1
|
Sintila SA, Boziki M, Bakirtzis C, Stardeli T, Smyrni N, Nikolaidis I, Parissis D, Afrantou T, Karapanayiotides T, Koutroulou I, Giantzi V, Theotokis P, Kesidou E, Xiromerisiou G, Dardiotis E, Ioannidis P, Grigoriadis N. The Experience of a Tertiary Reference Hospital in the Study of Rare Neurological Diseases. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020266. [PMID: 36837468 PMCID: PMC9959728 DOI: 10.3390/medicina59020266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Rare diseases (RDs) are life-threatening or chronically impairing conditions that affect about 6% of the world's population. RDs are often called 'orphan' diseases, since people suffering from them attract little support from national health systems. Aim: The aim of this study is to describe the clinical characteristics of, and the available laboratory examinations for, patients who were hospitalized in a tertiary referral center and finally received a diagnosis associated with a Rare Neurological Disease (RND). Materials and Methods: Patients that were hospitalized in our clinic from 1 January 2014 to 31 March 2022 and were finally diagnosed with an RND were consecutively included. The RND classification was performed according to the ORPHAcode system. Results: A total of 342 out of 11.850 (2.9%) adult patients admitted to our department during this period received a diagnosis associated with an RND. The most common diagnosis (N = 80, 23%) involved an RND presenting with dementia, followed by a motor neuron disease spectrum disorder (N = 64, 18.7%). Family history indicative of an RND was present in only 21 patients (6.1%). Fifty-five (16%) people had previously been misdiagnosed with another neurological condition. The mean time delay between disease onset and diagnosis was 4.24 ± 0.41 years. Conclusions: Our data indicate that a broad spectrum of RNDs may reach a tertiary Neurological Center after a significant delay. Moreover, our data underline the need for a network of reference centers, both at a national and international level, expected to support research on the diagnosis and treatment of RND.
Collapse
Affiliation(s)
- Styliani-Aggeliki Sintila
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Marina Boziki
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Christos Bakirtzis
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Thomai Stardeli
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Nikoletta Smyrni
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Ioannis Nikolaidis
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Dimitrios Parissis
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Theodora Afrantou
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Theodore Karapanayiotides
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Ioanna Koutroulou
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Virginia Giantzi
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Paschalis Theotokis
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Evangelia Kesidou
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Panagiotis Ioannidis
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence: (P.I.); (N.G.)
| | - Nikolaos Grigoriadis
- 2nd Department of Neurology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence: (P.I.); (N.G.)
| |
Collapse
|
2
|
Boziki M, Bakirtzis C, Giantzi V, Sintila SA, Kallivoulos S, Afrantou T, Nikolaidis I, Ioannidis P, Karapanayiotides T, Koutroulou I, Parissis D, Grigoriadis N. Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center. Front Neurol 2021; 12:699844. [PMID: 34497577 PMCID: PMC8419322 DOI: 10.3389/fneur.2021.699844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Natalizumab (NTZ) and fingolimod (FTY) are second-line disease modifying treatments (DMTs) approved for Relapsing – Remitting Multiple Sclerosis (RRMS). Few studies are available on a direct comparison between NTZ and FTY, based on post-marketing experience, with conflicting results and reporting relatively short follow-up period. Aim: We hereby report real-world experience of a MS Center with respect to NTZ vs. FTY comparison in terms of efficacy and safety, referencing long-term follow-up. Methods: We used retrospective data for all patients that received 2nd-line treatment NTZ (since May 2007) or FTY (since September 2011). Primary endpoints were, among others, annual EDSS score (mean change from baseline), time to disability worsening or improvement, Annualized Relapse Rate (ARR) after 12 and 24 months and upon total treatment duration, time to first relapse and time to radiological progression. Results: A total of 138 unmatched patients, 84 treated with NTZ and 54 treated with FTY were included. Following Propensity Score (PS) matching, 31 patients in each group were retained. Mean follow-up period for NTZ- and FTY-treated patients was 4.43 ± 0.29 and 3.59 ± 0.32 years (p = 0.057), respectively. In the matched analysis, time to disability improvement and time to disability worsening was comparable between groups. A higher proportion of patients remained free of relapse under NTZ, compared to FTY (Log Rank test p = 0.021, HR: 0.25, 95% CI: 0.08–0.8), as well as free of MRI activity (Log Rank test p = 0.006, HR: 0.26, 95% CI: 0.08–0.6). Treatment discontinuation due to MRI activity was significantly higher for FTY-treated patients compared to NTZ (Log Rank test p = 0.019, HR: 0.12, 95% CI: 0.05–0.76). Conclusion: Our results indicate toward NTZ superiority with respect to relapse and MRI activity outcomes. The fact that NTZ-treated patients may achieve long-standing clinical and radiological remission points toward the need for long follow-up data.
Collapse
Affiliation(s)
- Marina Boziki
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Christos Bakirtzis
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Virginia Giantzi
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Styliani-Aggeliki Sintila
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Stylianos Kallivoulos
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Theodora Afrantou
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Ioannis Nikolaidis
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Panagiotis Ioannidis
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Theodoros Karapanayiotides
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Ioanna Koutroulou
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Dimitrios Parissis
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- 2nd Neurological University Department, American Hellenic Educational Progressive Association (AHEPA) General Hospital, Aristotle University of Thessaloniki (A.U.TH.), Thessaloniki, Greece
| |
Collapse
|
3
|
Boziki M, Metallidis S, Habidou E, Afrantou T, Bakirtzis C, Cheva A, Finitsis S, Grigoriadis N. Progressive multifocal leukoencephalopathy in an elderly immunocompetent-appearing patient: Relevance with L-selectin (CD62L) expression and immunosenescence. Clin Neurol Neurosurg 2021; 205:106625. [PMID: 33892220 DOI: 10.1016/j.clineuro.2021.106625] [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: 02/06/2021] [Revised: 02/24/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is attributed to reactivation of the John Cunningham virus (JCV), in the central nervous system as a result of immunosuppression. Low L-selectin (CD62L) expression on cryopreserved T-cells has been advocated as a biomarker for natalizumab related PML in patients with Relapsing-Remitting Multiple Sclerosis. A rare case of PML in an elderly patient without known factors of immunosuppression or immunomodulation is hereby presented. T-cell L-selectin expression levels and serum anti-JCV antibody index were evaluated in order to explore mechanistic insight to the pathways that presumably contribute towards PML development in this rare clinical setting.
Collapse
Affiliation(s)
- Marina Boziki
- 2nd University Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Simeon Metallidis
- 1st University Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Eleni Habidou
- 1st University Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Theodora Afrantou
- 2nd University Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Christos Bakirtzis
- 2nd University Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Angeliki Cheva
- Laboratory of General Pathology & Pathological Anatomy, Aristotle University of Thessaloniki, Greece
| | - Stefanos Finitsis
- Radiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- 2nd University Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
| |
Collapse
|