1
|
Yokote H, Miyazaki Y, Fujimori J, Nishida Y, Toru S, Niino M, Nakashima I, Miura Y, Yokota T. Characterization of Japanese multiple sclerosis patients with progression independent of relapse activity: A 2-year multicenter cohort study. J Neuroimmunol 2024; 394:578407. [PMID: 39068747 DOI: 10.1016/j.jneuroim.2024.578407] [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: 05/28/2024] [Revised: 07/03/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
Progression independent of relapse activity (PIRA) is prevalent among Caucasian patients with relapsing and remitting multiple sclerosis (RRMS). However, there is limited knowledge regarding the characteristics of PIRA in Asian patients with RRMS. Therefore, we retrospectively analyzed the clinical and radiological progression of 95 Japanese patients with RRMS during a 2-year observation period. PIRA was observed in three patients who were characterized by young age, large T2 lesion volume, and great reduction in brain volume. Despite having highly active disease, fewer patients with PIRA (33.3%) were treated with high-efficacy drugs compared with those without disease activity (60.7%).
Collapse
Affiliation(s)
- Hiroaki Yokote
- Department of Neurology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan; Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yusei Miyazaki
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Juichi Fujimori
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yoichiro Nishida
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuta Toru
- Department of Neurology, Nitobe Memorial Nakano General Hospital, Tokyo, Japan
| | - Masaaki Niino
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Ichiro Nakashima
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yoshiharu Miura
- Department of Neurology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
2
|
Chico-Garcia JL, Sainz Amo R, Monreal E, Sainz de la Maza S, Rodriguez Jorge F, Masjuan J, Costa-Frossard L, Villar LM. Progression independent of relapse activity can be predicted by passively acquired tapping speed through a smartphone for 1 month: A prospective study. Mult Scler 2024:13524585241272960. [PMID: 39246042 DOI: 10.1177/13524585241272960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
BACKGROUND Tapping speed (TS) correlates with baseline disability scales in people with multiple sclerosis (pwMS). OBJECTIVE The study aimed to address if progression independent of relapse activity (PIRA) could be predicted by first-month measurement of TS. METHODS Prospective study including pwMS in one referral MS center. Consecutive patients were included and keys/second (Keys/s) were passively measured each day using an in-house smartphone application for 1 month. Median, mean, and maximum keys/s were obtained. Multivariate logistic regression models (including keys/s, age, sex, and baseline disability scores) were obtained for prediction of a PIRA event after 1 year. RESULTS Overall, 59 patients were included in the final analysis (64.4% women, median age of 44.5 years). However, 10 patients presented a PIRA event, without differences regarding baseline characteristics between PIRA and no-PIRA groups. PIRA group presented lower median keys/s (2 vs 4 keys/s, p = 0.002) and mean keys/s (2.8 vs 4.6, p = 0.008), while maximum keys/s were similar (p = 0.32). A median ⩽ 3 keys/s was independently associated with PIRA (aOR = 16.8, p = 0.03), as did a mean ⩽ 3.7 keys/s (aOR = 17, p = 0.02). These differences were not detected regarding other variables analyzed. CONCLUSION Low median or mean keys/s obtained during initial month of assessment were indicative of a PIRA event within the next year.
Collapse
Affiliation(s)
- Juan Luis Chico-Garcia
- Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- Alcala University, Alcalá de Henares, Madrid, Spain; Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Raquel Sainz Amo
- Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcala University, Alcalá de Henares, Madrid, Spain
| | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcala University, Alcalá de Henares, Madrid, Spain
| | - Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcala University, Alcalá de Henares, Madrid, Spain
| | - Fernando Rodriguez Jorge
- Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcala University, Alcalá de Henares, Madrid, Spain
| | - Jaime Masjuan
- Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcala University, Alcalá de Henares, Madrid, Spain
| | - Lucienne Costa-Frossard
- Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcala University, Alcalá de Henares, Madrid, Spain
| | - Luisa María Villar
- Department of Immunology, Alcala University, Alcalá de Henares, Madrid, Spain
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| |
Collapse
|
3
|
Singh V, Zheng Y, Ontaneda D, Mahajan KR, Holloman J, Fox RJ, Nakamura K, Trapp BD. Disability independent of cerebral white matter demyelination in progressive multiple sclerosis. Acta Neuropathol 2024; 148:34. [PMID: 39217272 PMCID: PMC11365858 DOI: 10.1007/s00401-024-02796-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
The pathogenic mechanisms contributing to neurological disability in progressive multiple sclerosis (PMS) are poorly understood. Cortical neuronal loss independent of cerebral white matter (WM) demyelination in myelocortical MS (MCMS) and identification of MS patients with widespread cortical atrophy and disability progression independent of relapse activity (PIRA) support pathogenic mechanisms other than cerebral WM demyelination. The three-dimensional distribution and underlying pathology of myelinated T2 lesions were investigated in postmortem MCMS brains. Postmortem brain slices from previously characterized MCMS (10 cases) and typical MS (TMS) cases (12 cases) were co-registered with in situ postmortem T2 hyperintensities and T1 hypointensities. T1 intensity thresholds were used to establish a classifier that differentiates MCMS from TMS. The classifier was validated in 36 uncharacterized postmortem brains and applied to baseline MRIs from 255 living PMS participants enrolled in SPRINT-MS. Myelinated T2 hyperintensities in postmortem MCMS brains have a contiguous periventricular distribution that expands at the occipital poles of the lateral ventricles where a surface-in gradient of myelinated axonal degeneration was observed. The MRI classifier distinguished pathologically confirmed postmortem MCMS and TMS cases with an accuracy of 94%. For SPRINT-MS patients, the MRI classifier identified 78% as TMS, 10% as MCMS, and 12% with a paucity of cerebral T1 and T2 intensities. In SPRINT-MS, expanded disability status scale and brain atrophy measures were similar in MCMS and TMS cohorts. A paucity of cerebral WM demyelination in 22% of living PMS patients raises questions regarding a primary role for cerebral WM demyelination in disability progression in all MS patients and has implications for clinical management of MS patients and clinical trial outcomes in PMS. Periventricular myelinated fiber degeneration provides additional support for surface-in gradients of neurodegeneration in MS.
Collapse
Affiliation(s)
- Vikas Singh
- Department of Neurosciences, NC30, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Yufan Zheng
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Ontaneda
- Mellen Center for Treatment and Research in MS, Cleveland Clinic, Cleveland, OH, USA
| | - Kedar R Mahajan
- Department of Neurosciences, NC30, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Mellen Center for Treatment and Research in MS, Cleveland Clinic, Cleveland, OH, USA
| | - Jameson Holloman
- Department of Neurosciences, NC30, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Mellen Center for Treatment and Research in MS, Cleveland Clinic, Cleveland, OH, USA
| | - Robert J Fox
- Mellen Center for Treatment and Research in MS, Cleveland Clinic, Cleveland, OH, USA
| | - Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce D Trapp
- Department of Neurosciences, NC30, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| |
Collapse
|
4
|
Ziccardi S, Guandalini M, Fuchs TA, Calabrese M, Benedict RH. The time to include cognition in the multiple sclerosis concept of progression independent from relapse activity is now. Mult Scler 2024:13524585241264476. [PMID: 39193704 DOI: 10.1177/13524585241264476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Progression independent of relapse activity (PIRA) has been recently proposed in multiple sclerosis (MS) as a model identifying a continuous silent progression of disability without the manifestation of new clinical and magnetic resonance imaging (MRI) events that contribute to MS worsening. Despite evidence suggesting that clinical MS manifestations often affect cognitive functioning and the importance of neuropsychological monitoring over time, attention to silent cognitive progression is lacking, and the PIRA concept does not include a measure of cognitive function. In this personal viewpoint, we highlight the need to include cognition in the PIRA model to have a more comprehensive understanding of clinical progression in patients with MS.
Collapse
Affiliation(s)
- Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tom A Fuchs
- MS Center Amsterdam, Department of Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ralph Hb Benedict
- Departments of Neurology and Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
5
|
Tur C, Portaccio E. Progression independent of relapse activity in multiple sclerosis: Time to account for cognitive decline. Mult Scler 2024:13524585241273037. [PMID: 39193697 DOI: 10.1177/13524585241273037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| |
Collapse
|
6
|
Simone M, Lucisano G, Guerra T, Paolicelli D, Rocca MA, Brescia Morra V, Patti F, Annovazzi P, Gasperini C, De Luca G, Ferraro D, Margari L, Granella F, Pozzilli C, Romano S, Perini P, Bergamaschi R, Coniglio MG, Lus G, Vianello M, Lugaresi A, Portaccio E, Filippi M, Amato MP, Iaffaldano P. Disability trajectories by progression independent of relapse activity status differ in pediatric, adult and late-onset multiple sclerosis. J Neurol 2024:10.1007/s00415-024-12638-0. [PMID: 39179712 DOI: 10.1007/s00415-024-12638-0] [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: 04/24/2024] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND To compare Expanded Disability Status Scale (EDSS) trajectories over time between Multiple Sclerosis (MS) groups with pediatric (POMS), adult (AOMS) and late (LOMS) onset, and between patients with and without progression independent of relapse activity (PIRA). METHODS Patients with a first visit within 1 year from onset, ≥ 5-year follow-up and ≥ 1 visit every 6 months were selected from the Italian MS Register. Adjusted disability trajectories were assessed by longitudinal models for repeated measures. Comparisons between groups and between patients with and without PIRA in subgroups were performed by evaluating the yearly differences of mean EDSS score changes versus baseline (delta-EDSS). A first CDA event was defined as a 6-months confirmed disability increase from study baseline, measured by EDSS (increase ≥ 1.5 points with baseline EDSS = 0; ≥ 1.0 with baseline EDSS score ≤ 5.0 and ≥ 0.5 point with baseline EDSS > 5.5). PIRA was defined as a CDA event occurring more than 90 days after and more than 30 days before the onset of a relapse. RESULTS 3777 MS patients (268 POMS, 3282 AOMS, 227 LOMS) were included. The slope of disability trajectories significantly diverged in AOMS vs POMS starting from the second year of follow-up (Year 2: delta2-EDSS 0.18 (0.05; 0.31), p = 0.0054) and then mean delta2-EDSS gradually increased up to 0.23 (0.07; 0.39, p = 0.004) at year 5. Patients with PIRA had significant (p < 0.0001) steeper increase in EDSS scores than those without PIRA in all groups, although in POMS, the disability trajectories began to diverge later and at a lesser extent with delta-EDSS score of 0.48 vs 0.83 in AOMS and 1.57 in LOMS, at 3 years after the first PIRA. CONCLUSIONS Age is relevant in determining disability progression in MS. POMS shows a less steep increase in EDSS scores over time than older patients. The effect of PIRA in accelerating EDSS progression is less pronounced in POMS than in AOMS and LOMS.
Collapse
Affiliation(s)
- Marta Simone
- Child Neuropsychiatry Unit, Department of Precision and Regenerative Medicine, Jonic Area University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Lucisano
- CORESEARCH, Pescara, Italy
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Tommaso Guerra
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Maria A Rocca
- Dipartimento di Neurologia, Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience (NSRO), Multiple Sclerosis Clinical Care and Research Center, Federico II University, Naples, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Pietro Annovazzi
- Neuroimmunology Unit - Multiple Sclerosis Centre ASST Valle Olona, Gallarate Hospital, Gallarate, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S.Camillo Forlanini Hospital, Rome, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS. Annunziata, Chieti, Italy
| | - Diana Ferraro
- Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia, Milano, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Precision and Regenerative Medicine, Jonic Area University of Bari "Aldo Moro", Bari, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Pozzilli
- Department of Human Neuroscience, Multiple Sclerosis Center, S. Andrea Hospital, Rome, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Paola Perini
- Department of Neurosciences, Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | | | | | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | | | - Alessandra Lugaresi
- IRCCS Istituto Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | - Massimo Filippi
- Dipartimento di Neurologia, Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| |
Collapse
|
7
|
Praet J, Anderhalten L, Comi G, Horakova D, Ziemssen T, Vermersch P, Lukas C, van Leemput K, Steppe M, Aguilera C, Kadas EM, Bertrand A, van Rampelbergh J, de Boer E, Zingler V, Smeets D, Ribbens A, Paul F. A future of AI-driven personalized care for people with multiple sclerosis. Front Immunol 2024; 15:1446748. [PMID: 39224590 PMCID: PMC11366570 DOI: 10.3389/fimmu.2024.1446748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024] Open
Abstract
Multiple sclerosis (MS) is a devastating immune-mediated disorder of the central nervous system resulting in progressive disability accumulation. As there is no cure available yet for MS, the primary therapeutic objective is to reduce relapses and to slow down disability progression as early as possible during the disease to maintain and/or improve health-related quality of life. However, optimizing treatment for people with MS (pwMS) is complex and challenging due to the many factors involved and in particular, the high degree of clinical and sub-clinical heterogeneity in disease progression among pwMS. In this paper, we discuss these many different challenges complicating treatment optimization for pwMS as well as how a shift towards a more pro-active, data-driven and personalized medicine approach could potentially improve patient outcomes for pwMS. We describe how the 'Clinical Impact through AI-assisted MS Care' (CLAIMS) project serves as a recent example of how to realize such a shift towards personalized treatment optimization for pwMS through the development of a platform that offers a holistic view of all relevant patient data and biomarkers, and then using this data to enable AI-supported prognostic modelling.
Collapse
Affiliation(s)
| | - Lina Anderhalten
- Experimental and Clinical Research Center (ECRC), A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Giancarlo Comi
- Department of Neurorehabilitative Sciences, Casa di Cura Igea, Italy
- Department of Neurology, Vita-Salute San Raffaele University-Ospedale San Raffaele, Milan, Italy
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Patrick Vermersch
- Univ. Lille, InsermU1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Koen van Leemput
- Athinoula A. Martinos Center, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Department of Computer Science, Aalto University, Espoo, Finland
| | | | | | | | | | | | - Erik de Boer
- Bristol-Myers Squibb Company Corp, Princeton, NJ, United States
| | - Vera Zingler
- F. Hoffmann-La Roche Ltd., Product Development Medical Affairs, Neuroscience, Basel, Switzerland
| | | | | | - Friedemann Paul
- Experimental and Clinical Research Center (ECRC), A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
8
|
Niino M, Isobe N, Araki M, Ohashi T, Okamoto T, Ogino M, Okuno T, Ochi H, Kawachi I, Shimizu Y, Takahashi K, Takeuchi H, Tahara M, Chihara N, Nakashima I, Fukaura H, Misu T, Miyazaki Y, Miyamoto K, Mori M, Kinoshita M, Takai Y, Fujii C, Watanabe M, Fujihara K. Clinical practice guidelines for multiple sclerosis, neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-associated disease 2023 in Japan. Mult Scler Relat Disord 2024; 90:105829. [PMID: 39182455 DOI: 10.1016/j.msard.2024.105829] [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: 02/03/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND The previous Japanese clinical practice guidelines for multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) were published in 2017. Recently, for the first time in 6 years, the MS and NMOSD guideline development committee revised the Japanese guidelines for MS, NMOSD, and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS The committee utilized the Grading of Recommendations Assessment, Development, and Evaluation system based on the "Minds Handbook for Clinical Practice Guideline Development 2020 Ver. 3.0″ with a focus on clinical questions (CQs). The committee also discussed clinical issues other than CQs, categorizing them as a question-and-answer (Q&A) section, including "issues on which experts' opinions agree to a certain extent" and "issues that are important but not included in the CQ". RESULTS The committee identified 3, 1, and 1 key CQs related to MS, NMOSD, and MOGAD, respectively, and presented recommendations. A Q&A session regarding disease-modifying therapies and relapse prevention therapies for MS, NMOSD, and MOGAD was conducted. The revised guidelines were published in September 2023. CONCLUSIONS The Japanese guidelines for clinical practice on MS, NMOSD, and MOGAD were updated. Treatment strategies for MS, NMOSD, and MOGAD are changing, and these updated guidelines may assist with treatment decisions for these diseases in clinical practice.
