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Ziccardi S, Pisani AI, Schiavi GM, Guandalini M, Crescenzo F, Colombi A, Peloso A, Tamanti A, Bertolazzo M, Marastoni D, Calabrese M. Cortical lesions at diagnosis predict long-term cognitive impairment in multiple sclerosis: A 20-year study. Eur J Neurol 2023; 30:1378-1388. [PMID: 36692863 DOI: 10.1111/ene.15697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Although cognitive impairment (CI) is frequent in multiple sclerosis (MS) patients, few studies (and with conflicting results) have evaluated early predictors of CI in the long term. We aimed at determining associations between early clinical/neuroradiological variables with reference to CI after 20 years of MS. METHODS We investigated in 170 MS patients the relationship between clinical/magnetic resonance imaging (MRI) data at diagnosis and cognitive status almost 20 years after MS onset. Among others, number and volume of both white matter lesions (WMLs) and cortical lesions (CLs) were evaluated at diagnosis and after 2 years. All MS patients were followed over time and underwent a comprehensive neuropsychological assessment at the end of study. Advanced statistical methods (unsupervised cluster analysis and random forest model) were conducted. RESULTS CI patients showed higher focal cortical pathology at diagnosis compared to cognitively normal subjects (p < 0.001). Volumes of both WMLs and CLs emerged as the MRI metrics most associated with long-term CI. Moreover, number of CLs (especially ≥3) was also strongly associated with long-term CI (≥3 CLs: odds ratio [OR] = 3.7, 95% confidence interval = 1.8-7.5, p < 0.001), more than number of WMLs; the optimal cutoff of three CLs (area under the curve = 0.67, specificity = 75%, sensitivity = 55%) was estimated according to the risk of developing CI. CONCLUSIONS These results highlight the impact of considering both white and gray matter focal damage from early MS stages. Given the low predictive value of WML number and the poor clinical applicability of lesion volume estimation in the daily clinical context, the evaluation of number of CLs could represent a reliable prognostic marker of CI.
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Affiliation(s)
- Stefano Ziccardi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Isabella Pisani
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Marco Schiavi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Annalisa Colombi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Peloso
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Bertolazzo
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Damiano Marastoni
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
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2
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Darazam IA, Rabiei MM, Moradi O, Gharehbagh FJ, Roozbeh M, Nourinia R, Hatami F, Shojaei M, Lotfollahi L. A Case of Fingolimod-associated Cryptococcal Meningitis. Curr HIV Res 2022; 20:337-342. [PMID: 35770404 DOI: 10.2174/1570162x20666220629124225] [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: 01/20/2022] [Revised: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Leukopenia, a rare adverse effect of Fingolimod therapy, paves the way for opportunistic infections. In this study, we reported rare fingolimod associated cryptococcal meningitis. CASE PRESENTATION A 39-year-old woman with RRMS was referred to the emergency department. The patient's major complaints were headache, fever, weakness, and progressive loss of consciousness within the last two days prior to the referral. The patient had a history of hospitalization due to RRMS [two times]. In the second hospitalization, interferon Beta-1a was replaced with Fingolimod. Using polymerase chain reaction, Cryptococcus neoformans was detected in CSF. Liposomal amphotericin B and fluconazole [800 mg per day] were started. Six weeks later, the patient was discharged without any major complaints. CONCLUSION Albeit fingolimod associated cryptococcal meningitis is a rare event, Fingolimod therapy in patients with MS should be performed cautiously. Regular follow-ups may give rise to a timely diagnosis of probable fingolimod associated cryptococcal meningitis. Fingolimod therapy can lead to lymphocytopenia and various infections. We, therefore, suggest that intermittent blood lymphocyte counts as well as monitoring of clinical manifestations among MS patients treated with Fingolimod to avoid additional neurological and physical disabilities in these patients.
