, the greatest dynamics is observed for the main swing amplitude and its phase.
Conclusion: The study has shown that the purposeful biofeedback training of the gait function using the support period to reduce the functional asymmetry in this parameter, and also has a positive effect on other gait parameters.
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Avenali M, Picascia M, Tassorelli C, Sinforiani E, Bernini S. Evaluation of the efficacy of physical therapy on cognitive decline at 6-month follow-up in Parkinson disease patients with mild cognitive impairment: a randomized controlled trial. Aging Clin Exp Res 2021; 33:3275-3284. [PMID: 33978924 DOI: 10.1007/s40520-021-01865-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND In Parkinson's disease (PD), physical activity may represent a possible non-pharmacological intervention not only for improving motor symptoms but also for modulating cognitive impairment. AIMS To evaluate the efficacy of an intensive physical program on cognitive functions in mid-stage PD patients with mild cognitive impairment (PD-MCI) over a 6-month follow-up. METHODS This is a 6-month randomized controlled follow-up study. 40 PD-MCI patients were randomized to receive physical therapy (PT) or no specific intervention beside drug treatment (CT). Cognitive and motor assessments were performed at baseline (T0), 4 weeks after baseline (T1) and 6 months after T0. In a previous study, we reported a significant improvement in global cognitive functioning and attention/working-memory at T1. Here, we evaluated the residual effect of the training intervention at 6 months on both cognitive and motor performances. RESULTS Intra-group analysis showed that at T2 most of cognitive and motor performances remained stable in the PT when compared to T0, while a significant worsening was observed in the CT. Between-group comparison at T2 showed significantly better results in PT than CT as regards MoCA and motor scales. The percentage change of cognitive and motor performances between T1 and T2 confirmed the benefit of physical therapy on global cognitive functioning scores (MMSE and MoCA). CONCLUSIONS In this follow-up extension of a longitudinal randomized controlled study, we demonstrated that physical therapy has a positive effect on cognitive functions, which extends beyond the duration of the treatment itself to, at least temporarily, reducing cognitive decline. TRIAL REGISTRATION Trial registration number (ClinicalTrials.gov): NCT04012086 (9th July 2019).
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21
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Wei H, Li AP. Permeabilized cryopreserved human hepatocytes as an exogenous metabolic system in a novelmetabolism-dependent cytotoxicity assay (MDCA) for the evaluation of metabolic activation anddetoxification of drugs associated with drug induced liver injuries: Results with acetaminophen,amiodarone, cyclophosphamide, ketoconazole, nefazodone, and troglitazone. Drug Metab Dispos 2021; 50:140-149. [PMID: 34750194 DOI: 10.1124/dmd.121.000645] [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: 08/23/2021] [Accepted: 11/05/2021] [Indexed: 11/22/2022] Open
Abstract
We report here a novel in vitro experimental system, the metabolism-dependent cytotoxicity assay (MDCA), for the definition of the roles of hepatic drug metabolism in toxicity. MDCA employs permeabilized cofactor-supplemented cryopreserved human hepatocytes (MetMax{trade mark, serif} human hepatocytes, MMHH), as an exogenous metabolic activating system, and HEK-293 cells, a cell line devoid of drug metabolizing enzyme activity, as target cells for the quantification of drug toxicity. The assay was performed in the presence and absence of cofactors for key drug metabolism pathways known to play key roles in drug toxicity: NADPH/NAD+ for phase 1 oxidation, UDPGA for UGT mediated glucuronidation, PAPS for SULT mediated sulfation, and GSH for GST mediated GSH conjugation. Six drugs with clinically significant hepatoxicity, resulting in liver failure or a need for liver transplantation: acetaminophen, amiodarone, cyclophosphamide, ketoconazole, nefazodone and troglitazone were evaluated. All six drugs exhibited cytotoxicity enhancement by NADPH, suggesting metabolic activation via phase 1 oxidation. Attenuation of cytotoxicity by UDPGA was observed for acetaminophen, ketoconazole and troglitazone, by PAPS for acetaminophen, ketoconazole and troglitazone, and by GSH for all six drugs. Our results suggest that MDCA can be applied towards the elucidation of metabolic activation and detoxification pathways, providing information that can be applied in drug development to guide structure optimization to reduce toxicity and to aid the assessment of metabolism-based risk factors for drug toxicity. GSH detoxification represents an endpoint for the identification of drugs forming cytotoxic reactive metabolites, a key property of drugs with idiosyncratic hepatotoxicity. Significance Statement Application of the metabolism-dependent cytotoxicity assay (MDCA) for the elucidation of the roles of metabolic activation and detoxification pathways in drug toxicity may provide information to guide structure optimization in drug development to reduce hepatotoxic potential, and to aid the assessment of metabolism-based risk factors. GSH detoxification represents an endpoint for the identification of drugs forming cytotoxic reactive metabolites may be applied towards the evaluation of idiosyncratic hepatotoxicity.
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Affiliation(s)
- Hong Wei
- In Vitro ADMET Laboratories, United States
| | - Albert P Li
- In Vitro ADMET Laboratories Inc., United States
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22
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A Study of Biofeedback Gait Training in Cerebral Stroke Patients in the Early Recovery Phase with Stance Phase as Target Parameter. SENSORS 2021; 21:s21217217. [PMID: 34770524 PMCID: PMC8588439 DOI: 10.3390/s21217217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 01/15/2023]
Abstract
Walking function disorders are typical for patients after cerebral stroke. Biofeedback technology (BFB) is currently considered effective and promising for training walking function, including in patients after cerebral stroke. Most studies recognize that BFB training is a promising tool for improving walking function; however, the data on the use of highly selective walking parameters for BFB training are very limited. The aim of our study was to investigate the feasibility of using BFB training targeting one of the basic parameters of gait symmetry—stance phase duration—in cerebral stroke patients in the early recovery period. The study included 20 hemiparetic patients in the early recovery period after the first hemispheric ischemic stroke. The control group included 20 healthy subjects. The BFB training and biomechanical analysis of walking (before and after all BFB sessions) were done using an inertial system. The mean number of BFB sessions was nine (from 8 to 11) during the three weeks in clinic. There was not a single negative response to BFB training among the study patients, either during the sessions or later. The spatiotemporal parameters of walking showed the whole syndrome complex of slow walking and typical asymmetry of temporal walking parameters, and did not change significantly as a result of the study therapy. The changes were more significant for the functioning of hip and knee joints. The contralateral hip amplitude returned to the normal range. For the knee joint, the amplitude of the first flexion increased and the value of the amplitude of hyperextension decreased in the middle of the stance phase. Concerning muscle function, the observed significant decrease in the function of m. Gastrocnemius and the hamstring muscles on the paretic side remained without change at the end of the treatment course. We obtained positive dynamics of the biomechanical parameters of walking in patients after the BFB training course. The feasibility and efficacy of their use for targeted correction need further research.