Collapse
Affiliation(s)
- Masaaki Niino
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.
| | - Noriko Isobe
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Manabu Araki
- Department of Neurology, Kawakita General Hospital, Tokyo, Japan
| | - Takashi Ohashi
- Department of Neurology, Kamagaya General Hospital, Kamagaya, Chiba, Japan
| | - Tomoko Okamoto
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mieko Ogino
- Department of Neurology, Intractable Neurological Disease Center, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Tatsusada Okuno
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirofumi Ochi
- Department of Intractable Disease and Aging Science, Ehime University Graduate School of Medicine, Toon, Japan
| | - Izumi Kawachi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan; Medical Education Center, Niigata University School of Medicine, Niigata, Japan
| | - Yuko Shimizu
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kazuya Takahashi
- Department of Neurology, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Hideyuki Takeuchi
- Department of Neurology, Graduate School of Medicine, International University of Health and Welfare, Atami, Japan
| | - Masayuki Tahara
- Clinical Research Center and Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Norio Chihara
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ichiro Nakashima
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hikoaki Fukaura
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusei Miyazaki
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | | | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Kinoshita
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chihiro Fujii
- Department of Neurology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Mitsuru Watanabe
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
9
|
Portaccio E, Betti M, De Meo E, Addazio I, Pastò L, Razzolini L, Totaro R, Spitaleri D, Lugaresi A, Cocco E, Onofrj M, Di Palma F, Patti F, Maimone D, Valentino P, Torri Clerici V, Protti A, Ferraro D, Lus G, Maniscalco GT, Brescia Morra V, Salemi G, Granella F, Pesci I, Bergamaschi R, Aguglia U, Vianello M, Simone M, Lepore V, Iaffaldano P, Comi G, Filippi M, Trojano M, Amato MP. Progression independent of relapse activity in relapsing multiple sclerosis: impact and relationship with secondary progression. J Neurol 2024; 271:5074-5082. [PMID: 38805052 PMCID: PMC11319422 DOI: 10.1007/s00415-024-12448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES We investigated the occurrence and relative contribution of relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) to confirmed disability accrual (CDA) and transition to secondary progression (SP) in relapsing multiple sclerosis (MS). METHODS Relapsing-onset MS patients with follow-up > / = 5 years (16,130) were extracted from the Italian MS Registry. CDA was a 6-month confirmed increase in Expanded Disability Status Scale (EDSS) score. Sustained disability accumulation (SDA) was a CDA with no EDSS improvement in all subsequent visits. Predictors of PIRA and RAW and the association between final EDSS score and type of CDA were assessed using logistic multivariable regression and multivariable ordinal regression models, respectively. RESULTS Over 11.8 ± 5.4 years, 16,731 CDA events occurred in 8998 (55.8%) patients. PIRA (12,175) accounted for 72.3% of CDA. SDA occurred in 8912 (73.2%) PIRA and 2583 (56.7%) RAW (p < 0.001). 4453 (27.6%) patients transitioned to SPMS, 4010 (73.2%) out of 5476 patients with sustained PIRA and 443 (24.8%) out of 1790 patients with non-sustained PIRA. In the multivariable ordinal regression analysis, higher final EDSS score was associated with PIRA (estimated coefficient 0.349, 95% CI 0.120-0.577, p = 0.003). DISCUSSION In this real-world relapsing-onset MS cohort, PIRA was the main driver of disability accumulation and was associated with higher disability in the long term. Sustained PIRA was linked to transition to SP and could represent a more accurate PIRA definition and a criterion to mark the putative onset of the progressive phase.
Collapse
Affiliation(s)
- Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Careggi University Hospital, Florence, Italy.
| | - Matteo Betti
- Department of NEUROFARBA, University of Florence, Careggi University Hospital, Florence, Italy
| | - Ermelinda De Meo
- Department of NEUROFARBA, University of Florence, Careggi University Hospital, Florence, Italy
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ilaria Addazio
- Department of NEUROFARBA, University of Florence, Careggi University Hospital, Florence, Italy
| | - Luisa Pastò
- Department of NEUROFARBA, University of Florence, Careggi University Hospital, Florence, Italy
| | - Lorenzo Razzolini
- Department of NEUROFARBA, University of Florence, Careggi University Hospital, Florence, Italy
| | | | | | - Alessandra Lugaresi
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Dipartimento Di Scienze Biomediche E Neuromotorie, Università Di Bologna, Bologna, Italy
| | | | - Marco Onofrj
- University G. d'Annunzio Di Chieti-Pescara, Chieti, Italy
| | | | - Francesco Patti
- University of Catania, Catania, Italy
- UOS Sclerosi Multipla, Policlinico G Rodolico-San Marco, University of Catania, Catania, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Paola Valentino
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | | | | | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile Di Baggiovara, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Giacomo Lus
- University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | | | - Ilaria Pesci
- Ospedale VAIO Di Fidenza AUSL PR, Fidenza (PR), Italy
| | | | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Marta Simone
- Pediatric MS Center, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Vito Lepore
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, University of Bari Aldo Moro, DiBraiN, Bari, Italy
| | - Giancarlo Comi
- Casa Di Cura del Policlinico, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- Department of Translational Biomedicine and Neurosciences, University of Bari Aldo Moro, DiBraiN, Bari, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Careggi University Hospital, Florence, Italy
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- San Salvatore Hospital, L'Aquila, Italy
- AORN San G. Moscati, Avellino, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Dipartimento Di Scienze Biomediche E Neuromotorie, Università Di Bologna, Bologna, Italy
- University of Cagliari, Cagliari, Italy
- University G. d'Annunzio Di Chieti-Pescara, Chieti, Italy
- ASST Lariana Ospedale S. Anna, Como, Italy
- University of Catania, Catania, Italy
- UOS Sclerosi Multipla, Policlinico G Rodolico-San Marco, University of Catania, Catania, Italy
- Centro Sclerosi Multipla, Azienda Ospedaliera Cannizzaro, Catania, Italy
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
- Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- Niguarda Hospital, Milan, Italy
- Department of Neurosciences, Ospedale Civile Di Baggiovara, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
- University of Campania Luigi Vanvitelli, Naples, Italy
- A Cardarelli Hospital, Naples, Italy
- Federico II University, Naples, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
- University of Parma, Parma, Italy
- Ospedale VAIO Di Fidenza AUSL PR, Fidenza (PR), Italy
- IRCCS Fondazione Mondino, Pavia, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Ca' Fancello Hospital, AULSS2, Treviso, Italy
- Department of Translational Biomedicine and Neurosciences, University of Bari Aldo Moro, DiBraiN, Bari, Italy
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Casa Di Cura del Policlinico, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- IRCCS Don Carlo Gnocchi Foundation, Florence, Italy
| |
Collapse
|
10
|
Iaffaldano P, Lucisano G, Guerra T, Paolicelli D, Portaccio E, Inglese M, Foschi M, Patti F, Granella F, Romano S, Cavalla P, De Luca G, Gallo P, Bellantonio P, Gallo A, Montepietra S, Di Sapio A, Vianello M, Quatrale R, Spitaleri D, Clerici R, Torri Clerici V, Cocco E, Brescia Morra V, Marfia GA, Boccia VD, Filippi M, Amato MP, Trojano M. A comparison of natalizumab and ocrelizumab on disease progression in multiple sclerosis. Ann Clin Transl Neurol 2024; 11:2008-2015. [PMID: 38970214 PMCID: PMC11330227 DOI: 10.1002/acn3.52118] [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: 03/15/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 07/08/2024] Open
Abstract
OBJECTIVE No direct comparisons of the effect of natalizumab and ocrelizumab on progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) events are currently available. We aimed to compare the risk of achieving first 6 months confirmed PIRA and RAW events and irreversible Expanded Disability Status Scale (EDSS) 4.0 and 6.0 in a cohort of naïve patients treated with natalizumab or ocrelizumab from the Italian Multiple Sclerosis Register. METHODS Patients with a first visit within 1 year from onset, treated with natalizumab or ocrelizumab, and ≥3 visits were extracted. Pairwise propensity score-matched analyses were performed. Risk of reaching the first PIRA, RAW, and EDSS 4.0 and 6.0 events were estimated using multivariable Cox proportional hazards models. Kaplan-Meier curves were used to show cumulative probabilities of reaching outcomes. RESULTS In total, 770 subjects were included (natalizumab = 568; ocrelizumab = 212) and the propensity score-matching retrieved 195 pairs. No RAW events were found in natalizumab group and only 1 was reported in ocrelizumab group. A first PIRA event was reached by 23 natalizumab and 25 ocrelizumab exposed patients; 7 natalizumab- and 10 ocrelizumab-treated patients obtained an irreversible EDSS 4.0, while 13 natalizumab- and 15 ocrelizumab-treated patients reached an irreversible EDSS 6.0. No differences between the two groups were found in the risk (HR, 95%CI) of reaching a first PIRA (1.04, 0.59-1.84; p = 0.88) event, an irreversible EDSS 4.0 (1.23, 0.57-2.66; p = 0.60) and 6.0 (0.93, 0.32-2.68; p = 0.89). INTERPRETATION Both medications strongly suppress RAW events and, in the short term, the risk of achieving PIRA events, EDSS 4.0 and 6.0 milestones is not significantly different.
Collapse
Affiliation(s)
- Pietro Iaffaldano
- Department of Translational Biomedicines and NeurosciencesUniversity of Bari Aldo MoroBariItaly
| | - Giuseppe Lucisano
- CORESEARCH ‐ Center for Outcomes Research and Clinical EpidemiologyPescaraItaly
| | - Tommaso Guerra
- Department of Translational Biomedicines and NeurosciencesUniversity of Bari Aldo MoroBariItaly
| | - Damiano Paolicelli
- Department of Translational Biomedicines and NeurosciencesUniversity of Bari Aldo MoroBariItaly
| | | | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno ‐ Infantili (DINOGMI)Università di GenovaGenoaItaly
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Matteo Foschi
- Department of Neuroscience, Multiple Sclerosis Center‐Neurology UnitS. Maria delle Croci Hospital of Ravenna, AUSL RomagnaRavenna48121Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi MultiplaUniversità di CataniaCataniaItaly
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and SurgeryUniversity of ParmaParmaItaly
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS)Sapienza University of RomeRomeItaly
| | - Paola Cavalla
- Multiple Sclerosis Center and 1 Neurology Unit, Department of Neurosciences and Mental HealthAOU Città della Salute e della Scienza di Torino via Cherasco 15Torino10126Italy
| | - Giovanna De Luca
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS. AnnunziataChietiItaly
| | - Paolo Gallo
- Department of Neurosciences, Multiple Sclerosis Centre‐Veneto Region (CeSMuV)University Hospital of PaduaPaduaItaly
| | - Paolo Bellantonio
- Unit of Neurology and NeurorehabilitationIRCCS NeuromedPozzilliItaly
| | - Antonio Gallo
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Sara Montepietra
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAUSL‐IRCCS of Reggio EmiliaReggio EmiliaItaly
| | - Alessia Di Sapio
- Regional Referral MS Center, Neurological UnitUniv. Hospital San LuigiOrbassanoItaly
| | | | - Rocco Quatrale
- Ambulatorio Sclerosi Multipla ‐ Divisione di NeurologiaOspedale dell'AngeloMestreItaly
| | | | - Raffaella Clerici
- Centro ad Alta Specializzazione per la diagnosi e la cura della sclerosi multiplaOspedale Generale di zona ValduceComoItaly
| | | | - Eleonora Cocco
- Department of Medical Science and Public Health, Centro Sclerosi MultiplaUniversity of CagliariCagliariItaly
| | - Vincenzo Brescia Morra
- Department of Neuroscience (NSRO)Multiple Sclerosis Clinical Care and Research Center, Federico II UniversityNaplesItaly
| | | | - Vincenzo Daniele Boccia
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno ‐ Infantili (DINOGMI)Università di GenovaGenoaItaly
| | - Massimo Filippi
- Neurology Unit and MS CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | | | - Maria Trojano
- Department of Translational Biomedicines and NeurosciencesUniversity of Bari Aldo MoroBariItaly
| | | |
Collapse
|
11
|
Scalfari A, Traboulsee A, Oh J, Airas L, Bittner S, Calabrese M, Garcia Dominguez JM, Granziera C, Greenberg B, Hellwig K, Illes Z, Lycke J, Popescu V, Bagnato F, Giovannoni G. Smouldering-Associated Worsening in Multiple Sclerosis: An International Consensus Statement on Definition, Biology, Clinical Implications, and Future Directions. Ann Neurol 2024. [PMID: 39051525 DOI: 10.1002/ana.27034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
Despite therapeutic suppression of relapses, multiple sclerosis (MS) patients often experience subtle deterioration, which extends beyond the definition of "progression independent of relapsing activity." We propose the concept of smouldering-associated-worsening (SAW), encompassing physical and cognitive symptoms, resulting from smouldering pathological processes, which remain unmet therapeutic targets. We provide a consensus-based framework of possible pathological substrates and manifestations of smouldering MS, and we discuss clinical, radiological, and serum/cerebrospinal fluid biomarkers for potentially monitoring SAW. Finally, we share considerations for optimizing disease surveillance and implications for clinical trials to promote the integration of smouldering MS into routine practice and future research efforts. ANN NEUROL 2024.