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Affiliation(s)
- Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Rabiei
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Moradi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Javandoust Gharehbagh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Roozbeh
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Firouze Hatami
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maziar Shojaei
- Department of Neurology, Loghman Hakim Hospital, Kamali, Iran
| | - Legha Lotfollahi
- Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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GANAB as a Novel Biomarker in Multiple Sclerosis: Correlation with Neuroinflammation and IFI35. Pharmaceuticals (Basel) 2021; 14:ph14111195. [PMID: 34832977 PMCID: PMC8625565 DOI: 10.3390/ph14111195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 12/23/2022] Open
Abstract
Multiple sclerosis (MS) still lacks reliable biomarkers of neuroinflammation predictive for disease activity and treatment response. Thus, in a prospective study we assessed 55 MS patients (28 interferon (IFN)-treated, 10 treated with no-IFN therapies, 17 untreated) and 20 matched healthy controls (HCs) for the putative correlation of the densitometric expression of glucosidase II alpha subunit (GANAB) with clinical/paraclinical parameters and with interferon-induced protein 35 (IFI35). We also assessed the disease progression in terms of the Rio Score (RS) in order to distinguish the responder patients to IFN therapy (RS = 0) from the non-responder ones (RS ≥ 1). We found GANAB to be 2.51-fold downregulated in the IFN-treated group with respect to the untreated one (p < 0.0001) and 3.39-fold downregulated in responder patients compared to the non-responders (p < 0.0001). GANAB correlated directly with RS (r = 0.8088, p < 0.0001) and lesion load (LL) (r = 0.5824, p = 0.0014) in the IFN-treated group and inversely with disease duration (DD) (r = −0.6081, p = 0.0096) in the untreated one. Lower mean values were expressed for GANAB than IFI35 in IFN responder (p < 0.0001) and higher mean values in the non-responder patients (p = 0.0022). Inverse correlations were also expressed with IFI35 in the overall patient population (r = −0.6468, p < 0.0001). In conclusion, the modular expression of GANAB reflects IFI35, RS, DD, and LL values, making it a biomarker of neuroinflammation that is predictive for disease activity and treatment response in MS.
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Bajrami A, Magliozzi R, Pisani AI, Pizzini FB, Crescenzo F, Marastoni D, Calabrese M. Volume changes of thalamus, hippocampus and cerebellum are associated with specific CSF profile in MS. Mult Scler 2021; 28:550-560. [PMID: 34378437 DOI: 10.1177/13524585211031786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The underlying pathogenesis of surface-in grey matter abnormalities in MS, demonstrated by both neuropathology and advanced MRI analyses, is under investigation and it might be related to CSF-mediated mechanism of inflammation and/or damage. OBJECTIVE To examine the link of CSF inflammatory profile with the damage of three regions early-involved in MS and bordering with CSF: thalamus, hippocampus and cerebellum. METHODS In this longitudinal, prospective study, we evaluated, in 109 relapsing-remitting MS patients, at diagnosis and after 2-year follow-up, the association between the baseline CSF level of 19 inflammatory mediators and the volume changes of thalamus, hippocampus, cerebellar cortex and control regions (globus pallidus, putamen). RESULTS The multivariable analysis showed that the CXCL13 and sCD163 CSF levels at baseline were independent predictors of thalamus (Rmodel2=0.80; p < 0.001) and hippocampus (Rmodel2=0.47; p < 0.001) volume change after 2-year follow-up. These molecules, plus CCL25, IFN-γ and fibrinogen, were independent predictors of the cerebellar cortex volume loss (Rmodel2=0.60; p < 0.001). No independent predictors of volume changes of the control regions were found. CONCLUSION Our results indicate an association between the CSF inflammatory profile and grey matter volume loss of regions anatomically close to CSF boundaries, thus supporting the hypothesis of a surface-in GM damage in MS.
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Affiliation(s)
- Albulena Bajrami
- Multiple Sclerosis Specialist Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberta Magliozzi
- Multiple Sclerosis Specialist Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anna I Pisani
- Multiple Sclerosis Specialist Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca B Pizzini
- Department of Diagnostic and Pathology, Integrated University Hospital of Verona, Neuroradiology & Radiology Units, Verona, Italy
| | - Francesco Crescenzo
- Multiple Sclerosis Specialist Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy/Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | - Damiano Marastoni
- Multiple Sclerosis Specialist Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Multiple Sclerosis Specialist Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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5
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Pisani AI, Scalfari A, Crescenzo F, Romualdi C, Calabrese M. A novel prognostic score to assess the risk of progression in relapsing-remitting multiple sclerosis patients. Eur J Neurol 2021; 28:2503-2512. [PMID: 33835665 PMCID: PMC8360167 DOI: 10.1111/ene.14859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/03/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND At the patient level, the prognostic value of several features that are known to be associated with an increased risk of converting from relapsing-remitting (RR) to secondary phase (SP) multiple sclerosis (MS) remains limited. METHODS Among 262 RRMS patients followed up for 10 years, we assessed the probability of developing the SP course based on clinical and conventional and non-conventional magnetic resonance imaging (MRI) parameters at diagnosis and after 2 years. We used a machine learning method, the random survival forests, to identify, according to their minimal depth (MD), the most predictive factors associated with the risk of SP conversion, which were then combined to compute the secondary progressive risk score (SP-RiSc). RESULTS During the observation period, 69 (26%) patients converted to SPMS. The number of cortical lesions (MD = 2.47) and age (MD = 3.30) at diagnosis, the global cortical thinning (MD = 1.65), the cerebellar cortical volume loss (MD = 2.15) and the cortical lesion load increase (MD = 3.15) over the first 2 years exerted the greatest predictive effect. Three patients' risk groups were identified; in the high-risk group, 85% (46/55) of patients entered the SP phase in 7 median years. The SP-RiSc optimal cut-off estimated was 17.7 showing specificity and sensitivity of 87% and 92%, respectively, and overall accuracy of 88%. CONCLUSIONS The SP-RiSc yielded a high performance in identifying MS patients with high probability to develop SPMS, which can help improve management strategies. These findings are the premise of further larger prospective studies to assess its use in clinical settings.