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Enose-Akahata Y, Billioux BJ, Azodi S, Dwyer J, Vellucci A, Ngouth N, Nozuma S, Massoud R, Cortese I, Ohayon J, Jacobson S. Clinical trial of raltegravir, an integrase inhibitor, in HAM/TSP. Ann Clin Transl Neurol 2021; 8:1970-1985. [PMID: 34562313 PMCID: PMC8528465 DOI: 10.1002/acn3.51437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Human T‐cell lymphotropic virus 1 (HTLV‐1)‐associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic, progressive myelopathy. A high proviral load (PVL) is one of the main risk factors for HAM/TSP. Recently, it was shown that raltegravir could inhibit cell‐free and cell‐to‐cell transmission of HTLV‐1 in vitro. Given the substantial clinical experience in human immunodeficiency virus infection and its excellent safety profile, this agent may be an attractive therapeutic option for HAM/TSP patients. Methods Sixteen subjects with HAM/TSP received raltegravir 400 mg orally twice daily in an initial 6‐month treatment phase, followed by a 9‐month post‐treatment phase. HTLV‐1 PVLs were assessed using droplet digital PCR from the PBMCs every 3 months, and from the CSF at baseline, month 6, and month 15. We also evaluated the ability of raltegravir to regulate abnormal immune responses in HAM/TSP patients. Results While a downward trend was observed in PBMC and/or CSF PVLs of some patients, raltegravir overall did not have any impact on the PVL in this HAM/TSP patient cohort. Clinically, all patients’ neurological scores and objective measurements remained relatively stable, with some expected variability. Immunologic studies showed alterations in the immune profiles of a subset of patients including decreased CD4+CD25+ T cells and spontaneous lymphoproliferation. Interpretation Raltegravir was generally well tolerated in this HAM/TSP patient cohort. A subset of patients exhibited a mild decrease in PVL as well as variations in their immune profiles after taking raltegravir. These findings suggest that raltegravir may be a therapeutic option in select HAM/TSP patients. Clinical Trial Registration Number NCT01867320.
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Affiliation(s)
- Yoshimi Enose-Akahata
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Bridgette Jeanne Billioux
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Shila Azodi
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Jennifer Dwyer
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Ashley Vellucci
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Nyater Ngouth
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Satoshi Nozuma
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Raya Massoud
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, 20892, USA
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Cyclophosphamide treatment in active multiple sclerosis. Neurol Sci 2021; 42:3775-3780. [PMID: 33452657 DOI: 10.1007/s10072-021-05052-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 01/09/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cyclophosphamide (CYC) is an alkylating agent with immunosuppressive effect by inhibiting DNA synthesis and producing apoptosis used in many autoimmune diseases, including multiple sclerosis (MS). Here, we analyze the efficacy of CYC treatment in relapsing-remitting (RRMS) and active secondary progressive MS (SPMS) in our center with a monthly scheme. METHODS Patients with MS treated with CYC and a follow up of at least 36 months were eligible for inclusion. All participants had received a standard CYC regimen. The EDSS score mean annualized relapse rate (ARR) and progression index (PI) were measured as efficacy outcomes at 12, 24, and 36 months. Outcomes were also analyzed comparing disease course and activity. RESULTS A total of 16 patients were included (50% male, 18.75% RRMS and 81.25% SPMS). EDSS remained stable along the follow-up period, with 62.5% improving or maintaining the same EDSS score at 12 months. PI decreased 14% and 21% at 12 and 24-36 months of follow-up, respectively. ARR decreased 20% after 12 months, 19% after 24 months, and 30.23% after 36 months. Median differences in ARR were higher in patients with high relapse activity (0.60 vs 0.07, p = 0.001) and malignant course (0.60 vs 0.17, p = 0.027). PI also differed with higher mean differences in patients with high relapse activity (0.70 vs 0.03, p = 0.016) and malignant course (1.17 vs 0.03, p = 0.003). CONCLUSIONS CYC continues to be a valid therapeutic option, especially in regions with limited access to high-efficiency therapies particularly in patients with high relapsing activity and malignant course.
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Pardo G, Coates S, Okuda DT. Outcome measures assisting treatment optimization in multiple sclerosis. J Neurol 2021; 269:1282-1297. [PMID: 34338857 PMCID: PMC8857110 DOI: 10.1007/s00415-021-10674-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
Objective To review instruments used to assess disease stability or progression in persons with multiple sclerosis (pwMS) that can guide clinicians in optimizing therapy. Methods A non-systematic review of scientific literature was undertaken to explore modalities of monitoring symptoms and the disease evolution of MS. Results Multiple outcome measures, or tools, have been developed for use in MS research as well as for the clinical management of pwMS. Beginning with the Expanded Disability Status Scale, introduced in 1983, clinicians and researchers have developed monitoring modalities to assess all aspects of MS and the neurological impairment it causes. Conclusions Much progress has been made in recent decades for the management of MS and for the evaluation of disease progression. New technology, such as wearable sensors, will provide new opportunities to better understand changes in function, dexterity, and cognition. Essential work over the decades since EDSS was introduced continues to improve our ability to treat this debilitating disease.
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Affiliation(s)
- Gabriel Pardo
- OMRF Multiple Sclerosis Center of Excellence, Oklahoma Medical Research Foundation, 820 NE 15th Street, Oklahoma City, OK, 73104, USA.
| | | | - Darin T Okuda
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
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Therapeutic plasma exchange in MS refractory relapses: Long-term outcome. Mult Scler Relat Disord 2021; 55:103168. [PMID: 34332460 DOI: 10.1016/j.msard.2021.103168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) is considered a treatment option for steroid-refractory multiple sclerosis (MS) relapses. Our objective was to assess long-term clinical response to TPE in MS steroid-refractory exacerbations. METHODS Retrospective study of relapsing remitting MS (RRMS) patients presenting intravenous methylprednisolone (IVMPS)-refractory relapses, who underwent TPE. Response to TPE was assessed at 1, 3, 6, 12 and 24-months post-treatment, and compared to a second group of RRMS patients with similar demographic and clinical characteristics presenting, IVMPS-refractory relapses but not treated with TPE. Multivariate regression analysis was used to assess potential predictors of significant clinical response. RESULTS Between 2011 to 2020, a total of 23 RRMS patients were treated with TPE. Twenty-one patients not receiving the treatment served as controls. No differences in demographic or clinical characteristics, or predictors of clinical improvement after TPE were detected between groups. Seventy-eight percent of patients treated with TPE presented clinical improvement at 24 months. TPE-treated patients presented lower EDSS scores at 6 and at 24 months. Younger age, presence of gadolinium-enhancing lesions and TPE treatment were associated with better clinical outcomes. No life-threatening side effects were reported. CONCLUSIONS TPE is a safe and well tolerated procedure that decreases long-term disability in RRMS patients with IVMPS-refractory relapses.
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Abdel Hafeez MA, Zamzam DA, Swelam MS, Steit AA, Masoud J, Nasser AA, Hazzou A, Hamid E, Aref H, Zakaria MF, Fouad MM. Telephone-based assessment of multiple sclerosis patients at Ain Shams University Hospital in the coronavirus disease 2019 pandemic. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:66. [PMID: 34093002 PMCID: PMC8164886 DOI: 10.1186/s41983-021-00316-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Assessment of multiple sclerosis (MS) patients during the era of the coronavirus disease 2019 (COVID-19) pandemic was confronted with the overwhelmed healthcare facilities in Egypt and fear of the patients to get infected while attending the follow-up visits. This study aimed to assess the value of telephone-based assessments in the follow-up of MS patients. It includes one hundred and five patients who participated in the study and completed 3 telephone-based assessments which are the Hauser Ambulation index, Multiple Sclerosis Neuropsychology Questionnaire (MSNQ), and Symptoms of Multiple Sclerosis Scale (SMSS). Results The Hauser Ambulation index was significantly correlated with the latest Expanded Disability Status Scale (EDSS) score done within 1 month from the telephone call (r=0.738, P<0.001). The analysis of MSNQ scores showed that one-third of the study population had evidence of cognitive and/or neuropsychological impairment. Post hoc analysis regarding the cognitive and psychological impairment component of SMSS revealed that the patients who answered “Never” had significantly lower MSNQ scores compared to those who answered “Sometimes” (P=0.016), “Often” (P=0.022), and “Always” (P=0.001). The comparison of the EDSS scores of the patients regarding the sensory-motor impairment component of SMSS showed a non-significant difference. Conclusion The Hauser Ambulation index may be a reliable telephone-based tool for the assessment of physical disability. The MSNQ and the cognitive and psychological impairment component of SMSS can be used for the assessment of cognitive and psychological impairment among patients with MS.