Collapse
Affiliation(s)
- Antonio Scalfari
- Center of Neuroscience, Department of Medicine, Charing Cross Hospital, Imperial College, London, UK
| | | | - Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Laura Airas
- University of Turku and Turku University Hospital, Turku, Finland
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (Rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Cristina Granziera
- Translational Imaging in Neurology (THiNK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurology and MS Center, University Hospital Basel Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Basel, Switzerland
| | | | | | - Zsolt Illes
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jan Lycke
- Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Veronica Popescu
- University MS Centre Pelt-Hasselt, Noorderhart Hospital, Belgium Hasselt University, Pelt, Belgium
| | - Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, VA Hospital, TN Valley Healthcare System, Nashville, TN, USA
| | - Gavin Giovannoni
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
12
|
Boccia VD, Boffa G, Lapucci C, Costagli M, Bosisio L, Mancardi MM, Inglese M, Cellerino M. Lesion phenotyping based on magnetic susceptibility in pediatric multiple sclerosis. J Neuroimaging 2024. [PMID: 39004778 DOI: 10.1111/jon.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND AND PURPOSE Pediatric multiple sclerosis (MS) displays different pathological features compared to adult MS, which can be studied in vivo by assessing tissue magnetic susceptibility with 3T-MRI. We aimed to assess different white matter lesions (WMLs) phenotypes in pediatric MS patients using quantitative susceptibility mapping (QSM) and susceptibility mapping weighted imaging (SMWI) over 12 months. METHODS Eleven pediatric MS patients [female: 63.6%; mean ± standard deviation (SD) age and disease duration: 16.3 ± 2.2 and 2.4 ± 1.5; median (range) Expanded Disability Status Scale (EDSS) 1 (0-2)] underwent 3 Tesla-MRI exams and EDSS assessments at baseline and after 1 year. QSM and SMWI were obtained using 3-dimensional (3D)-segmented echo-planar-imaging with submillimetric spatial resolution. WMLs were classified according to their QSM appearance and SMWI was used to identify QSM hyperintensities ascribable to veins. Total brain volumes at baseline and follow-up were computed using high-resolution 3D T1-weighted images. RESULTS Mean ± SD paramagnetic rim lesions (PRLs) prevalence was 7.0% ± 9.0. Fifty-four percent (6/11) of patients exhibited at least one PRL, with one patient exhibiting ≥ 4 PRLs. All patients showed QSM-iso-/hypo-intense lesions, which represented a mean ± SD of 65.8% ± 22.7 of total WMLs. QSM-hyperintense WMLs showed a positive correlation with total brain volume reduction at follow-up (r = 0.705; p = .02). No lesion was classified as different between baseline and follow-up. CONCLUSION Chronic compartmentalized inflammation seems to occur early in pediatric MS patients with short disease duration. A high prevalence of iso-/hypo-intense lesions was found, which could account for the higher remyelination potential in pediatric MS.
Collapse
Affiliation(s)
- Vincenzo Daniele Boccia
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giacomo Boffa
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Caterina Lapucci
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Costagli
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Bosisio
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Matilde Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| |
Collapse
|
13
|
Hu Y, Frisell T, Alping P, Song H, Pawitan Y, Fang F, Piehl F. Hospital-Treated Infections and Risk of Disability Worsening in Multiple Sclerosis. Ann Neurol 2024. [PMID: 38984615 DOI: 10.1002/ana.27026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To investigate the association between infections and disability worsening in people with multiple sclerosis (MS) treated with either B-cell depleting therapy (rituximab) or interferon-beta/glatiramer acetate (IFN/GA). METHODS This cohort study spanned from 2000 to 2021, using data from the Swedish MS Registry linked to national health care registries, comprising 8,759 rituximab and 7,561 IFN/GA treatment episodes. The risk of hospital-treated infection was estimated using multivariable Cox models. The association between infections and increase in Expanded Disability Status Scale (EDSS) scores was assessed using a doubly robust generalized estimating equations model. Additionally, a piece-wise exponential model analyzed events of increased disability beyond defined cut-off values, controlling for relapses, and MRI activity. RESULTS Compared with IFN/GA, rituximab displayed increased risk of both inpatient- and outpatient-treated infections (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.50-2.90 and HR, 1.37; 95% CI, 1.13-1.67, respectively). An inpatient-treated infection was associated with a 0.19-unit increase in EDSS (95% CI, 0.12-0.26). Degree of worsening was greatest for progressive MS, and under IFN/GA treatment, which unlike rituximab, was more commonly associated with MRI activity. After controlling for relapses and MRI activity, inpatient-treated infections were associated with disability worsening in people with relapsing-remitting MS treated with IFN/GA (HR, 2.01; 95% CI, 1.59-2.53), but not in those treated with rituximab. INTERPRETATION Compared to IFN/GA, rituximab doubled the infection risk, but reduced the risk of subsequent disability worsening. Further, the risk of worsening after hospital-treated infection was greater with progressive MS than with relapsing-remitting MS. Infection risk should be considered to improve long term outcomes. ANN NEUROL 2024.
Collapse
Affiliation(s)
- Yihan Hu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Peter Alping
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yudi Pawitan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Center for Neurology, Academic Specialist Center, Stockholm, Sweden
| |
Collapse
|
14
|
Ciccarelli O, Barkhof F, Calabrese M, De Stefano N, Eshaghi A, Filippi M, Gasperini C, Granziera C, Kappos L, Rocca MA, Rovira À, Sastre-Garriga J, Sormani MP, Tur C, Toosy AT. Using the Progression Independent of Relapse Activity Framework to Unveil the Pathobiological Foundations of Multiple Sclerosis. Neurology 2024; 103:e209444. [PMID: 38889384 PMCID: PMC11226318 DOI: 10.1212/wnl.0000000000209444] [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: 01/08/2024] [Accepted: 03/04/2024] [Indexed: 06/20/2024] Open
Abstract
Progression independent of relapse activity (PIRA), a recent concept to formalize disability accrual in multiple sclerosis (MS) independent of relapses, has gained popularity as a potential clinical trial outcome. We discuss its shortcomings and appraise the challenges of implementing it in clinical settings, experimental trials, and research. The current definition of PIRA assumes that acute inflammation, which can manifest as a relapse, and neurodegeneration, manifesting as progressive disability accrual, can be disentangled by introducing specific time windows between the onset of relapses and the observed increase in disability. The term PIRMA (progression independent of relapse and MRI activity) was recently introduced to indicate disability accrual in the absence of both clinical relapses and new brain and spinal cord MRI lesions. Assessing PIRMA in clinical practice is highly challenging because it necessitates frequent clinical assessments and brain and spinal cord MRI scans. PIRA is commonly assessed using Expanded Disability Status Scale, a scale heavily weighted toward motor disability, whereas a more granular assessment of disability deterioration, including cognitive decline, using composite measures or other tools, such as digital tools, would possess greater utility. Similarly, using PIRA as an outcome measure in randomized clinical trials is also challenging and requires methodological considerations. The underpinning pathobiology of disability accumulation, that is not associated with relapses, may encompass chronic active lesions (slowly expanding lesions and paramagnetic rim lesions), cortical lesions, brain and spinal cord atrophy, particularly in the gray matter, diffuse and focal microglial activation, persistent leptomeningeal enhancement, and white matter tract damage. We propose to use PIRA to understand the main determinant of disability accrual in observational, cohort studies, where regular MRI scans are not included, and introduce the term of "advanced-PIRMA" to investigate the contributions to disability accrual of the abovementioned processes, using conventional and advanced imaging. This is supported by the knowledge that MRI reflects the MS pathogenic mechanisms better than purely clinical descriptors. Any residual disability accrual, which remains unexplained after considering all these mechanisms with imaging, will highlight future research priorities to help complete our understanding of MS pathogenesis.
Collapse
Affiliation(s)
- Olga Ciccarelli
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Frederik Barkhof
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Massimiliano Calabrese
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Nicola De Stefano
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Arman Eshaghi
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Massimo Filippi
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Claudio Gasperini
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Cristina Granziera
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Ludwig Kappos
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Maria A Rocca
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Àlex Rovira
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Jaume Sastre-Garriga
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Maria Pia Sormani
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Carmen Tur
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| | - Ahmed T Toosy
- From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy
| |
Collapse
|
15
|
Jakimovski D, Qureshi F, Ramanathan M, Keshavan A, Leyden K, Jalaleddini K, Ghoreyshi A, Dwyer MG, Bergsland N, Marr K, Weinstock-Guttman B, Zivadinov R. Lower arterial cerebral blood flow is associated with worse neuroinflammation and immunomodulation composite proteomic scores. Mult Scler Relat Disord 2024; 87:105687. [PMID: 38776599 DOI: 10.1016/j.msard.2024.105687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/05/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Brain hypoperfusion is linked with worse physical, cognitive and MRI outcomes in multiple sclerosis (MS). Understanding the proteomic signatures related to hypoperfusion could provide insights into the pathophysiological mechanism. METHODS 140 people with MS (pwMS; 86 clinically isolated syndrome (CIS)/relapsing-remitting (RRMS) and 54 progressive (PMS)) were included. Cerebral arterial blood flow (CABF) was determined using ultrasound Doppler measurement as the sum of blood flow in the bilateral common carotid arteries and vertebral arteries. Proteomic analysis was performed using the Multiple Sclerosis Disease Activity (MSDA) test assay panel performed on the Olink™ platform. The MSDA test measures the concentrations of 18 proteins that are age and sex-adjusted. It utilizes a stacked classifier logistic regression model to determine 4 disease pathway scores (immunomodulation, neuroinflammation, myelin biology, and neuroaxonal integrity) as well as an overall disease activity score (1 to 10). MRI measures of T2 lesion volume (LV) and whole brain volume (WBV) were derived. RESULTS The pwMS were on average 54 years old and had an average CABF of 951 mL/min. There were no differences in CABF between CIS/RRMS vs. PMS groups. Lower CABF levels were correlated with the overall disease activity score (r = -0.26, p = 0.003) and with the neuroinflammation (r = -0.29, p = 0.001), immunomodulation (r = -0.26, p = 0.003) and neuroaxonal integrity (r = -0.23, p = 0.007) pathway scores. After age and body mass index (BMI)-adjustment, lower CABF remained associated with the neuroinflammatory (r = -0.23, p = 0.011) and immunomodulation (r = -0.20, p = 0.024) pathway scores. The relationship between CABF and the neuroinflammation pathway score remained significant after adjusting for T2-LV and WBV (p = 0.038). Individual analyses identified neurofilament light chain, CCL-20 and TNFSF13B as contributors. When compared to the highest quartile (>1133.5 mL/min), the pwMS in the lowest CABF quartile (<764 mL/min) had greater overall disease activity score (p = 0.003), neuroinflammation (p = 0.001), immunomodulation (p = 0.004) and neuroaxonal integrity pathway scores (p = 0.007). CONCLUSION Lower cerebral arterial perfusion in MS is associated with changes in neuroinflammatory/immunomodulation pathways and their respective proteomic biomarkers. These findings may suggest a relationship between the hypoperfusion and pro-inflammatory MS changes rather than being merely an epiphenomenon subsequent to lower energy demands.
Collapse
Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | | | - Murali Ramanathan
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | | | | | | | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Karen Marr
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| |
Collapse
|
16
|
Calabrese M, Preziosa P, Scalfari A, Colato E, Marastoni D, Absinta M, Battaglini M, De Stefano N, Di Filippo M, Hametner S, Howell OW, Inglese M, Lassmann H, Martin R, Nicholas R, Reynolds R, Rocca MA, Tamanti A, Vercellino M, Villar LM, Filippi M, Magliozzi R. Determinants and Biomarkers of Progression Independent of Relapses in Multiple Sclerosis. Ann Neurol 2024; 96:1-20. [PMID: 38568026 DOI: 10.1002/ana.26913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/04/2024] [Accepted: 02/15/2024] [Indexed: 06/20/2024]
Abstract
Clinical, pathological, and imaging evidence in multiple sclerosis (MS) suggests that a smoldering inflammatory activity is present from the earliest stages of the disease and underlies the progression of disability, which proceeds relentlessly and independently of clinical and radiological relapses (PIRA). The complex system of pathological events driving "chronic" worsening is likely linked with the early accumulation of compartmentalized inflammation within the central nervous system as well as insufficient repair phenomena and mitochondrial failure. These mechanisms are partially lesion-independent and differ from those causing clinical relapses and the formation of new focal demyelinating lesions; they lead to neuroaxonal dysfunction and death, myelin loss, glia alterations, and finally, a neuronal network dysfunction outweighing central nervous system (CNS) compensatory mechanisms. This review aims to provide an overview of the state of the art of neuropathological, immunological, and imaging knowledge about the mechanisms underlying the smoldering disease activity, focusing on possible early biomarkers and their translation into clinical practice. ANN NEUROL 2024;96:1-20.
Collapse
Affiliation(s)
- Massimiliano Calabrese
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Scalfari
- Centre of Neuroscience, Department of Medicine, Imperial College, London, UK
| | - Elisa Colato
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Damiano Marastoni
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Martina Absinta
- Translational Neuropathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battaglini
- Siena Imaging S.r.l., Siena, Italy
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Owain W Howell
- Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Matilde Inglese
- Dipartimento di neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili - DINOGMI, University of Genova, Genoa, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Roland Martin
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
- Therapeutic Design Unit, Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
- Cellerys AG, Schlieren, Switzerland
| | - Richard Nicholas
- Department of Brain Sciences, Faculty of Medicine, Burlington Danes, Imperial College London, London, UK
| | - Richard Reynolds
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Agnese Tamanti
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Marco Vercellino
- Multiple Sclerosis Center & Neurologia I U, Department of Neuroscience, University Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Maria Villar
- Department of Immunology, Ramon y Cajal University Hospital. IRYCIS. REI, Madrid, Spain
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Magliozzi
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| |
Collapse
|
17
|
Woo MS, Engler JB, Friese MA. The neuropathobiology of multiple sclerosis. Nat Rev Neurosci 2024; 25:493-513. [PMID: 38789516 DOI: 10.1038/s41583-024-00823-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Chronic low-grade inflammation and neuronal deregulation are two components of a smoldering disease activity that drives the progression of disability in people with multiple sclerosis (MS). Although several therapies exist to dampen the acute inflammation that drives MS relapses, therapeutic options to halt chronic disability progression are a major unmet clinical need. The development of such therapies is hindered by our limited understanding of the neuron-intrinsic determinants of resilience or vulnerability to inflammation. In this Review, we provide a neuron-centric overview of recent advances in deciphering neuronal response patterns that drive the pathology of MS. We describe the inflammatory CNS environment that initiates neurotoxicity by imposing ion imbalance, excitotoxicity and oxidative stress, and by direct neuro-immune interactions, which collectively lead to mitochondrial dysfunction and epigenetic dysregulation. The neuronal demise is further amplified by breakdown of neuronal transport, accumulation of cytosolic proteins and activation of cell death pathways. Continuous neuronal damage perpetuates CNS inflammation by activating surrounding glia cells and by directly exerting toxicity on neighbouring neurons. Further, we explore strategies to overcome neuronal deregulation in MS and compile a selection of neuronal actuators shown to impact neurodegeneration in preclinical studies. We conclude by discussing the therapeutic potential of targeting such neuronal actuators in MS, including some that have already been tested in interventional clinical trials.
Collapse
Affiliation(s)
- Marcel S Woo
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Broder Engler
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
18
|
Krieger S, Cook K, Hersh CM. Understanding multiple sclerosis as a disease spectrum: above and below the clinical threshold. Curr Opin Neurol 2024; 37:189-201. [PMID: 38535979 PMCID: PMC11064902 DOI: 10.1097/wco.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Research in multiple sclerosis (MS) has long been predicated on clinical groupings that do not reflect the underlying biologic heterogeneity apparent within patient populations. This review explicates the various levels of explanation through which the spectrum of disease is described and investigated both above and below the clinical threshold of detection, as framed by the topographical model of MS, to help advance a cogent mechanistic framework. RECENT FINDINGS Contemporary evidence has amended the view of MS as consisting of sequential disease phases in favor of a spectrum of disease with an admixture of interdependent and dynamic pathobiological axes driving tissue injury and progression. Recent studies have shown the presence of acute and compartmentalized inflammation and mechanisms of neurodegeneration beginning early and evolving throughout the disease continuum. Still, the gap between the understanding of immunopathologic processes in MS and the tools used to measure relevant molecular, laboratory, radiologic, and clinical metrics needs attention to enable better prognostication of disease and monitoring for changes along specific pathologic axes and variable treatment outcomes. SUMMARY Aligning on a consistently-applied mechanistic framework at distinct levels of explanation will enable greater precision across bench and clinical research, and inform discourse on drivers of disability progression and delivery of care for individuals with MS.