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Affiliation(s)
- Anna Isabella Pisani
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Francesco Crescenzo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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Chase Huizar C, Raphael I, Forsthuber TG. Genomic, proteomic, and systems biology approaches in biomarker discovery for multiple sclerosis. Cell Immunol 2020; 358:104219. [PMID: 33039896 PMCID: PMC7927152 DOI: 10.1016/j.cellimm.2020.104219] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
Multiple sclerosis (MS) is a neuroinflammatory disorder characterized by autoimmune-mediated inflammatory lesions in CNS leading to myelin damage and axonal loss. MS is a heterogenous disease with variable and unpredictable disease course. Due to its complex nature, MS is difficult to diagnose and responses to specific treatments may vary between individuals. Therefore, there is an indisputable need for biomarkers for early diagnosis, prediction of disease exacerbations, monitoring the progression of disease, and for measuring responses to therapy. Genomic and proteomic studies have sought to understand the molecular basis of MS and find biomarker candidates. Advances in next-generation sequencing and mass-spectrometry techniques have yielded an unprecedented amount of genomic and proteomic data; yet, translation of the results into the clinic has been underwhelming. This has prompted the development of novel data science techniques for exploring these large datasets to identify biologically relevant relationships and ultimately point towards useful biomarkers. Herein we discuss optimization of omics study designs, advances in the generation of omics data, and systems biology approaches aimed at improving biomarker discovery and translation to the clinic for MS.
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Affiliation(s)
- Carol Chase Huizar
- Department of Biology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Itay Raphael
- Department of Neurological Surgery, University of Pittsburgh, UPMC Children's Hospital, Pittsburgh, PA, USA.
| | - Thomas G Forsthuber
- Department of Biology, University of Texas at San Antonio, San Antonio, TX, USA.
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7
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Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Double filtration plasmapheresis (DFPP) is an emerging semi-selective apheretic method for treating immuno-mediated neurological diseases. Here we report the first case of steroid-refractory relapsed multiple sclerosis (MS) on Fingolimod (FTY), treated effectively by this technique, in a 37-year-old woman. This condition is thought to be caused by soluble inflammatory species, but its demyelinating pattern is unknown; moreover, despite megadoses of intravenous 6-methyl prednisolone, it induces severe neurological deterioration, but dramatically responded to DFPP in our patient. The clinical improvement was driven by a strong DFPP-induced anti-inflammatory effect, with significant reduction of C3/C4 components, total gamma globulin concentrations (IgG), and gamma-fibrinogen (FGG), resulting in a brain pseudoatrophy phenomenon. Our findings are: first, the steroid-refractory relapsed MS on FTY, however serious, can be treated with DFPP; second, given the good clinical improvement due to the DFPP-induced neuroinflammatory components removal, this clinical condition can be associated with a Lucchinetti pattern II of demyelination.
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8
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De Masi R, Orlando S. IFI35 as a biomolecular marker of neuroinflammation and treatment response in multiple sclerosis. Life Sci 2020; 259:118233. [PMID: 32781067 DOI: 10.1016/j.lfs.2020.118233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/22/2020] [Accepted: 08/05/2020] [Indexed: 02/08/2023]
Abstract
Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) with unpredictable clinical outcome. As such, there is an urgent need to identify biomarkers that can predict the treatment response. Therefore, in an open-label, clinical, paraclinical and molecular prospective study, we assessed 50 interferon (IFN) treated MS patients for Rio Score (RS)/Modified Rio Score (MRS) and densitometric expression of the interferon-induced protein 35 (IFI35), a signal-protein with potential to be clinically relevant in the management of the disease. We found 4.92-fold upregulated IFI35 in IFN-treated MS group respect to healthy controls (p < .0001) and 2.31-fold respect to untreated MS group (p < .0001). Moreover, IFI35 expression profile correlated with RS and MRS rank values (r = -0.6018, p < .0001; r = -0.620, p < .0001), white matter volume (r = -0.5041; p = .0017) and cerebral lesion load (r = -0.5075; p = .0026). Finally, the main proportion of IFN-treated MS patients non-reaching the 65% threshold in IFI35 expression leaved the RS/MRS rank value 0 in a period ranging from 5 to 15 months (p < .0001) from the study entry; instead, all patients that reaching this threshold maintained the RS/MRS value 0 until the study end (p < .0001). In conclusion, the expression level of IFI35 in untreated MS patients highlights a correlation with neuroinflammation. Furthermore, IFI35 expression in IFN-treated MS patients shows a modular correlation between dosing regimes, which is predictive for long-term clinical outcome and drug efficacy.