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Affiliation(s)
| | - Dina A Zamzam
- Neurology Department, Ain Shams University, Cairo, Egypt
| | | | - Alaa Abo Steit
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - Janet Masoud
- Neurology Department, Ain Shams University, Cairo, Egypt
| | | | - Ahmed Hazzou
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - Eman Hamid
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - Hany Aref
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - Magd F Zakaria
- Neurology Department, Ain Shams University, Cairo, Egypt
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Rolfes L, Pawlitzki M, Pfeuffer S, Huntemann N, Wiendl H, Ruck T, Meuth SG. Failed, Interrupted, or Inconclusive Trials on Immunomodulatory Treatment Strategies in Multiple Sclerosis: Update 2015-2020. BioDrugs 2021; 34:587-610. [PMID: 32785877 PMCID: PMC7519896 DOI: 10.1007/s40259-020-00435-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the past decades, multiple sclerosis (MS) treatment has experienced vast changes resulting from major advances in disease-modifying therapies (DMT). Looking at the overall number of studies, investigations with therapeutic advantages and encouraging results are exceeded by studies of promising compounds that failed due to either negative or inconclusive results or have been interrupted for other reasons. Importantly, these failed clinical trials are informative experiments that can help us to understand the pathophysiological mechanisms underlying MS. In several trials, concepts taken from experimental models were not translatable to humans, although they did not lack a well-considered pathophysiological rationale. The lessons learned from these discrepancies may benefit future studies and reduce the risks for patients. This review summarizes trials on MS since 2015 that have either failed or have been interrupted for various reasons. We identify potential causes of failure or inconclusiveness, looking at the path from basic animal experiments to clinical trials, and discuss the implications for our current view on MS pathogenesis, clinical practice, and future study designs. We focus on anti-inflammatory treatment strategies, without including studies on already approved and effective DMT. Clinical trials addressing neuroprotective and alternative treatment strategies are presented in a separate article.
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Affiliation(s)
- Leoni Rolfes
- Department of Neurology With Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Marc Pawlitzki
- Department of Neurology With Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Steffen Pfeuffer
- Department of Neurology With Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Niklas Huntemann
- Department of Neurology With Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology With Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Tobias Ruck
- Department of Neurology With Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Sven G Meuth
- Department of Neurology With Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Ebihara S, Otsubo Y, Miyagi M. Role of physical therapists and aromatherapy for fall prevention in older people: A narrative review. Geriatr Gerontol Int 2021; 21:445-450. [PMID: 33873257 DOI: 10.1111/ggi.14165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022]
Abstract
Falls among older people are usually the result of several causes combined. Identifying all the fall-related factors that apply to a particular individual and providing comprehensive multifactorial intervention is recommended for the prevention of falls among older people. However, the overall net benefit of multifactorial intervention in preventing falls is small, and it does not appear to improve fall-related outcomes, such as the number of fall-related injuries. Therefore, we might require new perspectives to overcome this situation. Here, we raise two novel strategies for fall prevention among older people. One is using physical therapists more actively. The other is using aromatherapy for stabilization of older people. Physical therapists should carry out detailed gait assessment and caregiver education. Aromatherapy is effective in improving balance and mental stability in older people. To overcome refractory geriatric syndrome, there is no choice but to eliminate all preconceived ideas before choosing the best fall prevention strategies. Geriatr Gerontol Int 2021; 21: 445-450.
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Affiliation(s)
- Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Yuta Otsubo
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Midori Miyagi
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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Androwis GJ, Sandroff BM, Niewrzol P, Fakhoury F, Wylie GR, Yue G, DeLuca J. A pilot randomized controlled trial of robotic exoskeleton-assisted exercise rehabilitation in multiple sclerosis. Mult Scler Relat Disord 2021; 51:102936. [PMID: 33878619 DOI: 10.1016/j.msard.2021.102936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/21/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Co-occurring mobility and cognitive impairments are common, debilitating, and poorly-managed with pharmacological therapies in persons with multiple sclerosis (MS). Exercise rehabilitation (ER), particularly walking ER, has been suggested as one of the best approaches for managing these manifestations of MS. However, there is a focal lack of efficacy of ER on mobility and cognitive outcomes in persons with MS who present with substantial neurological disability. Such severe neurological disability oftentimes precludes the ability for participation in highly-intensive and repetitive ER that is necessary for eliciting adaptations in mobility and cognition. To address such a concern, robotic exoskeleton-assisted ER (REAER) might represent a promising intervention approach for managing co-occurring mobility and cognitive impairments in those with substantial MS disability who might not benefit from traditional ER. METHODS The current pilot single-blind, randomized controlled trial (RCT) compared the effects of 4-weeks of REAER with 4-weeks of conventional gait training (CGT) as a standard-of-care control condition on functional mobility (timed up-and-go; TUG), walking endurance (six-minute walk test; 6MWT), cognitive processing speed (CPS; Symbol Digit Modalities Test; SDMT), and brain connectivity (thalamocortical resting-state functional connectivity (RSFC) based on fMRI) outcomes in 10 persons with substantial MS-related neurological disability. RESULTS Overall, compared with CGT, 4-weeks of REAER was associated with large improvements in functional mobility (ηp2=.38), CPS (ηp2=.53), and RSFC between the thalamus and ventromedial prefrontal cortex (ηp2=.72), but not walking endurance (ηp2=.01). Further, changes in RSFC were moderately associated with changes in TUG, 6MWT, and SDMT performance, respectively, whereby increased thalamocortical RSFC was associated with improved functional mobility, walking endurance, and CPS (|ρ|>.36). CONCLUSION The current pilot RCT provides initial support for REAER as an approach for improving functional mobility and CPS, perhaps based on adaptive and integrative central nervous system plasticity, namely increases in RSFC between the thalamus and ventromedial prefrontal cortex, in a small sample of persons with substantial MS disability. Such a pilot trial provides proof-of-concept data for the design and implementation of an appropriately-powered RCT of REAER in a larger sample of persons with MS who present with co-occurring impairments in both mobility and cognitive functioning.
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Affiliation(s)
- Ghaith J Androwis
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA.
| | - Brian M Sandroff
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | | | | | - Glenn R Wylie
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Guang Yue
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - John DeLuca
- Kessler Foundation, West Orange, New Jersey, USA; Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
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No Early Effect of Intrathecal Rituximab in Progressive Multiple Sclerosis (EFFRITE Clinical Trial). Mult Scler Int 2021; 2021:8813498. [PMID: 33763241 PMCID: PMC7964121 DOI: 10.1155/2021/8813498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background The progressive phase of multiple sclerosis (MS) is characterized by an intrathecal (IT) compartmentalization of inflammation, involving B-cells within meningeal follicles, and resisting all the available immunosuppressive treatments. A new therapeutic paradigm may be to target this inflammation by injecting immunosuppressive drugs inside the central nervous system compartment. Methods We designed a single-center, open-label, randomized, controlled, phase II study designed to evaluate the safety and efficacy of IT rituximab in progressive MS (EFFRITE trial; ClinicalTrial Registration NCT02545959). Patients were randomized into three arms (1 : 1 : 1): control group, IT rituximab (20 mg, IT) group, and intravenous+IT (IV+IT) group. The main outcome was a change in levels of CSF biomarkers of inflammation (osteopontin). Secondary outcomes were changes in levels of CSF biomarkers of axonal loss (neurofilament light chain) and clinical and MRI changes. Results Ten patients were included (2 : 4 : 4). No adverse event occurred. OPN level remained stable in CSF at each time point, whereas NFL had slightly decreased (-8.7%) at day 21 (p = 0.02). Clinical parameters remained stable and leptomeningeal enhancements remained unchanged. Conclusion Clinical outcome and biomarkers of inflammation were not dramatically modified after IT injection of rituximab, probably due to its limited efficiency in CSF. Drug issues for future studies are discussed.