Collapse
Affiliation(s)
- Stephen Krieger
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai
| | - Karin Cook
- Medical Education Director, Neurology at Heartbeat/Publicis Health, New York
| | - Carrie M. Hersh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland Clinic Las Vegas, Nevada, USA
| |
Collapse
|
19
|
Epstein SE, Longbrake EE. Shifting our attention earlier in the multiple sclerosis disease course. Curr Opin Neurol 2024; 37:212-219. [PMID: 38546031 DOI: 10.1097/wco.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE OF REVIEW Revisions of multiple sclerosis (MS) diagnostic criteria enable clinicians to diagnose patients earlier in the biologic disease course. Prompt initiation of therapy correlates with improved clinical outcomes. This has led to increased attention on the earliest stages of MS, including the MS prodrome and radiologically isolated syndrome (RIS). Here, we review current understanding and approach to patients with preclinical MS. RECENT FINDINGS MS disease biology often begins well before the onset of typical MS symptoms, and we are increasingly able to recognize preclinical and prodromal stages of MS. RIS represents the best characterized aspect of preclinical MS, and its diagnostic criteria were recently revised to better capture patients at highest risk of conversion to clinical MS. The first two randomized control trials evaluating disease modifying therapy use in RIS also found that treatment could delay or prevent onset of clinical disease. SUMMARY Despite progress in our understanding of the earliest stages of the MS disease course, additional research is needed to systematically identify patients with preclinical MS as well as capture those at risk for developing clinical disease. Recent data suggests that preventive immunomodulatory therapies may be beneficial for high-risk patients with RIS; though management remains controversial.
Collapse
|
20
|
Grijalvo M, Ordieres-Meré J, Villalba-Díez J, Aladro-Benito Y, Martín-Ávila G, Simon-Hurtado A, Vivaracho-Pascual C. Sufficiency for PSS tracking gait disorders in multiple sclerosis: A managerial perspective. Heliyon 2024; 10:e30001. [PMID: 38707444 PMCID: PMC11066638 DOI: 10.1016/j.heliyon.2024.e30001] [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: 09/27/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
This study primarily aimed to explore the capabilities of digitalisation in the healthcare context, focusing on a specific disease. In this case, the study examined the potential of remote monitoring of gait to address the sensitivity of multiple sclerosis progression to gait characteristics by adopting a non-invasive approach to remotely quantify gait disturbances in a patient's daily life. To better understand the managerial aspects associated with this approach, the researchers conducted a literature review along with a set of semi-structured interviews. The target population included MS patients as well as the key agents involved in their care: patients' family members, neurologists, MS nurses, physiotherapists, medical directors, and pharmacist. The study identifies the perceived barriers and drivers that could contribute to the successful deployment of PSS remote gait monitoring as a healthcare service: i) At mega-level governance. Implications on privacy and security data are notable barriers missing on the speech. ii) At macro level, funding is highlighted as main barrier. The cost and lack of health system subsidies may render initiatives unsustainable, as emphasised by the interviewees. iii) At meso level, useable data is recognised as a driver. The data collection process can align with diverse interests to create value and business opportunities for the ecosystem actors, enhance care, attract stakeholders, such as insurers and pharma, and form partnerships. iv) At micro-level processes, we find two potential barriers: wearable device and app usability (comfort, navigation, efficiency) and organisational/behavioural aspects (training, digital affinity, skills), which are crucial for value creation in innovation ecosystems among patients and healthcare professionals. Finally, we find an interesting gap in the literature and interviews. Stakeholders' limited awareness of technological demands, especially from information technologies, for a successful long-term service, can be consider two key barriers for PSS.
Collapse
Affiliation(s)
- Mercedes Grijalvo
- Department of Organizational Engineering, Business Administration and Statistics, Universidad Politécnica de Madrid, Madrid, Spain
| | - Joaquín Ordieres-Meré
- Department of Organizational Engineering, Business Administration and Statistics, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Yolanda Aladro-Benito
- Department of Neurology, Getafe University Hospital, Madrid, Spain
- Faculty of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
| | | | - Arancha Simon-Hurtado
- Departamento de Informática, Escuela de Ingeniería Informática de Valladolid, Universidad de Valladolid, Paseo de Belén 15, 47011, Valladolid, Spain
| | - Carlos Vivaracho-Pascual
- Departamento de Informática, Escuela de Ingeniería Informática de Valladolid, Universidad de Valladolid, Paseo de Belén 15, 47011, Valladolid, Spain
| |
Collapse
|
21
|
Immovilli P, Schiavetti I, Franceschini A, De Mitri P, Gelati L, Rota E, Guidetti D. Breakthrough COVID-19 in people with multiple sclerosis on disease modifying treatments: Is it still a severe disease? Mult Scler Relat Disord 2024; 85:105547. [PMID: 38518506 DOI: 10.1016/j.msard.2024.105547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Disease modifying treatments (DMTs) for multiple sclerosis (MS) are effective in preventing both relapses and disability progression. Highly effective treatments (HETs) are more effective than platform therapy in preventing confirmed disability progression (CDP), when used early. Infections may complicate HETs administration, and their prevention through vaccination is crucial in order to assure the safety of people with MS (pwMS). The aim of the present study is to describe the effect of MS DMTs on COVID-19 vaccination and the risk of breakthrough infection in a cohort of pwMS. MATERIALS AND METHODS This is a monocentric retrospective observational study conducted at the MS center of the Guglielmo da Saliceto Hospital in Piacenza, Italy. One hundred and fifty-seven (157) pwMS who received two doses of the SARS-CoV-2 vaccine (with 80.3 % receiving a booster dose) were included in the study. RESULTS fifty-six pwMS (35.7 %) were females, the mean age was 48.6 (SD: 12.87) years, and 59 (37.6 %) had at least one comorbidity. Twenty-five (15.9 %) breakthrough infections were observed, with 17 (68.0 %) classified as mild and 8 (32.0 %) as moderate. A multivariable linear regression model confirmed that B-cell suppressor DMTs and EDSS were factors associated with the latest antibody titre. Patients treated with B-cell suppressors exhibited a risk almost four times higher for breakthrough infections compared to other patients, with a hazard ratio (HR) of 3.72 (95 % CI: 1.50 - 9.27) (p = 0.005). CONCLUSIONS B-cell suppressor DMTs are associated with the risk of breakthrough COVID-19 in our cohort, but vaccination fully protected pwMS against severe breakthrough disease.
Collapse
Affiliation(s)
- Paolo Immovilli
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, via Taverna 38, Piacenza 29121, Italy.
| | - Irene Schiavetti
- Department of Health Sciences, University of Genova, via Pastore 1, Genoa 16132, Italy
| | - Alessandro Franceschini
- Neurology Unit, Medicine and Surgery Department, University of Parma, via Abbeveratoia 4, Parma 43126, Italy
| | - Paola De Mitri
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, via Taverna 38, Piacenza 29121, Italy
| | - Lorenza Gelati
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, via Taverna 38, Piacenza 29121, Italy
| | - Eugenia Rota
- Neurology Unit, San Giacomo Hospital, ASL Alessandria, via E. Raggio 12, Novi Ligure 15067, Italy
| | - Donata Guidetti
- Neurology Unit, Emergency Department, Guglielmo da Saliceto Hospital, via Taverna 38, Piacenza 29121, Italy
| |
Collapse
|
22
|
Ontaneda D, Chitnis T, Rammohan K, Obeidat AZ. Identification and management of subclinical disease activity in early multiple sclerosis: a review. J Neurol 2024; 271:1497-1514. [PMID: 37864717 PMCID: PMC10972995 DOI: 10.1007/s00415-023-12021-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
IMPORTANCE Early treatment initiation in multiple sclerosis (MS) is crucial in preventing irreversible neurological damage and disability progression. The current assessment of disease activity relies on relapse rates and magnetic resonance imaging (MRI) lesion activity, but inclusion of other early, often "hidden," indicators of disease activity may describe a more comprehensive picture of MS. OBSERVATIONS Early indicators of MS disease activity other than relapses and MRI activity, such as cognitive impairment, brain atrophy, and fatigue, are not typically captured by routine disease monitoring. Furthermore, silent progression (neurological decline not clearly captured by standard methods) may occur undetected by relapse and MRI lesion activity monitoring. Consequently, patients considered to have no disease activity actually may have worsening disease, suggesting a need to revise MS management strategies with respect to timely initiation and escalation of disease-modifying therapy (DMT). Traditionally, first-line MS treatment starts with low- or moderate-efficacy therapies, before escalating to high-efficacy therapies (HETs) after evidence of breakthrough disease activity. However, multiple observational studies have shown that early initiation of HETs can prevent or reduce disability progression. Ongoing randomized clinical trials are comparing escalation and early HET approaches. CONCLUSIONS AND RELEVANCE There is an urgent need to reassess how MS disease activity and worsening are measured. A greater awareness of "hidden" indicators, potentially combined with biomarkers to reveal silent disease activity and neurodegeneration underlying MS, would provide a more complete picture of MS and allow for timely therapeutic intervention with HET or switching DMTs to address suboptimal treatment responses.
Collapse
Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kottil Rammohan
- Division of Multiple Sclerosis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
23
|
Lorefice L, Ferraro OE, Fenu G, Amato MP, Bresciamorra V, Conte A, De Luca G, Ferraro D, Filippi M, Gazzola P, Iaffaldano P, Inglese M, Lus G, Marfia GA, Patti F, Pesci I, Salemi G, Trojano M, Zaffaroni M, Monti MC, Cocco E. Late-onset multiple sclerosis: disability trajectories in relapsing-remitting patients of the Italian MS Registry. J Neurol 2024; 271:1630-1637. [PMID: 38172380 DOI: 10.1007/s00415-023-12152-9] [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: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Generally infrequent, multiple sclerosis (MS) with late onset (LOMS) is characterized by an onset over the age of 50 and a mainly progressive course, while relapsing-remitting (RR) forms are less frequently observed and explored. This study aimed to characterize a large cohort of MS patients with RRMS at onset to assess the baseline factors related to the worst disability trajectories and explore the role of LOMS. METHODS The data were extracted from the Italian MS Register (IMSR). Disability trajectories, defined using at least two and up to twenty expanded disability status scale (EDSS) assessments annually performed, were implemented using group-based trajectory models (GBTMs) to identify different groups with the same trajectories over time. MS profiles were explored using multinomial logistic regression. RESULTS A total of 16,159 RR patients [1012 (6.26%) presented with LOMS] were analyzed. The GBTM identified four disability trajectories. The group with the most severe EDSS trend included 12.3% of the patients with a mean EDSS score > 4, which increased over time and exceeded 6 score. The group with medium severity EDSS trend comprised 21.9% of the patients and showed a change in EDSS > 3 scores over time. The largest group with 50.8% of patients reported a constant EDSS of 2 score. Finally, the benign group comprised 14.9% of the patients with a low and constant EDSS of 1 score over time. The probability of being in the worst groups increased if the patient was male; had LOMS or experienced brainstem, spinal, or supratentorial symptoms. CONCLUSIONS Four MS severity profiles among RRMS patients in the IMSR have been reported, with LOMS being associated with a rapid worsening of EDSS scores. These findings have important implications for recognizing and managing how older age, aging, and age-related factors interact with MS and its evolution.
Collapse
Affiliation(s)
- Lorena Lorefice
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy.
| | - Ottavia Elena Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Giuseppe Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Vincenzo Bresciamorra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, University of Naples "Federico II", Naples, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS. Annunziata Hospital University "G D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Diana Ferraro
- Department of Neurosciences, Civil Hospital of Baggiovara, AOU of Modena, Baggiovara, Italy
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Gazzola
- Neurology Unit, P.A. Micone Hospital, ASL3 Genovese, Genoa, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili (DINOGMI), Universita' Di Genova, Genoa, Liguria, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Science, University of Campania Luigi Vanvitelli, 80131, Naples, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Francesco Patti
- Department Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Unità Sanitaria Locale, Ospedale Di Vaio, Fidenza, Parma, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate - ASST Della Valle Olona, Gallarate, Italy
| | - Maria Cristina Monti
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy
| |
Collapse
|
24
|
Ruggieri S, Prosperini L, Al-Araji S, Annovazzi PO, Bisecco A, Ciccarelli O, De Stefano N, Filippi M, Fleischer V, Evangelou N, Enzinger C, Gallo A, Garjani A, Groppa S, Haggiag S, Khalil M, Lucchini M, Mirabella M, Montalban X, Pozzilli C, Preziosa P, Río J, Rocca MA, Rovira A, Stromillo ML, Zaffaroni M, Tortorella C, Gasperini C. Assessing treatment response to oral drugs for multiple sclerosis in real-world setting: a MAGNIMS Study. J Neurol Neurosurg Psychiatry 2024; 95:142-150. [PMID: 37775266 DOI: 10.1136/jnnp-2023-331920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The assessment of treatment response is a crucial step for patients with relapsing-remitting multiple sclerosis on disease-modifying therapies (DMTs). We explored whether a scoring system developed within the MAGNIMS (MRI in Multiple Sclerosis) network to evaluate treatment response to injectable drugs can be adopted also to oral DMTs. METHODS A multicentre dataset of 1200 patients who started three oral DMTs (fingolimod, teriflunomide and dimethyl fumarate) was collected within the MAGNIMS network. Disease activity after the first year was classified by the 'MAGNIMS' score based on the combination of relapses (0-≥2) and/or new T2 lesions (<3 or ≥3) on brain MRI. We explored the association of this score with the following 3-year outcomes: (1) confirmed disability worsening (CDW); (2) treatment failure (TFL); (3) relapse count between years 1 and 3. The additional value of contrast-enhancing lesions (CELs) and lesion location was explored. RESULTS At 3 years, 160 patients experienced CDW: 12% of them scored '0' (reference), 18% scored '1' (HR=1.82, 95% CI 1.20 to 2.76, p=0.005) and 37% scored '2' (HR=2.74, 95% CI 1.41 to 5.36, p=0.003) at 1 year. The analysis of other outcomes provided similar findings. Considering the location of new T2 lesions (supratentorial vs infratentorial/spinal cord) and the presence of CELs improved the prediction of CDW and TFL, respectively, in patients with minimal MRI activity alone (one or two new T2 lesions). CONCLUSIONS Early relapses and substantial MRI activity in the first year of treatment are associated with worse short-term outcomes in patients treated with some of the oral DMTs.