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Affiliation(s)
- Roberto De Masi
- Laboratory of Neuroproteomics, Multiple Sclerosis Centre, "F. Ferrari" Hospital, 73042 Casarano, Lecce, Italy; Complex Operative Unit of Neurology, "F. Ferrari" Hospital, 73042 Casarano, Lecce, Italy
| | - Stefania Orlando
- Laboratory of Neuroproteomics, Multiple Sclerosis Centre, "F. Ferrari" Hospital, 73042 Casarano, Lecce, Italy; Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, University of the Salento, 73100 Lecce, Italy.
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9
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Ayatollahi SA, Ghafouri-Fard S, Taheri M, Noroozi R. The efficacy of interferon-beta therapy in multiple sclerosis patients: investigation of the RORA gene as a predictive biomarker. THE PHARMACOGENOMICS JOURNAL 2019; 20:271-276. [DOI: 10.1038/s41397-019-0114-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 09/09/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023]
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10
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Marastoni D, Buriani A, Pisani AI, Crescenzo F, Zuco C, Fortinguerra S, Sorrenti V, Marenda B, Romualdi C, Magliozzi R, Monaco S, Calabrese M. Increased NK Cell Count in Multiple Sclerosis Patients Treated With Dimethyl Fumarate: A 2-Year Longitudinal Study. Front Immunol 2019; 10:1666. [PMID: 31379857 PMCID: PMC6658905 DOI: 10.3389/fimmu.2019.01666] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/03/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Dimethyl fumarate (DMF) is a disease-modifying drug for relapsing-remitting multiple sclerosis. Among others, DMF impedes immune activation by shifting the balance between inflammatory and regulatory cell types and by inducing apoptosis-triggered lymphopenia. Although the decrease in lymphocyte count is an early effect of the drug in several patients, the long-term impact on lymphocyte subsets is largely unknown. Methods: We performed a 2-years observational study on total lymphocyte count and subsets thereof by flow cytometry of peripheral blood of 38 multiple sclerosis patients in treatment with DMF. Data were collected at the beginning and after 3, 6, 12, and 24 months of therapy. Results: Total lymphocyte count decreased in relation to time of exposure to DMF. Mean absolute B cell count decreased by 34.1% (p < 0.001) within the first 3 months of therapy and then remained stable over time. Mean absolute CD3+ T cells count decrement reached 47.5% after 12 months of treatment (p < 0.001). NK cells count showed a heterogeneous trend, increasing by 85.9% (p < 0.001) after 2 years of treatment. CD4+ T cells and CD8+ T cells substantially decreased, with a significant increase of CD4+/CD8+ ratio during the first year of therapy. Conclusions: NK cells showed a heterogeneous behavior during DMF treatment with a significant increase over time. Since NK cells may also have a regulatory effect on immune system modulation, their increase during DMF treatment might play a role in the efficacy and safety of the drug.