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Kim HJ, Nakashima I, Viswanathan S, Wang KC, Shang S, Miller L, Yountz M, Wingerchuk DM, Pittock SJ, Levy M, Berthele A, Totolyan N, Palace J, Barnett MH, Fujihara K. Eculizumab in Asian patients with anti-aquaporin-IgG-positive neuromyelitis optica spectrum disorder: A subgroup analysis from the randomized phase 3 PREVENT trial and its open-label extension. Mult Scler Relat Disord 2021; 50:102849. [PMID: 33676197 DOI: 10.1016/j.msard.2021.102849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/19/2022]
Abstract
Background Eculizumab, a terminal complement inhibitor, significantly reduced the risk of relapse compared with placebo in patients with anti-aquaporin-4 immunoglobulin G-positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) in the PREVENT trial. We report efficacy and safety analyses in Asian patients in PREVENT and its open-label extension (OLE). Methods PREVENT was a double-blind, randomized, phase 3 trial. Patients with AQP4+ NMOSD were randomly assigned (2:1) to receive intravenous eculizumab (maintenance dose, 1200 mg/2 weeks) or placebo. Patients who completed PREVENT could receive eculizumab in an OLE. Analyses were performed in a prespecified subgroup of Asian patients. Results Of 143 patients enrolled, 52 (36.4%) were included in the Asian subgroup (eculizumab, n = 37; placebo, n = 15); 45 Asian patients received eculizumab in the OLE. Most Asian patients (86.5%) received concomitant immunosuppressive therapy. During PREVENT, one adjudicated relapse occurred in patients receiving eculizumab and six occurred in patients receiving placebo in the Asian subgroup (hazard ratio, 0.05; 95% confidence interval: 0.01-0.35; p = 0.0002). An estimated 95.2% of Asian patients remained relapse-free after 144 weeks of eculizumab treatment. Upper respiratory tract infections, headache, and nasopharyngitis were the most common adverse events with eculizumab in the Asian subgroup. Conclusion Eculizumab reduces the risk of relapse in Asian patients with AQP4+ NMOSD, with a benefit-risk profile similar to the overall PREVENT population. The benefits of eculizumab were maintained during long-term therapy. Clinical trial registration ClinicalTrials.gov identifiers: NCT01892345 (PREVENT); NCT02003144 (open-label extension).
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Affiliation(s)
- Ho Jin Kim
- Department of Neurology, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, South Korea.
| | - Ichiro Nakashima
- Department of Neurology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi 980-8574, Japan; Division of Neurology, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyaginoku, Sendai, Miyagi 983-8512, Japan.
| | - Shanthi Viswanathan
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, Kuala Lumpur 50560, Malaysia
| | - Kai-Chen Wang
- Cheng Hsin General Hospital, 45 Zhenxing Street, Beitou District, Taipei, Taiwan 112; School of Medicine, National Yang-Ming University, 155, Section 2, Linong St, Beitou District, Taipei, Taiwan 112
| | - Shulian Shang
- Alexion Pharmaceuticals, 121 Seaport Boulevard, Boston, MA 02210, United States.
| | - Larisa Miller
- Alexion Pharmaceuticals, 121 Seaport Boulevard, Boston, MA 02210, United States.
| | - Marcus Yountz
- Alexion Pharmaceuticals, 121 Seaport Boulevard, Boston, MA 02210, United States.
| | - Dean M Wingerchuk
- Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259, United States.
| | - Sean J Pittock
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, United States.
| | - Achim Berthele
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Neuro-Kopf-Zentrum, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Natalia Totolyan
- Department of Neurology, First Pavlov State Medical University of St. Petersburg, St. 6/8, Lva Tolstogo str., 197022 Petersburg, Russia.
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, University of Oxford, Headley Way, Oxford OX3 9DU, United Kingdom.
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, 94, Mallett Street, Camperdown, Sydney, NSW 2050, Australia; Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi 980-8574, Japan; Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima 960-1295, Japan; Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience (STRINS), Koriyama, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan.
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Basso MR, Whiteside D, Combs D, Woods SP, Hoffmeister J, Mulligan R, Arnett P, Alden E, Tobin O. Memory in multiple sclerosis: A reappraisal using the item specific deficit approach. Neuropsychology 2021; 35:207-219. [PMID: 33764111 PMCID: PMC8396077 DOI: 10.1037/neu0000712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE As many as 65% of people with multiple sclerosis (MS) have clinically significant memory impairment, but the nature of this deficit is controversial. Some investigations suggest that an inability to retrieve newly learned information from memory is prominent, whereas others imply that compromised acquisition accounts for impairment. Prior research has not simultaneously evaluated acquisition and retrieval processes in MS, and fewer have attempted to account for initial acquisition when studying retrieval. The Item Specific Deficit Approach (ISDA) offers a method of quantifying acquisition, retrieval, and retention processes, with the latter two mechanisms being adjusted for initial acquisition. To simultaneously quantify acquisition and retrieval abilities, the ISDA was applied to list learning performance in two independent samples of people with MS and corresponding healthy comparison groups. PARTICIPANTS AND METHODS Study 1 included 85 people with MS and 47 healthy individuals. Study 2 involved a separate sample of 79 people with MS and 22 healthy people. They were administered neuropsychological batteries, and participants with MS were classified as globally impaired or unimpaired. The California Verbal Learning Test-II was administered to assess new-learning in both studies, and responses were scored using the ISDA. RESULTS Both studies revealed that cognitively impaired people with MS manifest weaknesses involving acquisition and retrieval. Nearly identical effect sizes emerged across samples, with cognitive impairment achieving a medium effect upon acquisition and a large effect upon retrieval. CONCLUSIONS These findings accord well with previous research showing diminished acquisition and retrieval among people with MS. The results may also reconcile contradictory findings in the extant literature by showing that memory impairment in MS is not exclusively attributable to either acquisition or retrieval. Rather, both processes may manifest across people with MS. The replication across samples with nearly identical effect sizes implies that these effects are reliable and possess external validity. These data hold implications for memory rehabilitation interventions involving people with MS, and suggest that acquisition and retrieval processes should be addressed in treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Shurupova M, Aizenshtein A, Trofimova A, Ivanova G. Clinical and anamnestic data that affect the outcome of rehabilitation on virtual reality in patients with stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:33-40. [DOI: 10.17116/jnevro202112112233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Correia MS, Neville IS, Almeida CCD, Hayashi CY, Ferreira LTD, Quadros DG, Gomes Dos Santos A, Solla DJF, Marta GN, Teixeira MJ, Paiva WS. Clinical outcome assessments of motor status in patients undergoing brain tumor surgery. Clin Neurol Neurosurg 2020; 201:106420. [PMID: 33388662 DOI: 10.1016/j.clineuro.2020.106420] [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: 09/17/2020] [Revised: 11/21/2020] [Accepted: 12/04/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Clinical outcome assessment (COA) is an important instrument for testing the effectiveness of treatments and for supporting healthcare professionals on decision-making. This review aims to assess the use of COAs, and the evaluation time points of motor status in patients with brain tumor (BT) undergoing surgery. METHODS We performed a scoping review through MEDLINE, EMBASE, and LILACS databases, looking for original studies in primary or secondary BT, having motor function status as the primary outcome. EXCLUSION CRITERIA mixed sample, BT recurrence, and an unspecific description of motor deficits evaluation. RESULTS Nine studies met the eligibility criteria. There were 449 patients assessed. A total of 18 scales evaluated these BT patients, 12 performance outcomes measures (PerfO) tested motor function. Four scales were the clinician-reported outcome measures (ClinRO) found in this review, two assessed performance status, and two rated ambulation. Two patient-reported outcome measures (PRO) appraised functionality. CONCLUSIONS A variety of instruments were used to assess BT patients. Rehabilitation studies are more likely to associate the use of PerfO and PRO concerning motor and functional status. The use of specific validated scales to the BT population was rare. The lack of a standardized approach hampers the quality of BT patient's assessment.