Collapse
Affiliation(s)
- Serena Ruggieri
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Sarmad Al-Araji
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Pietro Osvaldo Annovazzi
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimo Filippi
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Vinzenz Fleischer
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nikos Evangelou
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology (Division of Neuroradiology, Vascular and Interventional Radiology), Medical University of Graz, Graz, Austria
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Afagh Garjani
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sergiu Groppa
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Shalom Haggiag
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Matteo Lucchini
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Xavier Montalban
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Preziosa
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jordi Río
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Maria A Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria L Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| |
Collapse
|
25
|
Cagol A, Benkert P, Melie-Garcia L, Schaedelin SA, Leber S, Tsagkas C, Barakovic M, Galbusera R, Lu PJ, Weigel M, Ruberte E, Radue EW, Yaldizli Ö, Oechtering J, Lorscheider J, D'Souza M, Fischer-Barnicol B, Müller S, Achtnichts L, Vehoff J, Disanto G, Findling O, Chan A, Salmen A, Pot C, Bridel C, Zecca C, Derfuss T, Lieb JM, Remonda L, Wagner F, Vargas MI, Du Pasquier RA, Lalive PH, Pravatà E, Weber J, Cattin PC, Absinta M, Gobbi C, Leppert D, Kappos L, Kuhle J, Granziera C. Association of Spinal Cord Atrophy and Brain Paramagnetic Rim Lesions With Progression Independent of Relapse Activity in People With MS. Neurology 2024; 102:e207768. [PMID: 38165377 PMCID: PMC10834139 DOI: 10.1212/wnl.0000000000207768] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Progression independent of relapse activity (PIRA) is a crucial determinant of overall disability accumulation in multiple sclerosis (MS). Accelerated brain atrophy has been shown in patients experiencing PIRA. In this study, we assessed the relation between PIRA and neurodegenerative processes reflected by (1) longitudinal spinal cord atrophy and (2) brain paramagnetic rim lesions (PRLs). Besides, the same relationship was investigated in progressive MS (PMS). Last, we explored the value of cross-sectional brain and spinal cord volumetric measurements in predicting PIRA. METHODS From an ongoing multicentric cohort study, we selected patients with MS with (1) availability of a susceptibility-based MRI scan and (2) regular clinical and conventional MRI follow-up in the 4 years before the susceptibility-based MRI. Comparisons in spinal cord atrophy rates (explored with linear mixed-effect models) and PRL count (explored with negative binomial regression models) were performed between: (1) relapsing-remitting (RRMS) and PMS phenotypes and (2) patients experiencing PIRA and patients without confirmed disability accumulation (CDA) during follow-up (both considering the entire cohort and the subgroup of patients with RRMS). Associations between baseline MRI volumetric measurements and time to PIRA were explored with multivariable Cox regression analyses. RESULTS In total, 445 patients with MS (64.9% female; mean [SD] age at baseline 45.0 [11.4] years; 11.2% with PMS) were enrolled. Compared with patients with RRMS, those with PMS had accelerated cervical cord atrophy (mean difference in annual percentage volume change [MD-APC] -1.41; p = 0.004) and higher PRL load (incidence rate ratio [IRR] 1.93; p = 0.005). Increased spinal cord atrophy (MD-APC -1.39; p = 0.0008) and PRL burden (IRR 1.95; p = 0.0008) were measured in patients with PIRA compared with patients without CDA; such differences were also confirmed when restricting the analysis to patients with RRMS. Baseline volumetric measurements of the cervical cord, whole brain, and cerebral cortex significantly predicted time to PIRA (all p ≤ 0.002). DISCUSSION Our results show that PIRA is associated with both increased spinal cord atrophy and PRL burden, and this association is evident also in patients with RRMS. These findings further point to the need to develop targeted treatment strategies for PIRA to prevent irreversible neuroaxonal loss and optimize long-term outcomes of patients with MS.
Collapse
Affiliation(s)
- Alessandro Cagol
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Pascal Benkert
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Lester Melie-Garcia
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Sabine A Schaedelin
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Selina Leber
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Charidimos Tsagkas
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Muhamed Barakovic
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Riccardo Galbusera
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Po-Jui Lu
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Matthias Weigel
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Esther Ruberte
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Ernst-Wilhelm Radue
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Özgür Yaldizli
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Johanna Oechtering
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Johannes Lorscheider
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Marcus D'Souza
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Bettina Fischer-Barnicol
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Stefanie Müller
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Lutz Achtnichts
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Jochen Vehoff
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Giulio Disanto
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Oliver Findling
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Andrew Chan
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Anke Salmen
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Caroline Pot
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Claire Bridel
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Chiara Zecca
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Tobias Derfuss
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Johanna M Lieb
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Luca Remonda
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Franca Wagner
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Maria Isabel Vargas
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Renaud A Du Pasquier
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Patrice H Lalive
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Emanuele Pravatà
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Johannes Weber
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Philippe C Cattin
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Martina Absinta
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Claudio Gobbi
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - David Leppert
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Ludwig Kappos
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Jens Kuhle
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Cristina Granziera
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| |
Collapse
|
26
|
Iaffaldano P, Portaccio E, Lucisano G, Simone M, Manni A, Guerra T, Paolicelli D, Betti M, De Meo E, Pastò L, Razzolini L, Rocca MA, Ferrè L, Brescia Morra V, Patti F, Zaffaroni M, Gasperini C, De Luca G, Ferraro D, Granella F, Pozzilli C, Romano S, Gallo P, Bergamaschi R, Coniglio MG, Lus G, Vianello M, Banfi P, Lugaresi A, Totaro R, Spitaleri D, Cocco E, Di Palma F, Maimone D, Valentino P, Torri Clerici V, Protti A, Maniscalco GT, Salemi G, Pesci I, Aguglia U, Lepore V, Filippi M, Trojano M, Amato MP. Multiple Sclerosis Progression and Relapse Activity in Children. JAMA Neurol 2024; 81:50-58. [PMID: 38010712 PMCID: PMC10682937 DOI: 10.1001/jamaneurol.2023.4455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
Importance Although up to 20% of patients with multiple sclerosis (MS) experience onset before 18 years of age, it has been suggested that people with pediatric-onset MS (POMS) are protected against disability because of greater capacity for repair. Objective To assess the incidence of and factors associated with progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) in POMS compared with typical adult-onset MS (AOMS) and late-onset MS (LOMS). Design, Setting, and Participants This cohort study on prospectively acquired data from the Italian MS Register was performed from June 1, 2000, to September 30, 2021. At the time of data extraction, longitudinal data from 73 564 patients from 120 MS centers were available in the register. Main Outcomes and Measures The main outcomes included age-related cumulative incidence and adjusted hazard ratios (HRs) for PIRA and RAW and associated factors. Exposures Clinical and magnetic resonance imaging features, time receiving disease-modifying therapy (DMT), and time to first DMT. Results After applying the inclusion and exclusion criteria, the study assessed 16 130 patients with MS (median [IQR] age at onset, 28.7 [22.8-36.2 years]; 68.3% female). Compared with AOMS and LOMS, patients with POMS had less disability, exhibited more active disease, and were exposed to DMT for a longer period. A first 48-week-confirmed PIRA occurred in 7176 patients (44.5%): 558 patients with POMS (40.4%), 6258 patients with AOMS (44.3%), and 360 patients with LOMS (56.8%) (P < .001). Factors associated with PIRA were older age at onset (AOMS vs POMS HR, 1.42; 95% CI, 1.30-1.55; LOMS vs POMS HR, 2.98; 95% CI, 2.60-3.41; P < .001), longer disease duration (HR, 1.04; 95% CI, 1.04-1.05; P < .001), and shorter DMT exposure (HR, 0.69; 95% CI, 0.64-0.74; P < .001). The incidence of PIRA was 1.3% at 20 years of age, but it rapidly increased approximately 7 times between 21 and 30 years of age (9.0%) and nearly doubled for each age decade from 40 to 70 years (21.6% at 40 years, 39.0% at 50 years, 61.0% at 60 years, and 78.7% at 70 years). The cumulative incidence of RAW events followed a similar trend from 20 to 60 years (0.5% at 20 years, 3.5% at 30 years, 7.8% at 40 years, 14.4% at 50 years, and 24.1% at 60 years); no further increase was found at 70 years (27.7%). Delayed DMT initiation was associated with higher risk of PIRA (HR, 1.16; 95% CI, 1.00-1.34; P = .04) and RAW (HR, 1.75; 95% CI, 1.28-2.39; P = .001). Conclusions and Relevance PIRA can occur at any age, and although pediatric onset is not fully protective against progression, this study's findings suggest that patients with pediatric onset are less likely to exhibit PIRA over a decade of follow-up. However, these data also reinforce the benefit for DMT initiation in patients with POMS, as treatment was associated with reduced occurrence of both PIRA and RAW regardless of age at onset.
Collapse
Affiliation(s)
- Pietro Iaffaldano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Emilio Portaccio
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Marta Simone
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Alessia Manni
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Tommaso Guerra
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Matteo Betti
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Ermelinda De Meo
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Luisa Pastò
- Department of Neurofarba, University of Florence, Florence, Italy
| | | | - Maria A. Rocca
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Ferrè
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Federico II University, Naples, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate (Varese), Italy
| | - Claudio Gasperini
- Centro Sclerosi Multipla–Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS. Annunziata, Chieti, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Department of Human Neuroscience, S. Andrea Hospital, Rome, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Paolo Gallo
- Department of Neurosciences, Multiple Sclerosis Centre–Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | | | | | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | | | - Paola Banfi
- Neurology and Stroke Unit, University of Insubria, Varese, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Rocco Totaro
- San Salvatore Hospital, Demyelinating Disease Center, L’Aquila, Italy
| | - Daniele Spitaleri
- Department of Neurology, AORN San G. Moscati di Avellino, Avellino, Italy
| | - Eleonora Cocco
- University of Cagliari, Department of Medical Science and Public Health, Centro Sclerosi Multipla, Cagliari, Italy
| | - Franco Di Palma
- Department of Neurology, ASST Lariana Ospedale S. Anna, Como, Italy
| | - Davide Maimone
- Department of Neurology, Ospedale Garibaldi, Catania, Italy
| | - Paola Valentino
- Institute of Neurology, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | | | | | | | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza Hospital, Fidenza, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Vito Lepore
- Public Health Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| |
Collapse
|
27
|
Bellanca CM, Augello E, Mariottini A, Bonaventura G, La Cognata V, Di Benedetto G, Cantone AF, Attaguile G, Di Mauro R, Cantarella G, Massacesi L, Bernardini R. Disease Modifying Strategies in Multiple Sclerosis: New Rays of Hope to Combat Disability? Curr Neuropharmacol 2024; 22:1286-1326. [PMID: 38275058 PMCID: PMC11092922 DOI: 10.2174/1570159x22666240124114126] [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: 05/04/2023] [Revised: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 01/27/2024] Open
Abstract
Multiple sclerosis (MS) is the most prevalent chronic autoimmune inflammatory- demyelinating disorder of the central nervous system (CNS). It usually begins in young adulthood, mainly between the second and fourth decades of life. Usually, the clinical course is characterized by the involvement of multiple CNS functional systems and by different, often overlapping phenotypes. In the last decades, remarkable results have been achieved in the treatment of MS, particularly in the relapsing- remitting (RRMS) form, thus improving the long-term outcome for many patients. As deeper knowledge of MS pathogenesis and respective molecular targets keeps growing, nowadays, several lines of disease-modifying treatments (DMT) are available, an impressive change compared to the relative poverty of options available in the past. Current MS management by DMTs is aimed at reducing relapse frequency, ameliorating symptoms, and preventing clinical disability and progression. Notwithstanding the relevant increase in pharmacological options for the management of RRMS, research is now increasingly pointing to identify new molecules with high efficacy, particularly in progressive forms. Hence, future efforts should be concentrated on achieving a more extensive, if not exhaustive, understanding of the pathogenetic mechanisms underlying this phase of the disease in order to characterize novel molecules for therapeutic intervention. The purpose of this review is to provide a compact overview of the numerous currently approved treatments and future innovative approaches, including neuroprotective treatments as anti-LINGO-1 monoclonal antibody and cell therapies, for effective and safe management of MS, potentially leading to a cure for this disease.
Collapse
Affiliation(s)
- Carlo Maria Bellanca
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Egle Augello
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Alice Mariottini
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Gabriele Bonaventura
- Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, 95126 Catania, Italy
| | - Valentina La Cognata
- Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, 95126 Catania, Italy
| | - Giulia Di Benedetto
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| | - Anna Flavia Cantone
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Giuseppe Attaguile
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Rosaria Di Mauro
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Luca Massacesi
- Department of Neurosciences Drugs and Child Health, University of Florence, Florence, Italy
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital, University of Catania, 95123 Catania, Italy
| |
Collapse
|
28
|
Lauerer M, McGinnis J, Bussas M, El Husseini M, Pongratz V, Engl C, Wuschek A, Berthele A, Riederer I, Kirschke JS, Zimmer C, Hemmer B, Mühlau M. Prognostic value of spinal cord lesion measures in early relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 95:37-43. [PMID: 37495267 PMCID: PMC10804039 DOI: 10.1136/jnnp-2023-331799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Spinal cord (SC) lesions have been associated with unfavourable clinical outcomes in multiple sclerosis (MS). However, the relation of whole SC lesion number (SCLN) and volume (SCLV) to the future occurrence and type of confirmed disability accumulation (CDA) remains largely unexplored. METHODS In this monocentric retrospective study, SC lesions were manually delineated. Inclusion criteria were: age between 18 and 60 years, relapsing-remitting MS, disease duration under 2 years and clinical follow-up of 5 years. The first CDA event after baseline, determined by a sustained increase in the Expanded Disability Status Scale over 6 months, was classified as either progression independent of relapse activity (PIRA) or relapse-associated worsening (RAW). SCLN and SCLV were compared between different (sub)groups to assess their prospective value. RESULTS 204 patients were included, 148 of which had at least one SC lesion and 59 experienced CDA. Patients without any SC lesions experienced significantly less CDA (OR 5.8, 95% CI 2.1 to 19.8). SCLN and SCLV were closely correlated (rs=0.91, p<0.001) and were both significantly associated with CDA on follow-up (p<0.001). Subgroup analyses confirmed this association for patients with PIRA on CDA (34 events, p<0.001 for both SC lesion measures) but not for RAW (25 events, p=0.077 and p=0.22). CONCLUSION Patients without any SC lesions are notably less likely to experience CDA. Both the number and volume of SC lesions on MRI are associated with future accumulation of disability largely independent of relapses.