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Affiliation(s)
- Mayla Santana Correia
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, 01246-000, Brazil.
| | - Iuri Santana Neville
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, 01246-000, Brazil; Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | - Cesar Cimonari de Almeida
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | - Cintya Yukie Hayashi
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | - Luana Talita Diniz Ferreira
- Hospital Samaritano Paulista, Sao Paulo, 01333-030, Brazil; School of Public Health, University of Sao Paulo, Sao Paulo, 01246-904, Brazil
| | - Danilo Gomes Quadros
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | | | - Davi Jorge Fontoura Solla
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | - Gustavo Nader Marta
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, 01246-000, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, 01308-050, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil; Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, 01246-903, Brazil
| | - Wellingson Silva Paiva
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil; Hospital Samaritano Paulista, Sao Paulo, 01333-030, Brazil
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Response-shift effects in neuromyelitis optica spectrum disorder: a secondary analysis of clinical trial data. Qual Life Res 2020; 30:1267-1282. [PMID: 33269417 PMCID: PMC8068626 DOI: 10.1007/s11136-020-02707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/24/2022]
Abstract
Background Researchers have long posited that response-shift effects may obfuscate treatment effects. The present work investigated possible response-shift effects in a recent clinical trial testing a new treatment for Neuromyelitis Optica Spectrum Disorder (NMOSD). This pivotal trial provided impressive support for the drug Eculizumab in preventing relapse, but less strong or null results as the indicators became more subjective or evaluative. This pattern of results suggests that response-shift effects are present. Methods This secondary analysis utilized data from a randomized, double-blind trial evaluating the impact of Eculizumab in preventing relapses in 143 people with NMOSD. Treatment arm and then relapse status were hypothesized ‘catalysts’ of response shift in two series of analyses. We devised a “de-constructed” version of Oort structural-equation modeling using random-effects modeling for use in small samples. This method begins by testing an omnibus response-shift hypothesis and then, pending a positive result, implements a series of random-effects models to elucidate specific response-shift effects. Results In the omnibus test, the ‘standard quality-of-life (QOL) model’ captured substantially less well the experience of placebo as compared to Eculizumab group. Recalibration and reconceptualization response-shift effects were detected. Detected relapse-related response shifts included recalibration, reprioritization, and reconceptualization. Conclusions Trial patients experienced response shifts related to treatment- and relapse-related experiences. Published trial results likely under-estimated Eculizumab vs. Placebo differences due to recalibration and reconceptualization, and relapse effects due to recalibration, reprioritization, and reconceptualization. This novel random-effects- model application builds on response-shift theory and provides a small-sample method for better estimating treatment effects in clinical trials. Electronic supplementary material The online version of this article (10.1007/s11136-020-02707-y) contains supplementary material, which is available to authorized users.
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Gelfand JM, Greenfield AL, Barkovich M, Mendelsohn BA, Van Haren K, Hess CP, Mannis GN. Allogeneic HSCT for adult-onset leukoencephalopathy with spheroids and pigmented glia. Brain 2020; 143:503-511. [PMID: 31840744 DOI: 10.1093/brain/awz390] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
Adult-onset leukoencephalopathy with spheroids and pigmented glia (ALSP) is an autosomal dominant leukoencephalopathy caused by mutations in colony stimulating factor 1 receptor (CSF1R). Here we report clinical and imaging outcomes following allogeneic haematopoietic stem cell transplantation (HSCT) in two patients with ALSP at the University of California, San Francisco between January 2016 and December 2017. Patient 1 proceeded to transplantation at age 53 with a haplo-identical sibling donor. Patient 2, whose sister and mother had died of the disease, proceeded to transplantation at age 49 with a 12/12 human leukocyte antigen-matched unrelated donor. Both patients received reduced intensity conditioning regimens. At 28 and 26 months post-HSCT, respectively, both patients were alive, without evidence of graft-versus-host disease, with major infection at 1 year in one and new-onset seizures in the other. In both cases, neurological worsening continued post-HSCT; however, the progression in cognitive deficits, overall functional status and gait impairment gradually stabilized. There was continued progression of parkinsonism in both patients. On brain MRI, within 1 year there was stabilization of T2/FLAIR abnormalities, and after 2 years there was complete resolution of abnormal multifocal reduced diffusion. In summary, after >2 years of follow-up, allogeneic HSCT in ALSP led to interval resolution of diffusion MRI abnormalities, stabilization of T2/FLAIR MRI abnormalities, and partial clinical stabilization, supportive of treatment response. Allogeneic HSCT may be beneficial in ALSP by providing a supply of bone marrow-derived brain-engrafting myeloid cells with donor wild-type CSF1R to repopulate the microglial niche.
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Affiliation(s)
- Jeffrey M Gelfand
- Department of Neurology, Division of Neuroimmunology and Glial Biology, University of California, San Francisco, CA, USA
| | - Ariele L Greenfield
- Department of Neurology, Division of Neuroimmunology and Glial Biology, University of California, San Francisco, CA, USA
| | - Matthew Barkovich
- Department of Radiology, Division of Neuroradiology, University of California, San Francisco, CA, USA
| | - Bryce A Mendelsohn
- Division of Genetics, Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Keith Van Haren
- Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Christopher P Hess
- Department of Neurology, Division of Neuroimmunology and Glial Biology, University of California, San Francisco, CA, USA.,Department of Radiology, Division of Neuroradiology, University of California, San Francisco, CA, USA
| | - Gabriel N Mannis
- Hematology and Blood and Marrow Transplantation, University of California, San Francisco, CA, USA
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Gor-García-Fogeda MD, Cano-de-la-Cuerda R, Daly JJ, Molina-Rueda F. Construct Validity of the Gait Assessment and Intervention Tool (GAIT) in People With Multiple Sclerosis. PM R 2020; 13:307-313. [PMID: 32449255 DOI: 10.1002/pmrj.12423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In clinical practice, observational scales are the most common approach used to assess gait pattern in people with neurological disorders. The Gait Assessment and Intervention Tool (GAIT) is an observational gait scale, and it has proved to be the most comprehensive, homogeneous, and objective of all the observational gait scales studied in people with neurological conditions. OBJECTIVE To study the construct validity of the GAIT in people with multiple sclerosis (MS). DESIGN An observational study was conducted. SETTING Multiple Sclerosis Foundation in Madrid (Spain). PATIENTS Thirty-five patients with MS were assessed. MAIN OUTCOME MEASURE(S) GAIT construct validity was assessed using the following scales: Rivermead Visual Gait Assessment (RVGA), Tinetti Gait Scale (TGS), 10-Meter Walking Test (10MWT), Timed Up&Go (TUG), Hauser Ambulatory Index (HAI), Multiple Sclerosis Walking Scale-12 (MSWS-12), Functional Gait Assessment (FGA), Modified Ashworth Scale (MAS), and Rivermead Mobility Index (RMI). RESULTS A total of 35 subjects with MS were assessed. The correlations between the GAIT and the RVGA were excellent (r > .90) and moderate with TGS (values between -.62 and -.59). Correlations with HAI, FGA, MSWS-12, and RMI were moderate (with values between .57 and .67). Correlations were lower for the velocity scales TUG and MAS. CONCLUSIONS The construct validity of the GAIT is high, as a measure of gait coordination in people with MS. Specifically, there was excellent correlation with the RVGA. There was a moderate correlation for the GAIT with measures of functional mobility, but a lesser correlation of the GAIT with measures restricted to temporal gait characteristics (speed measures) or measurements of impairments underlying gait patterns such as balance or muscle tone.