Collapse
Affiliation(s)
- Markus Lauerer
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
| | - Julian McGinnis
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- Institute for AI in Medicine, Technical University, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
| | - Malek El Husseini
- Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
| | - Viola Pongratz
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
| | - Christina Engl
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
| | - Alexander Wuschek
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
| | - Isabelle Riederer
- Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Mark Mühlau
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
| |
Collapse
|
29
|
Dzau W, Sharmin S, Patti F, Izquierdo G, Eichau S, Prat A, Girard M, Duquette P, Onofrj M, Lugaresi A, Ozakbas S, Gerlach O, Boz C, Grammond P, Terzi M, Amato MP, La Spitaleri D, Ramo-Tello C, Maimone D, Cartechini E, Buzzard K, Skibina O, van der Walt A, Butzkueven H, Iuliano G, Soysal A, Kalincik T. Risk of secondary progressive multiple sclerosis after early worsening of disability. J Neurol Neurosurg Psychiatry 2023; 94:984-991. [PMID: 37414538 DOI: 10.1136/jnnp-2023-331748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Whether progression independent of relapse activity (PIRA) heralds earlier onset of secondary progressive multiple sclerosis (SPMS) and more rapid accumulation of disability during SPMS remains to be determined. We investigated the association between early PIRA, relapse-associated worsening (RAW) of disability and time to SPMS, subsequent disability progression and their response to therapy. METHODS This observational cohort study included patients with relapsing-remitting multiple sclerosis (RRMS) from the MSBase international registry across 146 centres and 39 countries. Associations between the number of PIRA and RAW during early multiple sclerosis (MS) (the initial 5 years of MS onset) were analysed with respect to: time to SPMS using Cox proportional hazards models adjusted for disease characteristics; and disability progression during SPMS, calculated as the change of Multiple Sclerosis Severity Scores over time, using multivariable linear regression. RESULTS 10 692 patients met the inclusion criteria: 3125 (29%) were men and the mean MS onset age was 32.2 years. A higher number of early PIRA (HR=1.50, 95% CI 1.28 to 1.76, p<0.001) and RAW (HR=2.53, 95% CI 2.25 to 2.85, p<0.001) signalled a higher risk of SPMS. A higher proportion of early disease-modifying therapy exposure (per 10%) reduced the effect of early RAW (HR=0.94, 95% CI 0.89 to 1.00, p=0.041) but not PIRA (HR=0.97, 95% CI 0.91 to 1.05, p=0.49) on SPMS risk. No association between early PIRA/RAW and disability progression during SPMS was found. CONCLUSIONS Early disability increase during RRMS is associated with a greater risk of SPMS but not the rate of disability progression during SPMS. The deterioration associated with early relapses represents a potentially treatable risk factor of SPMS. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12605000455662).
Collapse
Affiliation(s)
- Winston Dzau
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Francesco Patti
- Neuroscience, University of Catania Department of Surgical and Medical Sciences and Advanced Technologies 'G.F. Ingrassia', Catania, Italy
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Guillermo Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Alexandre Prat
- MS Center, CHUM, Montreal, Quebec, Canada
- Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Marc Girard
- MS Center, CHUM, Montreal, Quebec, Canada
- Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Pierre Duquette
- MS Center, CHUM, Montreal, Quebec, Canada
- Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara Department of Sciences, Chieti, Italy
| | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serkan Ozakbas
- Faculty of Medicine, Dokuz Eylul Universitesi, Izmir, Turkey
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Universiteit Maastricht, Maastricht, The Netherlands
| | - Cavit Boz
- Medical Faculty, Karadeniz Technical University, Trabzon, Trabzon, Turkey
| | - Pierre Grammond
- Department of Neurology, CIUSSS du Centre-Ouest-de-l'Ile-de-Montreal, Montreal, Quebec, Canada
| | - Murat Terzi
- Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Firenze, Italy
| | - Daniele La Spitaleri
- Department of Neurology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità San Giuseppe Moscati, Avellino, Italy
| | | | - Davide Maimone
- UO Neurologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Catania, Sicilia, Italy
| | | | - Katherine Buzzard
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neurology, Box Hill Hospital, Box Hill, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Olga Skibina
- Department of Neurology, Box Hill Hospital, Box Hill, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Neurology, The Alfred, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neurology, The Alfred, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neurology, The Alfred, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Gerardo Iuliano
- Department of Neurology, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona' Plesso 'Ruggi', Salerno, Italy
| | - Aysun Soysal
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Tomas Kalincik
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
30
|
Müller J, Cagol A, Lorscheider J, Tsagkas C, Benkert P, Yaldizli Ö, Kuhle J, Derfuss T, Sormani MP, Thompson A, Granziera C, Kappos L. Harmonizing Definitions for Progression Independent of Relapse Activity in Multiple Sclerosis: A Systematic Review. JAMA Neurol 2023; 80:1232-1245. [PMID: 37782515 DOI: 10.1001/jamaneurol.2023.3331] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Importance Emerging evidence suggests that progression independent of relapse activity (PIRA) is a substantial contributor to long-term disability accumulation in relapsing-remitting multiple sclerosis (RRMS). To date, there is no uniform agreed-upon definition of PIRA, limiting the comparability of published studies. Objective To summarize the current evidence about PIRA based on a systematic review, to discuss the various terminologies used in the context of PIRA, and to propose a harmonized definition for PIRA for use in clinical practice and future trials. Evidence Review A literature search was conducted using the search terms multiple sclerosis, PIRA, progression independent of relapse activity, silent progression, and progression unrelated to relapses in PubMed, Embase, Cochrane, and Web of Science, published between January 1990 and December 2022. Findings Of 119 identified single records, 48 eligible studies were analyzed. PIRA was reported to occur in roughly 5% of all patients with RRMS per annum, causing at least 50% of all disability accrual events in typical RRMS. The proportion of PIRA vs relapse-associated worsening increased with age, longer disease duration, and, despite lower absolute event numbers, potent suppression of relapses by highly effective disease-modifying therapy. However, different studies used various definitions of PIRA, rendering the comparability of studies difficult. Conclusion and Relevance PIRA is the most frequent manifestation of disability accumulation across the full spectrum of traditional MS phenotypes, including clinically isolated syndrome and early RRMS. The harmonized definition suggested here may improve the comparability of results in current and future cohorts and data sets.
Collapse
Affiliation(s)
- Jannis Müller
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alessandro Cagol
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Charidimos Tsagkas
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Pascal Benkert
- Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Özgür Yaldizli
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Jens Kuhle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Tobias Derfuss
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Maria Pia Sormani
- Department of Health Sciences, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alan Thompson
- Queen Square MS Centre, UCL Institute of Neurology, London, United Kingdom
- NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Cristina Granziera
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| |
Collapse
|
31
|
Ramanathan U, Besbris JM, Kramer NM, Yu AW, Solomon AJ, Jones CA, Mehta AK. Top Ten Tips Palliative Care Clinicians Should Know about Multiple Sclerosis. J Palliat Med 2023; 26:1555-1561. [PMID: 37074065 DOI: 10.1089/jpm.2023.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, neurodegenerative condition of the central nervous system, with distinct challenges due to its heterogeneous presentation, prognostic uncertainty, and variable clinical course of neurological and non-neurological symptoms and disability. Although there have been significant advances in management of MS, many patients experience disability progression. Despite MS being a frequent cause of neurological disability, particularly in young persons, involvement of palliative care physicians in the care of patients with MS has been limited. This article provides ten tips for palliative clinicians for caring for patients with MS and their care partners.
Collapse
Affiliation(s)
- Usha Ramanathan
- Department of Medicine and University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Jessica M Besbris
- Department of Internal Medicine and Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neha M Kramer
- Department of Neurology and Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Amy W Yu
- Division of Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ambereen K Mehta
- Department of Internal Medicine and Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
32
|
Mosconi P, Guerra T, Paletta P, D'Ettorre A, Ponzio M, Battaglia MA, Amato MP, Bergamaschi R, Capobianco M, Comi G, Gasperini C, Patti F, Pugliatti M, Ulivelli M, Trojano M, Lepore V. Data monitoring roadmap. The experience of the Italian Multiple Sclerosis and Related Disorders Register. Neurol Sci 2023; 44:4001-4011. [PMID: 37311951 PMCID: PMC10264214 DOI: 10.1007/s10072-023-06876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Over the years, disease registers have been increasingly considered a source of reliable and valuable population studies. However, the validity and reliability of data from registers may be limited by missing data, selection bias or data quality not adequately evaluated or checked. This study reports the analysis of the consistency and completeness of the data in the Italian Multiple Sclerosis and Related Disorders Register. METHODS The Register collects, through a standardized Web-based Application, unique patients. Data are exported bimonthly and evaluated to assess the updating and completeness, and to check the quality and consistency. Eight clinical indicators are evaluated. RESULTS The Register counts 77,628 patients registered by 126 centres. The number of centres has increased over time, as their capacity to collect patients. The percentages of updated patients (with at least one visit in the last 24 months) have increased from 33% (enrolment period 2000-2015) to 60% (enrolment period 2016-2022). In the cohort of patients registered after 2016, there were ≥ 75% updated patients in 30% of the small centres (33), in 9% of the medium centres (11), and in all the large centres (2). Clinical indicators show significant improvement for the active patients, expanded disability status scale every 6 months or once every 12 months, visits every 6 months, first visit within 1 year and MRI every 12 months. CONCLUSIONS Data from disease registers provide guidance for evidence-based health policies and research, so methods and strategies ensuring their quality and reliability are crucial and have several potential applications.
Collapse
Affiliation(s)
- Paola Mosconi
- Laboratorio di Ricerca per il Coinvolgimento dei Cittadini in Sanità, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy.
| | - Tommaso Guerra
- Dipartimento Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Università degli Studi Aldo Moro, Bari, Italy
| | - Pasquale Paletta
- Laboratorio di Ricerca per il Coinvolgimento dei Cittadini in Sanità, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy
| | - Antonio D'Ettorre
- Laboratorio di Ricerca per il Coinvolgimento dei Cittadini in Sanità, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | | | - Roberto Bergamaschi
- Centro Interdipartimentale Sclerosi Multipla, Fondazione Istituto Neurologico C. Mondino, Pavia, Italy
| | - Marco Capobianco
- Centro Sclerosi Multipla, SC Neurologia, AO Santa Croce E Carle, Cuneo, Italy
| | - Giancarlo Comi
- Casa di Cura del Policlinico, Università Vita Salute San Raffaele, Milan, Italy
| | - Claudio Gasperini
- UOC di Neurologia e Neurofisiopatologia Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | - Francesco Patti
- Centro Sclerosi Multipla AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - Maura Pugliatti
- Centro di Servizio e Ricerca sulla Sclerosi Multipla, AOU di Ferrara, Ferrara, Italy
| | - Monica Ulivelli
- Dipartimento di Scienze Mediche Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | - Maria Trojano
- Dipartimento Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Università degli Studi Aldo Moro, Bari, Italy
| | - Vito Lepore
- Laboratorio di Ricerca per il Coinvolgimento dei Cittadini in Sanità, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy
| |
Collapse
|
33
|
Thompson AJ, Moccia M, Amato MP, Calabresi PA, Finlayson M, Hawton A, Lublin FD, Marrie RA, Montalban X, Panzara M, Sormani MP, Strum J, Vickrey BG, Coetzee T. Do the current MS clinical course descriptors need to change and if so how? A survey of the MS community. Mult Scler 2023; 29:1363-1372. [PMID: 37691493 PMCID: PMC10580678 DOI: 10.1177/13524585231196786] [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: 06/25/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES The current clinical course descriptors of multiple sclerosis (MS) include a combination of clinical and magnetic resonance imaging (MRI) features. Recently there has been a growing call to base these descriptors more firmly on biological mechanisms. We investigated the implications of proposing a new mechanism-driven framework for describing MS. METHODS In a web-based survey, multiple stakeholders rated the need to change current MS clinical course descriptors, the definitions of disease course and their value in clinical practice and related topics. RESULTS We received 502 responses across 49 countries. In all, 77% of the survey respondents supported changing the current MS clinical course descriptors. They preferred a framework that informs treatment decisions, aids the design and conduct of clinical trials, allows patients to understand their disease, and links disease mechanisms and clinical expression of disease. Clinical validation before dissemination and ease of communication to patients were rated as the most important aspects to consider when developing any new framework for describing MS. CONCLUSION A majority of MS stakeholders agreed that the current MS clinical course descriptors need to change. Any change process will need to engage a wide range of affected stakeholders and be guided by foundational principles.
Collapse
Affiliation(s)
- Alan J Thompson
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, Faculty of Brain Sciences, University College London, London, UK
| | - Marcello Moccia
- Department of Molecular Biology and Molecular Biotechnology, Federico II University of Naples, Naples, Italy Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Peter A Calabresi
- Department of Neurology and The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queens University, Kingston, ON, Canada
| | - Annie Hawton
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Fred D Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruth Ann Marrie
- Departments of Medicine & Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia and Department of Neurology-Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy Coetzee
- National Multiple Sclerosis Society, 733 Third Avenue, New York, NY 10017, USA
- National Multiple Sclerosis Society, New York, NY, USA
| |
Collapse
|
34
|
Prosperini L, Haggiag S, Ruggieri S, Tortorella C, Gasperini C. Stopping Disease-Modifying Treatments in Multiple Sclerosis: A Systematic Review and Meta-Analysis of Real-World Studies. CNS Drugs 2023; 37:915-927. [PMID: 37740822 DOI: 10.1007/s40263-023-01038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The question of whether multiple sclerosis requires life-long disease-modifying treatments (DMTs) remains unanswered. Some studies suggest that older patients with stable disease may safely discontinue their DMTs, yet comprehensive evidence-based data are scarce and real-world studies have provided mixed results. OBJECTIVE The aim of this study was to assess the rate of disease reactivation and associated risk factors after discontinuation of DMTs in patients with multiple sclerosis. METHODS We searched scientific databases (PubMed/MEDLINE, Scopus and Google Scholar) to identify real-world studies published until 31 July, 2023 that reported the number of patients who experienced relapses and/or disability accrual (outcomes of interest) following a therapy discontinuation longer than 12 months. Magnetic resonance activity and treatment re-start after DMT discontinuation were also considered as additional outcomes. We excluded studies where therapy discontinuation was explicitly related to an unintended or planned pregnancy or preceded a treatment switch. We ran random-effects meta-analyses, subgroup analyses and meta-regression models to provide pooled estimates of post-discontinuation relapse and disability events, and to identify their potential moderators (predictors). RESULTS After an independent screening, 22 articles met the eligibility criteria, yielding a pooled sample size of 2942 patients followed for 1-7 years after discontinuation (11,689 patient-years). The pooled rates for relapse and disability events were 6.7 and 5.8 per 100 patient-years, respectively. However, available data did not allow us to disentangle isolated disability accrual from relapse-associated worsening. Studies including older patients (β = -0.65, p = 0.006), patients with a longer exposure to DMTs (β = -2.22, p = 0.001) and patients with a longer period of disease stability (β = -2.74, p = 0.002) showed a lower risk of relapse events. According to meta-regression equations, the risk of relapse events after DMT discontinuation became negligible (arbitrarily set at < 1% per year) at approximately 60 years of age, and after either 10 years of DMT exposure, or 8 years of disease stability. Additional analyses showed pooled rates for magnetic resonance imaging activity and re-start events of 16.7 and 17.5 per 100 patient-years, respectively. CONCLUSIONS Based on our quantitative synthesis of real-world data, in the absence of definitive answers from clinical trials, DMT discontinuation appears feasible with a high degree of certainty in selected patients. While our findings are robust regarding relapse events, future efforts are warranted to determine if DMT discontinuation is associated with isolated disability accrual.