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Affiliation(s)
| | - Roberto Cano-de-la-Cuerda
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Janis J Daly
- National Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, Gainesville Veterans Affairs Medical Center, Gainesville, FL, USA
| | - Francisco Molina-Rueda
- National Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, Gainesville Veterans Affairs Medical Center, Gainesville, FL, USA.,Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
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Snow NJ, Wadden KP, Chaves AR, Ploughman M. Transcranial Magnetic Stimulation as a Potential Biomarker in Multiple Sclerosis: A Systematic Review with Recommendations for Future Research. Neural Plast 2019; 2019:6430596. [PMID: 31636661 PMCID: PMC6766108 DOI: 10.1155/2019/6430596] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/31/2019] [Indexed: 12/23/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system. Disease progression is variable and unpredictable, warranting the development of biomarkers of disease status. Transcranial magnetic stimulation (TMS) is a noninvasive method used to study the human motor system, which has shown potential in MS research. However, few reviews have summarized the use of TMS combined with clinical measures of MS and no work has comprehensively assessed study quality. This review explored the viability of TMS as a biomarker in studies of MS examining disease severity, cognitive impairment, motor impairment, or fatigue. Methodological quality and risk of bias were evaluated in studies meeting selection criteria. After screening 1603 records, 30 were included for review. All studies showed high risk of bias, attributed largely to issues surrounding sample size justification, experimenter blinding, and failure to account for key potential confounding variables. Central motor conduction time and motor-evoked potentials were the most commonly used TMS techniques and showed relationships with disease severity, motor impairment, and fatigue. Short-latency afferent inhibition was the only outcome related to cognitive impairment. Although there is insufficient evidence for TMS in clinical assessments of MS, this review serves as a template to inform future research.
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Affiliation(s)
- Nicholas J. Snow
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Katie P. Wadden
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Arthur R. Chaves
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Pittock SJ, Berthele A, Fujihara K, Kim HJ, Levy M, Palace J, Nakashima I, Terzi M, Totolyan N, Viswanathan S, Wang KC, Pace A, Fujita KP, Armstrong R, Wingerchuk DM. Eculizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder. N Engl J Med 2019; 381:614-625. [PMID: 31050279 DOI: 10.1056/nejmoa1900866] [Citation(s) in RCA: 469] [Impact Index Per Article: 93.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing, autoimmune, inflammatory disorder that typically affects the optic nerves and spinal cord. At least two thirds of cases are associated with aquaporin-4 antibodies (AQP4-IgG) and complement-mediated damage to the central nervous system. In a previous small, open-label study involving patients with AQP4-IgG-positive disease, eculizumab, a terminal complement inhibitor, was shown to reduce the frequency of relapse. METHODS In this randomized, double-blind, time-to-event trial, 143 adults were randomly assigned in a 2:1 ratio to receive either intravenous eculizumab (at a dose of 900 mg weekly for the first four doses starting on day 1, followed by 1200 mg every 2 weeks starting at week 4) or matched placebo. The continued use of stable-dose immunosuppressive therapy was permitted. The primary end point was the first adjudicated relapse. Secondary outcomes included the adjudicated annualized relapse rate, quality-of-life measures, and the score on the Expanded Disability Status Scale (EDSS), which ranges from 0 (no disability) to 10 (death). RESULTS The trial was stopped after 23 of the 24 prespecified adjudicated relapses, given the uncertainty in estimating when the final event would occur. The mean (±SD) annualized relapse rate in the 24 months before enrollment was 1.99±0.94; 76% of the patients continued to receive their previous immunosuppressive therapy during the trial. Adjudicated relapses occurred in 3 of 96 patients (3%) in the eculizumab group and 20 of 47 (43%) in the placebo group (hazard ratio, 0.06; 95% confidence interval [CI], 0.02 to 0.20; P<0.001). The adjudicated annualized relapse rate was 0.02 in the eculizumab group and 0.35 in the placebo group (rate ratio, 0.04; 95% CI, 0.01 to 0.15; P<0.001). The mean change in the EDSS score was -0.18 in the eculizumab group and 0.12 in the placebo group (least-squares mean difference, -0.29; 95% CI, -0.59 to 0.01). Upper respiratory tract infections and headaches were more common in the eculizumab group. There was one death from pulmonary empyema in the eculizumab group. CONCLUSIONS Among patients with AQP4-IgG-positive NMOSD, those who received eculizumab had a significantly lower risk of relapse than those who received placebo. There was no significant between-group difference in measures of disability progression. (Funded by Alexion Pharmaceuticals; PREVENT ClinicalTrials.gov number, NCT01892345; EudraCT number, 2013-001150-10.).
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Affiliation(s)
- Sean J Pittock
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Achim Berthele
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Kazuo Fujihara
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Ho Jin Kim
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Michael Levy
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Jacqueline Palace
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Ichiro Nakashima
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Murat Terzi
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Natalia Totolyan
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Shanthi Viswanathan
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Kai-Chen Wang
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Amy Pace
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Kenji P Fujita
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Róisín Armstrong
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
| | - Dean M Wingerchuk
- From the Mayo Clinic, Rochester, MN (S.J.P.); Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (A.B.); Tohoku University Graduate School of Medicine (K.F., I.N.) and Tohoku Medical and Pharmaceutical University (I.N.), Sendai, School of Medicine, Fukushima Medical University, Fukushima City (K.F.), and Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; Research Institute and Hospital, National Cancer Center, Goyang, South Korea (H.J.K.); Johns Hopkins University, Baltimore (M.L.); Massachusetts General Hospital and Harvard Medical School (M.L.) and Alexion Pharmaceuticals (A.P., K.P.F., R.A.) - all in Boston; John Radcliffe Hospital, Oxford, United Kingdom (J.P.); Ondokuz Mayis University, Samsun, Turkey (M.T.); First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia (N.T.); Kuala Lumpur Hospital, Kuala Lumpur, Malaysia (S.V.); Cheng-Hsin General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan (K.-C.W.); and the Mayo Clinic, Scottsdale, AZ (D.M.W.)