Collapse
Affiliation(s)
- Luca Prosperini
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
| | - Shalom Haggiag
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University, Viale dell'Università 30, 00185, Rome, Italy
- Neuroimmunology Unit, Santa Lucia Foundation, Via del Fosso di Fiorano 64/65, 00143, Rome, Italy
| | - Carla Tortorella
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Claudio Gasperini
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| |
Collapse
|
35
|
Rosenstein I, Axelsson M, Novakova L, Malmeström C, Blennow K, Zetterberg H, Lycke J. Intrathecal kappa free light chain synthesis is associated with worse prognosis in relapsing-remitting multiple sclerosis. J Neurol 2023; 270:4800-4811. [PMID: 37314506 PMCID: PMC10511607 DOI: 10.1007/s00415-023-11817-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND While kappa free light chain (KFLC) index has become a useful diagnostic biomarker in multiple sclerosis (MS), its prognostic properties are less explored. B cells play a crucial role in MS pathogenesis, but the impact from increased intrathecal production of immunoglobulins and KFLC remains to be determined. Recently, it has become evident that insidious worsening is not confined to progressive MS but is also common in relapsing-remitting MS (RRMS), a feature known as progression independent of relapse activity (PIRA). METHODS We retrospectively identified 131 patients with clinically isolated syndrome or early RRMS who had determined KFLC index as part of their diagnostic workup. Demographic and clinical data were extracted from the Swedish MS registry. Associations of baseline KFLC index with evidence of disease activity (EDA) and PIRA were investigated in multivariable cox proportional hazards regression models. RESULTS KFLC index was significantly higher in PIRA (median 148.5, interquartile range [IQR] 106.9-253.5) compared with non-PIRA (78.26, IQR 28.93-186.5, p = 0.009). In a multivariable cox regression model adjusted for confounders, KFLC index emerged as an independent risk factor for PIRA (adjusted hazard ratio [aHR] 1.005, 95% confidence interval [CI] 1.002-1.008, p = 0.002). Dichotomized by the cut-off value KFLC index > 100, patients with KFLC index > 100 had an almost fourfold increase in the risk for developing PIRA. KFLC index was also predictive of evidence of disease activity during follow-up. CONCLUSIONS Our data indicate that high KFLC index at baseline is predictive of PIRA, EDA-3, and overall worse prognosis in MS.
Collapse
Affiliation(s)
- Igal Rosenstein
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden.
| | - Markus Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden
| | - Lenka Novakova
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden
| | - Clas Malmeström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Hong Kong Centre for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Blå Stråket 7, 413 45, Gothenburg, Sweden
| |
Collapse
|
36
|
Mariottini A, Muraro PA, Saccardi R. Should autologous hematopoietic stem cell transplantation be offered as a first-line disease modifying therapy to patients with multiple sclerosis? Mult Scler Relat Disord 2023; 78:104932. [PMID: 37572554 DOI: 10.1016/j.msard.2023.104932] [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: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 08/14/2023]
Abstract
In multiple sclerosis (MS), progression independent of new focal inflammation may commence shortly after disease onset, and it is increasingly revealed that the risk of disability accrual is reduced by early use of high-efficacy disease-modifying therapies (HE-DMTs). People with aggressive MS may therefore benefit from early treatment with autologous haematopoietic stem cell transplantation (AHSCT), a procedure inducing maximal immunosuppression followed by immune reconstitution, demonstrated to be superior to DMTs in one randomized clinical trial. However, in current practice prior failure to HE-DMTs is typically required to establish the indication for AHSCT. In the present article, the available evidence on the potential role of AHSCT as first-line treatment in aggressive MS and the rationale for its early use will be summarized. Proposed definitions of aggressive MS that could help identifying MS patients eligible for early treatment with AHSCT will also be discussed.
Collapse
Affiliation(s)
- Alice Mariottini
- Department of Brain Sciences, Imperial College London, London, United Kingdom; Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Paolo A Muraro
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Riccardo Saccardi
- Cell Therapy and Transfusion Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| |
Collapse
|
37
|
Rodriguez-Mogeda C, van Lierop ZYGJ, van der Pol SMA, Coenen L, Hogenboom L, Kamermans A, Rodriguez E, van Horssen J, van Kempen ZLE, Uitdehaag BMJ, Teunissen CE, Witte ME, Killestein J, de Vries HE. Extended interval dosing of ocrelizumab modifies the repopulation of B cells without altering the clinical efficacy in multiple sclerosis. J Neuroinflammation 2023; 20:215. [PMID: 37752582 PMCID: PMC10521424 DOI: 10.1186/s12974-023-02900-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Recent studies suggest that extended interval dosing of ocrelizumab, an anti-B cell therapy, does not affect its clinical effectiveness in most patients with multiple sclerosis (MS). However, it remains to be established whether certain B cell subsets are differentially repopulated after different dosing intervals and whether these subsets relate to clinical efficacy. METHODS We performed high-dimensional single-cell characterization of the peripheral immune landscape of patients with MS after standard (SID; n = 43) or extended interval dosing (EID; n = 37) of ocrelizumab and in non-ocrelizumab-treated (control group, CG; n = 28) patients with MS, using mass cytometry by time of flight (CyTOF). RESULTS The first B cells that repopulate after both ocrelizumab dosing schemes were immature, transitional and regulatory CD1d+ CD5+ B cells. In addition, we observed a higher percentage of transitional, naïve and regulatory B cells after EID in comparison with SID, but not of memory B cells or plasmablasts. The majority of repopulated B cell subsets showed an increased migratory phenotype, characterized by higher expression of CD49d, CD11a, CD54 and CD162. Interestingly, after EID, repopulated B cells expressed increased CD20 levels compared to B cells in CG and after SID, which was associated with a delayed repopulation of B cells after a subsequent ocrelizumab infusion. Finally, the number of/changes in B cell subsets after both dosing schemes did not correlate with any relapses nor progression of the disease. CONCLUSIONS Taken together, our data highlight that extending the dosing interval of ocrelizumab does not lead to increased repopulation of effector B cells. We show that the increase of CD20 expression on B cell subsets in EID might lead to longer depletion or less repopulation of B cells after the next infusion of ocrelizumab. Lastly, even though extending the ocrelizumab interval dosing alters B cell repopulation, it does not affect the clinical efficacy of ocrelizumab in our cohort of patients with MS.
Collapse
Affiliation(s)
- Carla Rodriguez-Mogeda
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Zoë Y. G. J. van Lierop
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Susanne M. A. van der Pol
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Loet Coenen
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Neurobiology and Aging, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Laura Hogenboom
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alwin Kamermans
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Ernesto Rodriguez
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
| | - Jack van Horssen
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Zoé L. E. van Kempen
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernard M. J. Uitdehaag
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Charlotte E. Teunissen
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Alzheimer Center Amsterdam, Amsterdam, The Netherlands
| | - Maarten E. Witte
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
| | - Joep Killestein
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Helga E. de Vries
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| |
Collapse
|
38
|
Vasileiou ES, Fitzgerald KC. Multiple Sclerosis Pathogenesis and Updates in Targeted Therapeutic Approaches. Curr Allergy Asthma Rep 2023; 23:481-496. [PMID: 37402064 DOI: 10.1007/s11882-023-01102-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE OF REVIEW In this review, we provide a comprehensive update on current scientific advances and emerging therapeutic approaches in the field of multiple sclerosis. RECENT FINDINGS Multiple sclerosis (MS) is a common disorder characterized by inflammation and degeneration within the central nervous system (CNS). MS is the leading cause of non-traumatic disability in the young adult population. Through ongoing research, an improved understanding of the disease underlying mechanisms and contributing factors has been achieved. As a result, therapeutic advancements and interventions have been developed specifically targeting the inflammatory components that influence disease outcome. Recently, a new type of immunomodulatory treatment, known as Bruton tyrosine kinase (BTK) inhibitors, has surfaced as a promising tool to combat disease outcomes. Additionally, there is a renewed interested in Epstein-Barr virus (EBV) as a major potentiator of MS. Current research efforts are focused on addressing the gaps in our understanding of the pathogenesis of MS, particularly with respect to non-inflammatory drivers. Significant and compelling evidence suggests that the pathogenesis of MS is complex and requires a comprehensive, multilevel intervention strategy. This review aims to provide an overview of MS pathophysiology and highlights the most recent advances in disease-modifying therapies and other therapeutic interventions.
Collapse
Affiliation(s)
- Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
39
|
Campagna MP, Lechner-Scott J, Maltby VE, Lea RA, Butzkueven H, Jokubaitis VG. Conceiving complexity: Biological mechanisms underpinning the lasting effect of pregnancy on multiple sclerosis outcomes. Autoimmun Rev 2023; 22:103388. [PMID: 37352902 DOI: 10.1016/j.autrev.2023.103388] [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: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 06/25/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune, demyelinating disease with the highest incidence in women of childbearing age. The effect of pregnancy on disease activity and progression is a primary concern for women with MS and their clinical teams. It is well established that inflammatory disease activity is naturally suppressed during pregnancy, followed by an increase postpartum. However, the long-term effect of pregnancy on disease progression is less understood. Having had a pregnancy before MS onset has been associated with an older age at first demyelinating event, an average delay of 3.4 years. After MS onset, there is conflicting evidence about the impact of pregnancy on long-term outcomes. The study with the longest follow-up to date showed that pregnancy was associated with a 0.36-point lower disability score after 10-years of disease in 1830 women. Understanding the biological mechanism by which pregnancy induces long-term beneficial effects on MS outcomes could provide mechanistic insights into the elusive determinants of secondary progression. Here, we review potential biological processes underlying this effect, including evidence that acute sex hormone exposure induces lasting changes to neurobiological and DNA methylation patterns, and how sustained methylation changes in immune cells can alter immune composition and function long-term.
Collapse
Affiliation(s)
- Maria Pia Campagna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Vicki E Maltby
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Rodney A Lea
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Centre for Genomics and Personalised Health, School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija G Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|
40
|
Zanghì A, Galgani S, Bellantonio P, Zaffaroni M, Borriello G, Inglese M, Romano S, Conte A, Patti F, Trojano M, Avolio C, D'Amico E. Relapse-associated worsening in a real-life multiple sclerosis cohort: the role of age and pyramidal phenotype. Eur J Neurol 2023; 30:2736-2744. [PMID: 37294976 DOI: 10.1111/ene.15910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/27/2023] [Accepted: 06/05/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE The overall disability in patients with relapsing-remitting multiple sclerosis is likely to be partly rather than entirely attributed to relapse. MATERIALS AND METHODS The aim was to investigate the determinants of recovery from first relapse and relapse-associated worsening (RAW) in relapsing-remitting multiple sclerosis patients from the Italian MS Registry during a 5-year epoch from the beginning of first-line disease-modifying therapy. To determine recovery, the functional system (FS) score was used to calculate the difference between the score on the date of maximum improvement and the score before the onset of relapse. Incomplete recovery was defined as a combination of partial (1 point in one FS) and poor recovery (2 points in one FS or 1 point in two FSs or any other higher combination). RAW was indicated by a confirmed disability accumulation measured by the Expanded Disability Status Scale score confirmed 6 months after the first relapse. RESULTS A total of 767 patients had at least one relapse within 5 years of therapy. Of these patients, 57.8% experienced incomplete recovery. Age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04; p = 0.007) and pyramidal phenotype were associated with incomplete recovery (OR = 2.1, 95% CI 1.41-3.14; p < 0.001). RAW was recorded in 179 (23.3%) patients. Age (OR = 1.02, 95% CI 1.01-1.04; p = 0.029) and pyramidal phenotype (OR = 1.84, 95% CI 1.18-2.88; p = 0.007) were the strongest predictors in the multivariable model. CONCLUSIONS Age and pyramidal phenotype were the strongest determinants of RAW in early disease epochs.
Collapse
Affiliation(s)
- Aurora Zanghì
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Simonetta Galgani
- Centro Sclerosi Multipla, Az. Osp. S. Camillo Forlanini, Rome, Italy
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Center, Gallarate Hospital, ASST della Valle Olona, Gallarate, Italy
| | | | - Matilde Inglese
- Centro Per Lo Studio E La Cura Della Sclerosi Multipla E Malattie Demielinizzanti, Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili, Clinica Neurologica-Ospedale Policlinico San Martino (DiNOGMI), Genoa, Italy
| | - Silvia Romano
- Neurology Unit, NESMOS Department, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonella Conte
- Multiple Sclerosis Center, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| |
Collapse
|
41
|
Voigt I, Inojosa H, Wenk J, Akgün K, Ziemssen T. Building a monitoring matrix for the management of multiple sclerosis. Autoimmun Rev 2023; 22:103358. [PMID: 37178996 DOI: 10.1016/j.autrev.2023.103358] [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: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Multiple sclerosis (MS) has a longitudinal and heterogeneous course, with an increasing number of therapy options and associated risk profiles, leading to a constant increase in the number of parameters to be monitored. Even though important clinical and subclinical data are being generated, treating neurologists may not always be able to use them adequately for MS management. In contrast to the monitoring of other diseases in different medical fields, no target-based approach for a standardized monitoring in MS has been established yet. Therefore, there is an urgent need for a standardized and structured monitoring as part of MS management that is adaptive, individualized, agile, and multimodal-integrative. We discuss the development of an MS monitoring matrix which can help facilitate data collection over time from different dimensions and perspectives to optimize the treatment of people with MS (pwMS). In doing so, we show how different measurement tools can combined to enhance MS treatment. We propose to apply the concept of patient pathways to disease and intervention monitoring, not losing track of their interrelation. We also discuss the use of artificial intelligence (AI) to improve the quality of processes, outcomes, and patient safety, as well as personalized and patient-centered care. Patient pathways allow us to track the patient's journey over time and can always change (e.g., when there is a switch in therapy). They therefore may assist us in the continuous improvement of monitoring in an iterative process. Improving the monitoring process means improving the care of pwMS.
Collapse
Affiliation(s)
- Isabel Voigt
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Hernan Inojosa
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Judith Wenk
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
| |
Collapse
|
42
|
Fuh-Ngwa V, Charlesworth JC, Zhou Y, van der Mei I, Melton PE, Broadley SA, Ponsonby AL, Simpson-Yap S, Lechner-Scott J, Taylor BV. The association between disability progression, relapses, and treatment in early relapse onset MS: an observational, multi-centre, longitudinal cohort study. Sci Rep 2023; 13:11584. [PMID: 37463930 DOI: 10.1038/s41598-023-38415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
The indirect contribution of multiple sclerosis (MS) relapses to disability worsening outcomes, and vice-versa, remains unclear. Disease modifying therapies (DMTs) are potential modulators of this association. Understanding how these endo-phenotypes interact may provide insights into disease pathogenesis and treatment practice in relapse-onset MS (ROMS). Utilising a unique, prospectively collected clinical data from a longitudinal cohort of 279 first demyelinating event cases followed for up to 15 years post-onset, we examined indirect associations between relapses and treatment and the risk of disability worsening, and vice-versa. Indirect association parameters were estimated using joint models for longitudinal and survival data. Early relapses within 2.5 years of MS onset predicted early disability worsening outcomes (HR = 3.45, C.I 2.29-3.61) per relapse, but did not contribute to long-term disability worsening thereinafter (HR = 0.21, C.I 0.15-0.28). Conversely, disability worsening outcomes significantly contributed to relapse risk each year (HR = 2.96, C.I 2.91-3.02), and persisted over time (HR = 3.34, C.I 2.90-3.86), regardless of DMT treatments. The duration of DMTs significantly reduced the hazards of relapses (1st-line DMTs: HR = 0.68, C.I 0.58-0.79; 3rd-line DMTs: HR = 0.37, C.I 0.32-0.44) and disability worsening events (1st-line DMTs: HR = 0.74, C.I 0.69-0.79; 3rd-line DMTs: HR = 0.90, C.I 0.85-0.95), respectively. Results from time-dynamic survival probabilities further revealed individuals having higher risk of future relapses and disability worsening outcomes, respectively. The study provided evidence that in ROMS, relapses accrued within 2.5 years of MS onset are strong indicators of disability worsening outcomes, but late relapses accrued 2.5 years post onset are not overt risk factors for further disability worsening. In contrast, disability worsening outcomes are strong positive predictors of current and subsequent relapse risk. Long-term DMT use and older age strongly influence the individual outcomes and their associations.
Collapse
Affiliation(s)
- Valery Fuh-Ngwa
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.
| | - Jac C Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Phillip E Melton
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Anne-Louise Ponsonby
- Florey Institute for Neuroscience and Mental Health, Parkville, VIC, 3052, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
- Neuroepidemiology Unit, Center for Epidemiology and Biostatistics, The University of Melbourne School of Population & Global Health, Melbourne, VIC, 3053, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health New Lambton, Hunter New England Health, New Lambton Heights, NSW, Australia
- Department of Neurology, The University of Newcastle Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.
| |
Collapse
|
43
|
Šubert M, Novotný M, Tykalová T, Srpová B, Friedová L, Uher T, Horáková D, Rusz J. Lexical and syntactic deficits analyzed via automated natural language processing: the new monitoring tool in multiple sclerosis. Ther Adv Neurol Disord 2023; 16:17562864231180719. [PMID: 37384113 PMCID: PMC10293520 DOI: 10.1177/17562864231180719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/13/2023] [Indexed: 06/30/2023] Open
Abstract
Background Impairment of higher language functions associated with natural spontaneous speech in multiple sclerosis (MS) remains underexplored. Objectives We presented a fully automated method for discriminating MS patients from healthy controls based on lexical and syntactic linguistic features. Methods We enrolled 120 MS individuals with Expanded Disability Status Scale ranging from 1 to 6.5 and 120 age-, sex-, and education-matched healthy controls. Linguistic analysis was performed with fully automated methods based on automatic speech recognition and natural language processing techniques using eight lexical and syntactic features acquired from the spontaneous discourse. Fully automated annotations were compared with human annotations. Results Compared with healthy controls, lexical impairment in MS consisted of an increase in content words (p = 0.037), a decrease in function words (p = 0.007), and overuse of verbs at the expense of noun (p = 0.047), while syntactic impairment manifested as shorter utterance length (p = 0.002), and low number of coordinate clause (p < 0.001). A fully automated language analysis approach enabled discrimination between MS and controls with an area under the curve of 0.70. A significant relationship was detected between shorter utterance length and lower symbol digit modalities test score (r = 0.25, p = 0.008). Strong associations between a majority of automatically and manually computed features were observed (r > 0.88, p < 0.001). Conclusion Automated discourse analysis has the potential to provide an easy-to-implement and low-cost language-based biomarker of cognitive decline in MS for future clinical trials.
Collapse
Affiliation(s)
- Martin Šubert
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Michal Novotný
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Tereza Tykalová
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Barbora Srpová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lucie Friedová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomáš Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horáková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 160 00 Prague, Czech Republic
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Department of Neurology and ARTORG Center for Biomedical Engineering Research, Inselspital (Bern University Hospital), University of Bern, Bern, Switzerland
| |
Collapse
|
44
|
Lorefice L, Mellino P, Fenu G, Cocco E. How to measure the treatment response in progressive multiple sclerosis: Current perspectives and limitations in clinical settings'. Mult Scler Relat Disord 2023; 76:104826. [PMID: 37327601 DOI: 10.1016/j.msard.2023.104826] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/04/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
New treatment options are available for active progressive multiple sclerosis (MS), including primary and secondary progressive forms. Several pieces of evidence have recently suggested a "window of beneficial treatment opportunities," principally in the early stages of progression. However, for progressive MS, which is characterised by an inevitable tendency to get worse, it is crucial to redefine the "response to treatment" beyond the concept of "no evidence of disease activity" (NEDA-3), which was initially conceived to evaluate disease outcomes in relapsing-remitting form, albeit it is currently applied to all MS cases in clinical practice. This review examines the current perspectives and limitations in assessing the effectiveness of DMTs and disease outcomes in progressive MS, the current criteria applied in defining the response to DMTs, and the strengths and limitations of clinical scales and tools for evaluating MS evolution and patient perception. Additionally, the impact of age and comorbidities on the assessment of MS outcomes was examined.
Collapse
Affiliation(s)
- L Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Address: via Is Guadazzonis 2, Cagliari 09126, Italy.
| | - P Mellino
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Address: via Is Guadazzonis 2, Cagliari 09126, Italy
| | - G Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Address: via Is Guadazzonis 2, Cagliari 09126, Italy
| |
Collapse
|
45
|
Sainz de la Maza S, Gómez-Ballesteros R, Borges M, Martín-Martínez J, Sotoca J, Alonso A, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco-Quílez MR, Dotor García-Soto J, del Campo-Amigo M, Navarro-Cantó L, Agüera E, Garcés-Redondo M, Carmona O, Gabaldón-Torres L, Forero L, Hervàs M, Medrano N, Maurino J, Castillo-Triviño T. Detecting disability using self-reported and clinical assessments in early-stage relapsing-remitting multiple sclerosis: Looking for a complementary approach. Mult Scler J Exp Transl Clin 2023; 9:20552173231169475. [PMID: 37187856 PMCID: PMC10176560 DOI: 10.1177/20552173231169475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/23/2023] [Indexed: 05/17/2023] Open
Abstract
Disability accrual is mainly driven by progression independent of relapse activity, which is present even in early stages of relapsing-remitting multiple sclerosis (RRMS) and sometimes overlooked. This multicenter, non-interventional study evaluated whether patient-reported outcomes measures (PROMs) could capture disability in 189 early-stage RRMS patients (mean age: 36.1 ± 9.4 years, 71.4% female, mean disease duration: 1.4 ± 0.8 years, median EDSS: 1.0). The 9-Hole Peg Test (9-HPT), NeuroQoL Upper Extremity (NeuroQoL-UE), Timed 25-Foot Walk (T25-FW), Multiple Sclerosis Walking Scale (MSWS-12), Symbol Digit Modalities Test (SDMT), and Perceived Deficits Questionnaire (PDQ-5) were used to assess hand function, gait, and cognition, respectively. These functions were at least mildly affected in this early-stage population, finding significant correlations between PROMs and clinical assessments. PROMs could enable early-stage RRMS patients to communicate their perceived disability in different domains, assisting clinicians in disease monitoring and decision making.
Collapse
Affiliation(s)
- Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario
Ramón y Cajal, IRyCIS, Universidad de Alcalá, Madrid, Spain
| | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen
Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari Mútua
Terrassa, Terrassa, Spain
| | - Ana Alonso
- Department of Neurology, Hospital Regional
Universitario de Málaga, Málaga, Spain
| | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de
Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación
Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari
Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de
Vilanova, Lleida, Spain
| | | | | | - María del Campo-Amigo
- Department of Neurology, Complexo Hospitalario
Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de
Elche, Elche, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital
Universitario Reina Sofía, Córdoba, Spain
| | - Moisés Garcés-Redondo
- Department of Neurology, Hospital Clínico Universitario
Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut
Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital
Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervàs
- Department of Neurology, Consorci Corporació Sanitària
Parc Taulí, Sabadell, Spain
| | | | | | | |
Collapse
|
46
|
Advances in Neurodegenerative Diseases. J Clin Med 2023; 12:jcm12051709. [PMID: 36902495 PMCID: PMC10002914 DOI: 10.3390/jcm12051709] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Neurological disorders are the leading cause of physical and cognitive disability across the globe, currently affecting approximately 15% of the worldwide population [...].
Collapse
|
47
|
Peeters G, Van Remoortel A, Nagels G, Van Schependom J, D'haeseleer M. Occurrence and Severity of Coronavirus Disease 2019 Are Associated With Clinical Disability Worsening in Patients With Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200089. [PMID: 36807080 PMCID: PMC9942531 DOI: 10.1212/nxi.0000000000200089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/09/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Large-scale observational studies have shown that, in patients with multiple sclerosis (MS), the risk of becoming more severely ill from coronavirus disease 2019 (COVID-19) is determined by older age, male sex, cardiovascular comorbidities, African American ethnicity, progressive disease, recent use of corticosteroids, and B cell-depleting disease-modifying treatment. In contrast, the effect of COVID-19 on the disease course of MS has been studied much less extensively. Our main goal was to explore whether COVID-19 is associated with accelerated clinical disability worsening in patients with MS. METHODS Since March 2020, demographics and infectious outcome (categorized as ambulatory, hospitalized, and/or death) of patients with MS who developed COVID-19 have been collected at the Belgian National MS Center in Melsbroek. On February 28, 2022, this database was locked and complemented with clinical disability measures-Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FWT), 9-Hole Peg Test (9HPT), and Symbol Digit Modalities Test (SDMT)-that were available from a larger local database, obtained during routine medical follow-up. For each parameter, the first 2 assessments before COVID-19 diagnosis (T0 and T1; T1 is the closest to COVID-19 diagnosis), and the first thereafter (T2), were retrieved. RESULTS We identified 234 unique cases of COVID-19. Thirty-one patients were hospitalized (13.2%), and 5 died (2.1%) as a result of their infection. Among survivors with complete EDSS results (N = 138), mean annualized T1-to-T2 EDSS worsening was more pronounced, compared with the respective change between T0 and T1 (0.3 ± 0.9 vs 0.1 ± 0.9, p = 0.012). No such differences were found for the T25FWT, 9HPT, and SDMT scores. Severe COVID-19 (hospitalization) was associated with clinically relevant T1-to-T2 EDSS worsening (OR 2.65, p = 0.042). Vaccination coverage in the total cohort was 53.8%. Being unprotected by vaccination at the time of infection was associated with a worse COVID-19 outcome (hospitalization and/or death; OR 3.52, p = 0.002) but not with clinically relevant T1-to-T2 EDSS worsening. DISCUSSION The occurrence and severity of COVID-19 are both associated with clinical disability worsening in patients with MS. Vaccination protects against a more severe course of COVID-19 in this specific population. TRIAL REGISTRATION INFORMATION The study has been registered at ClinicalTrials.gov (study registration number: NCT05403463).
Collapse
Affiliation(s)
| | | | | | | | - Miguel D'haeseleer
- From the Universitair Ziekenhuis Brussel (UZ Brussel) (G.P., G.N., M.D.), Department of Neurology, Belgium; Nationaal Multiple Sclerose Centrum (NMSC) (G.P., A.V.R., M.D.), Melsbroek, Belgium; Vrije Universiteit Brussel (VUB) (G.N., J.V.S., M.D.), Center for Neurosciences (C4N), NEUR and AIMS, Brussels, Belgium; Icometrix (G.N.), Leuven, Belgium; and Vrije Universiteit Brussel (VUB) (J.V.S.), Department of Electronics and Informatics (ETRO), Belgium.
| |
Collapse
|
48
|
Tur C, Carbonell-Mirabent P, Cobo-Calvo Á, Otero-Romero S, Arrambide G, Midaglia L, Castilló J, Vidal-Jordana Á, Rodríguez-Acevedo B, Zabalza A, Galán I, Nos C, Salerno A, Auger C, Pareto D, Comabella M, Río J, Sastre-Garriga J, Rovira À, Tintoré M, Montalban X. Association of Early Progression Independent of Relapse Activity With Long-term Disability After a First Demyelinating Event in Multiple Sclerosis. JAMA Neurol 2023; 80:151-160. [PMID: 36534392 PMCID: PMC9856884 DOI: 10.1001/jamaneurol.2022.4655] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Progression independent of relapse activity (PIRA) is the main event responsible for irreversible disability accumulation in relapsing multiple sclerosis (MS). Objective To investigate clinical and neuroimaging predictors of PIRA at the time of the first demyelinating attack and factors associated with long-term clinical outcomes of people who present with PIRA. Design, Setting, and Participants This cohort study, conducted from January 1, 1994, to July 31, 2021, included patients with a first demyelinating attack from multiple sclerosis; patients were recruited from 1 study center in Spain. Patients were excluded if they refused to participate, had alternative diagnoses, did not meet protocol requirements, had inconsistent demographic information, or had less than 3 clinical assessments. Exposures Exposures included (1) clinical and neuroimaging features at the first demyelinating attack and (2) presenting PIRA, ie, confirmed disability accumulation (CDA) in a free-relapse period at any time after symptom onset, within (vs after) the first 5 years of the disease (ie, early/late PIRA), and in the presence (vs absence) of new T2 lesions in the previous 2 years (ie, active/nonactive PIRA). Main Outcomes and Measures Expanded Disability Status Scale (EDSS) yearly increase rates since the first attack and adjusted hazard ratios (HRs) for predictors of time to PIRA and time to EDSS 6.0. Results Of the 1128 patients (mean [SD] age, 32.1 [8.3] years; 781 female individuals [69.2%]) included in the study, 277 (25%) developed 1 or more PIRA events at a median (IQR) follow-up time of 7.2 (4.6-12.4) years (for first PIRA). Of all patients with PIRA, 86 of 277 (31%) developed early PIRA, and 73 of 144 (51%) developed active PIRA. Patients with PIRA were slightly older, had more brain lesions, and were more likely to have oligoclonal bands than those without PIRA. Older age at the first attack was the only predictor of PIRA (HR, 1.43; 95% CI, 1.23-1.65; P < .001 for each older decade). Patients with PIRA had steeper EDSS yearly increase rates (0.18; 95% CI, 0.16-0.20 vs 0.04; 95% CI, 0.02-0.05; P < .001) and an 8-fold greater risk of reaching EDSS 6.0 (HR, 7.93; 95% CI, 2.25-27.96; P = .001) than those without PIRA. Early PIRA had steeper EDSS yearly increase rates than late PIRA (0.31; 95% CI, 0.26-0.35 vs 0.13; 95% CI, 0.10-0.16; P < .001) and a 26-fold greater risk of reaching EDSS 6.0 from the first attack (HR, 26.21; 95% CI, 2.26-303.95; P = .009). Conclusions and Relevance Results of this cohort study suggest that for patients with multiple sclerosis, presenting with PIRA after a first demyelinating event was not uncommon and suggests an unfavorable long-term prognosis, especially if it occurs early in the disease course.
Collapse
Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Otero-Romero
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
49
|
Granziera C, Derfuss T, Kappos L. Time to Change the Current Clinical Classification of Multiple Sclerosis? JAMA Neurol 2023; 80:128-130. [PMID: 36534379 DOI: 10.1001/jamaneurol.2022.4156] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology, Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Derfuss
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology, Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology, Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
50
|
Correale J, Rush CA, Barboza A. Are highly active and aggressive multiple sclerosis the same entity? Front Neurol 2023; 14:1132170. [PMID: 36937521 PMCID: PMC10020517 DOI: 10.3389/fneur.2023.1132170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Jorge Correale
- Departamento de Neurología, Fleni, Buenos Aires, Argentina
- Instituto de Química y Fisicoquímica Biológicas (IQUIFIB), Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
- *Correspondence: Jorge Correale ;
| | - Carolina A. Rush
- Department of Medicine-Neurosciences, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrés Barboza
- Departamento de Neurologia, Hospital Central de Mendoza, Mendoza, Argentina
| |
Collapse
|