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Cree BAC. Multiple Sclerosis Therapy: Are We Ready for a One-Size-Fits-All Approach? J Neuroophthalmol 2019; 38:258-262. [PMID: 29750736 DOI: 10.1097/wno.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Bruce A C Cree
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
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D'Amico E, Zanghì A, Gastaldi M, Patti F, Zappia M, Franciotta D. Placing CD20-targeted B cell depletion in multiple sclerosis therapeutic scenario: Present and future perspectives. Autoimmun Rev 2019; 18:665-672. [PMID: 31059839 DOI: 10.1016/j.autrev.2019.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis (MS) is an acquired demyelinating disease of the central nervous system (CNS) that traditionally has been considered to be mediated primarily by T cells. Increasing evidence, however, suggests the fundamental role of B cells in the pathogenesis and development of the disease. Recently, anti-CD20 B cell-based therapies have demonstrated impressive and somewhat surprising results in MS, showing profound anti-inflammatory effects with a favorable risk-benefit ratio. Moreover, for the first time in the MS therapeutic scenario, the anti-CD20 monoclonal antibody ocrelizumab has been granted for the treatment of the primary progressive form of the disease. In this review, we provide a brief overview about anti-CD20 B cell-based therapies in MS, in the perspective of their influence on the future management of the disease, and of their possible positioning in a new wider therapeutic scenario.
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Affiliation(s)
| | - Aurora Zanghì
- Department G.F.Ingrassia, University of Catania, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Mario Zappia
- Department G.F.Ingrassia, University of Catania, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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Mao Z, Álvarez-González C, Allen-Philbey K, De Trane S, Yildiz O, Campion T, Adams A, Turner BP, Marta M, Gnanapavan S, Espasandin M, Mathews J, Giovannoni G, Baker D, Schmierer K. Treating the ineligible: Disease modification in people with multiple sclerosis beyond NHS England commissioning policies. Mult Scler Relat Disord 2019; 27:247-253. [DOI: 10.1016/j.msard.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/28/2018] [Accepted: 11/01/2018] [Indexed: 12/14/2022]
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Tetrahydrocannabinol/Cannabidiol Oromucosal Spray in Patients With Multiple Sclerosis: A Pilot Study on the Plasma Concentration-Effect Relationship. Clin Neuropharmacol 2018; 41:171-176. [PMID: 30024443 DOI: 10.1097/wnf.0000000000000294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We aimed to assess the potential relationship between intrasubject 9-tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray plasma profiles and clinical effects elicited by subacute dosing in chronically treated patients with multiple sclerosis (MS). METHODS The study design was pilot, single center, open, and prospective. The patients were challenged with a morning test dose of 2 THC/CBD sprays at a 15-minute interval. Venous blood samples were collected before the first spray administration and every 30 minutes after the second spray, until 240 minutes postdosing. Patients rated their spasticity by the Numerical Rating Scale (NRS) simultaneously with blood drawings. Postural and motor tests were performed before the first spray and 90 and 180 minutes thereafter. RESULTS Twelve patients were recruited. Peak plasma concentrations of THC/CBD largely varied among patients, from 0.60 to 13.29 ng/mL for THC and 0.55 to 11.93 ng/mL for CBD. Time to peak plasma concentrations ranged from 150 to 240 minutes for THC and 90 to 240 minutes for CBD. Patients' NRS serial scores decreased after dosing, from a median value of 6 to 3.5 (P < 0.001). A significant inverse correlation was observed between median intrasubject repeated NRS scores and corresponding median values of both THC (P < 0.01) and CBD (P < 0.002) plasma concentrations. No significant effect of cannabinoids dosing could be appreciated according to posturographic and motor tests. CONCLUSIONS Our kinetic dynamic findings from THC/CBD oromucosal spray are the first obtained in real MS patients. Although preliminary, they suggest that subacute dosing might elicit a subjective clinically significant effect on MS-related spasticity, paralleling cannabinoids measurable plasma concentrations.
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Saleh S, Sandroff BM, Owoeye O, Vitiello T, Hoxha A, Yue G, DeLuca J. Supra-Spinal Modulation Of Walking In Healthy Individuals And Persons With Multiple Sclerosis: A fNIRS Mobile Imaging Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3156-3159. [PMID: 30441064 DOI: 10.1109/embc.2018.8513052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Multiple sclerosis (MS) is one of the neurodegenerative diseases that damage the nervous system and inflicts cognitive and motor deficits. In motor domain, MS mainly causes slower gait resulting in challenges in activities of daily living. Premotor cortices are affected by MS, where several imaging studies have reported re-organization in the activity and connectivity of these regions. Recent advancements in mobile imaging technologies and signal processing techniques have made it possible to study supraspinal modulation of walking in able-bodied individuals and persons with injuries or neurological disorders. Functional near-infrared spectroscopy (fNIRS), for example, was used in studying dual-tasking in MS population. In the current study, we used fNIRS to record activities of premotor and supplementary motor areas in MS and healthy populations during standing and walking. Fourteen healthy controls and 14 persons with MS were tested during overground walking. Results show higher right premotor cortex activities compared with left premotor and bilateral supplementary motor areas in the MS group. In the healthy control group, activity was higher during walking in all the four studied brain regions. These results confirm the role of the premotor cortices in movement planning and in modulating walking activities; they also confirm that individuals with mild MS have a similar premotor control strategy as healthy controls while performing the same physical task.
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Jakimovski D, Weinstock-Guttman B, Hagemeier J, Vaughn CB, Kavak KS, Gandhi S, Bennett SE, Fuchs TA, Bergsland N, Dwyer MG, Benedict RH, Zivadinov R. Walking disability measures in multiple sclerosis patients: Correlations with MRI-derived global and microstructural damage. J Neurol Sci 2018; 393:128-134. [DOI: 10.1016/j.jns.2018.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
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Kosa P, Barbour C, Wichman A, Sandford M, Greenwood M, Bielekova B. NeurEx: digitalized neurological examination offers a novel high-resolution disability scale. Ann Clin Transl Neurol 2018; 5:1241-1249. [PMID: 30349859 PMCID: PMC6186944 DOI: 10.1002/acn3.640] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/17/2018] [Accepted: 08/10/2018] [Indexed: 11/09/2022] Open
Abstract
Objective To develop a sensitive neurological disability scale for broad utilization in clinical practice. Methods We employed advances of mobile computing to develop an iPad‐based App for convenient documentation of the neurological examination into a secure, cloud‐linked database. We included features present in four traditional neuroimmunological disability scales and codified their automatic computation. By combining spatial distribution of the neurological deficit with quantitative or semiquantitative rating of its severity we developed a new summary score (called NeurEx; ranging from 0 to 1349 with minimal measurable change of 0.25) and compared its performance with clinician‐ and App‐computed traditional clinical scales. Results In the cross‐sectional comparison of 906 neurological examinations, the variance between App‐computed and clinician‐scored disability scales was comparable to the variance between rating of the identical neurological examination by multiple sclerosis (MS)‐trained clinicians. By eliminating rating ambiguity, App‐computed scales achieved greater accuracy in measuring disability progression over time (n = 191 patients studied over 880.6 patient‐years). The NeurEx score had no apparent ceiling effect and more than 200‐fold higher sensitivity for detecting a measurable yearly disability progression (i.e., median progression slope of 8.13 relative to minimum detectable change of 0.25) than Expanded Disability Status Scale (EDSS) with a median yearly progression slope of 0.071 that is lower than the minimal measurable change on EDSS of 0.5. Interpretation NeurEx can be used as a highly sensitive outcome measure in neuroimmunology. The App can be easily modified for use in other areas of neurology and it can bridge private practice practitioners to academic centers in multicenter research studies.
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Affiliation(s)
- Peter Kosa
- Neuroimmunological Diseases Section (NDS) National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health Bethesda Maryland
| | - Christopher Barbour
- Neuroimmunological Diseases Section (NDS) National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health Bethesda Maryland.,Department of Mathematical Sciences Montana State University Bozeman Montana
| | - Alison Wichman
- Neuroimmunological Diseases Section (NDS) National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health Bethesda Maryland
| | - Mary Sandford
- Neuroimmunological Diseases Section (NDS) National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health Bethesda Maryland
| | - Mark Greenwood
- Department of Mathematical Sciences Montana State University Bozeman Montana
| | - Bibiana Bielekova
- Neuroimmunological Diseases Section (NDS) National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health Bethesda Maryland
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Witchel HJ, Oberndorfer C, Needham R, Healy A, Westling CEI, Guppy JH, Bush J, Barth J, Herberz C, Roggen D, Eskofier BM, Rashid W, Chockalingam N, Klucken J. Thigh-Derived Inertial Sensor Metrics to Assess the Sit-to-Stand and Stand-to-Sit Transitions in the Timed Up and Go (TUG) Task for Quantifying Mobility Impairment in Multiple Sclerosis. Front Neurol 2018; 9:684. [PMID: 30271371 PMCID: PMC6149240 DOI: 10.3389/fneur.2018.00684] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/30/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction: Inertial sensors generate objective and sensitive metrics of movement disability that may indicate fall risk in many clinical conditions including multiple sclerosis (MS). The Timed-Up-And-Go (TUG) task is used to assess patient mobility because it incorporates clinically-relevant submovements during standing. Most sensor-based TUG research has focused on the placement of sensors at the spine, hip or ankles; an examination of thigh activity in TUG in multiple sclerosis is wanting. Methods: We used validated sensors (x-IMU by x-io) to derive transparent metrics for the sit-to-stand (SI-ST) transition and the stand-to-sit (ST-SI) transition of TUG, and compared effect sizes for metrics from inertial sensors on the thighs to effect sizes for metrics from a sensor placed at the L3 level of the lumbar spine. Twenty-three healthy volunteers were compared to 17 ambulatory persons with MS (PwMS, HAI ≤ 2). Results: During the SI-ST transition, the metric with the largest effect size comparing healthy volunteers to PwMS was the Area Under the Curve of the thigh angular velocity in the pitch direction-representing both thigh and knee extension; the peak of the spine pitch angular velocity during SI-ST also had a large effect size, as did some temporal measures of duration of SI-ST, although less so. During the ST-SI transition the metric with the largest effect size in PwMS was the peak of the spine angular velocity curve in the roll direction. A regression was performed. Discussion: We propose for PwMS that the diminished peak angular velocity during SI-ST directly represents extensor weakness, while the increased roll during ST-SI represents diminished postural control. Conclusions: During the SI-ST transition of TUG, angular velocities can discriminate between healthy volunteers and ambulatory PwMS better than temporal features. Sensor placement on the thighs provides additional discrimination compared to sensor placement at the lumbar spine.
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Affiliation(s)
- Harry J. Witchel
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | | | - Robert Needham
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
| | | | - Joseph H. Guppy
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Jake Bush
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Jens Barth
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Daniel Roggen
- Department of Engineering and Design, University of Sussex, Brighton, United Kingdom
| | - Björn M. Eskofier
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Waqar Rashid
- Hurstwood Park Neuroscience Centre, Haywards Heath, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Jochen Klucken
- Molekulare Neurologie, Universitätsklinikum Erlangen, Erlangen, Germany
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Spinal cord hypometabolism associated with infection by human T-cell lymphotropic virus type 1(HTLV-1). PLoS Negl Trop Dis 2018; 12:e0006720. [PMID: 30148843 PMCID: PMC6128630 DOI: 10.1371/journal.pntd.0006720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 09/07/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background HTLV-1 infection is endemic in Brazil. About 1 to 2% of the Brazilian population is estimated to be infected, but most infected HTLV-1 individuals do not know about their own infection, which favors the continuity of sexual and vertical virus transmission. In addition, HTLV-1 associated central nervous system diseases and their pathophysiologic mechanisms are not fully understood. This study aimed to evaluate the correlation of spinal cord metabolism, viral and inflammatory profiles with features of neurological presentation in HTLV-1 infected individuals. Methodology This is a cross-sectional study of a cohort including 48 HTLV-1 infected individuals clinically classified as asymptomatic-AG (N = 21), symptomatic-SG (N = 11) and HAM/TSP-HG (N = 16) and a nested case-control study with HTLV-1 infected individuals-HIG (N = 48) and HTLV-1 non infected controls-CG (N = 30) that had their spinal cord analysed by Positron Emission Tomography with 18F-Fluordeoxyglucose (18F-FDG PET/CT). HTLV-1 infected individuals had 18F-FDG PET/CT results analyzed with clinical and demographic data, proviral load, cytokines and chemokines in the blood and cerebrospinal fluid (CSF). Principal Findings 18F-FDG PET/CT showed hypometabolism in the thoracic spinal cord in HTLV-1 infected individuals. The method had an accuracy of 94.4% to identify HAM/TSP. A greater involvement of the thoracic spinal cord was observed, although hypometabolism was also observed in the cervical spinal cord segment in HTLV-1 infected individuals. Individuals with HAM/TSP showed a pro-inflammatory profile in comparison to asymptomatic and symptomatic groups, with a higher level of Interferon-inducible T-cell alpha chemoattractant (ITAC/CXCL11), IL-6, IL-12p70 in the plasma; and ITAC, IL-4, IL-5, IL-8 (CXCL8) and TNF-alpha in the CSF. Using regression, thoracic spinal cord SUV (standardized uptake value) and CSF ITAC level were identified as the HAM/TSP predictors in the multivariate model. Conclusions 18F-FDG PET/CT imaging showed spinal cord hypometabolism in most HTLV-1 infected individuals, even in the asymptomatic HTLV-1 group. Thoracic spinal cord hypometabolism and CSF-ITAC levels were identified predictors of HAM/TSP. Significance Our findings suggested that in most HTLV-1 infected individuals there was compromise of central nervous system (CNS) structures despite of the lack of clinical symptoms. To explain the found hypometabolism, the role of microcirculatory and metabolic factors in the pathogenesis of neurological diseases associated with HTLV-1 infection must be further investigated. It is paramount to evaluate the central nervous function and to compare the performance among HTLV-1 infected individuals considered asymptomatic to the uninfected controls. For the past 30 years, human T-cell lymphotropic virus type-1 (HTLV-1) has been isolated and associated with neoplastic, inflammatory, and infectious diseases. It is known that the neurological disorder associated with HTLV-1 comprises HTLV-1-associated myelopathy (HAM/TSP) or any other isolated signals and symptoms. Despite all the knowledge accumulated so far, the association of neurological diseases to HTLV-1 infection remains difficult and neglected. We designed this study in order to assess the degree of neurological impairment associated with HTLV-1 infection through a metabolic evaluation with 18F-FDG PET/CT. Our results evidenced a more pronounced hypometabolism in the spinal cord of individuals with neurological impairment, but also evidenced hypometabolism in asymptomatic HTLV-1 infected individuals. We believe that areas of the CNS with lower circulatory and perfusional balance are more vulnerable to HTLV-1 infection. Mechanisms of cellular entry of the virus may be associated with loss of microcirculatory homeostasis and predisposition to a breakdown of the blood-brain barrier in these areas. Further studies are still necessary to shed light on the mechanisms associated with brain and spinal hypometabolism.
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