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Affiliation(s)
- Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Buriani
- Data Medica Group, Maria Paola Belloni Center for Personalized Medicine, Synlab Limited, Padova, Italy
| | - Anna Isabella Pisani
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Crescenzo
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carmela Zuco
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Fortinguerra
- Data Medica Group, Maria Paola Belloni Center for Personalized Medicine, Synlab Limited, Padova, Italy
| | - Vincenzo Sorrenti
- Data Medica Group, Maria Paola Belloni Center for Personalized Medicine, Synlab Limited, Padova, Italy
| | - Bruno Marenda
- Data Medica Group, Maria Paola Belloni Center for Personalized Medicine, Synlab Limited, Padova, Italy
| | | | - Roberta Magliozzi
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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11
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Effect of glatiramer acetate on cerebral grey matter pathology in patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2019; 27:305-311. [DOI: 10.1016/j.msard.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 01/17/2023]
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12
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Transbulbar B-Mode Sonography for Clinical Phenotyping Multiple Sclerosis. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8112177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess putative differences in optic nerve sheath diameter (ONSD) and associated clinical/paraclinical variables between relapsing remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) patients. We examined 60 relapse-free MS patients and 35 healthy controls by means of transbulbar B-mode sonography (TBS). Expanded disability status scale (EDSS) values were from 3 to 4 indicated patients with a transitional RR to SP phenotype. Mean ONSD was significantly lower in MS patients. Mean ONSD measured at 5 mm from the eyeball (ONSD5) was significantly lower in SP than in RR patients, while ONSD measured at 3 mm from the eyeball (ONSD3) was statistically higher in RR than in the transitional group. The myelination index (MI), i.e., the ratio of ONSD3 to ONSD5, was used to assess the relative myelination of the optic nerve (ON). Higher ONSD5 and MI (0.90) corresponded to patients with the RR phenotype having a mean EDSS of 2.0; lower MI (0.84) clustered the transitional patients having a mean EDSS of 3.7. Finally, lower MI with low ONSD3 identified the SP phenotype having a mean EDSS ≥ 4.0. The TBS in MS highlights chronic optic neuropathy, caused by early subclinical axonal loss and demyelination.
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Rumbach L, Racadot E, Armspach JP, Namer IJ, Bonneville JF, Wijdenes J, Marescaux C, Herve P, Chambron J. Biological Assessment and Mri Monitoring of the Therapeutic Efficacy of a Monoclonal Anti-T Cd4 Antibody in Multiple Sclerosis Patients. Mult Scler 2018. [DOI: 10.1177/135245859600100404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An initial group of 21 patients plus a second group of 14 patients with active multiple sclerosis (MS) (18 progressive and 17 relapsing-remitting forms) were treated with a murine monoclonal anti-T CD4/BF5 antibody as part of a phase 1 open trial. Tolerance was relatively good: minor general side-effects occurred in 22 patients only upon the first mAb infusion. One year later, functional disability was stabilised in only six of the 35 patients and after 2 years in two patients only (among 21). One year after treatment, nine of the 17 relapsing-remitting patients were relapse-free. CD4 counts decreased dramatically 2 h after treatment These counts were back to baseline counts at 3 months. A transient increase was found in IL-6 and TNFα levels 2 h after treatment, which probably accounts for the observed side effects. Cell adhesion molecule levels were not modified. Serial MRI scans were performed in the second group of 14 patients. In all of these patients, lesion modifications were observed in the three scans performed prior to treatment Yet, no changes in the lesions were noted on the MRI scans performed over the following 3 months. These findings demonstrate the feasibility of this treatment insofar as it induced a marked CD4 lymphocyte depletion. However, it did not seem to stabilise the evolution of the disease – although one must be careful in drawing such conclusions in a phase 1 trial – or to curb the evolution of MRI-documented lesions.
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Affiliation(s)
- L Rumbach
- Service de Neurologie, Hôpital Jean Minjoz-25030 Besançon
| | - E Racadot
- Centre de Transfusion Sanguine-25030 Besançon
| | - JP Armspach
- Institut de Physique Biologique, Faculté de Médecine-67085 Strasbourg
| | - IJ Namer
- Institut de Physique Biologique, Faculté de Médecine-67085 Strasbourg
| | - JF Bonneville
- Service de Radiologie B, Hôpital Jean Minjoz-25030 Besancon
| | - J Wijdenes
- Diaclone, Boulevard Fleming-25030 Besançon
| | - C Marescaux
- Service de Neurologie, Hôpitaux Universitaires-67091 Strasbourg
| | - P Herve
- Centre de Transfusion Sanguine-25030 Besançon
| | - J Chambron
- Institut de Physique Biologique, Faculté de Médecine-67085 Strasbourg
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Puthenparampil M, Cazzola C, Zywicki S, Federle L, Stropparo E, Anglani M, Rinaldi F, Perini P, Gallo P. NEDA-3 status including cortical lesions in the comparative evaluation of natalizumab versus fingolimod efficacy in multiple sclerosis. Ther Adv Neurol Disord 2018; 11:1756286418805713. [PMID: 30386435 PMCID: PMC6204617 DOI: 10.1177/1756286418805713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Cortical lesions (CLs) are typical of multiple sclerosis (MS) and have been recently incorporated in MS diagnostic criteria. Thus, the ‘no evidence of disease activity’ (NEDA) definition should now include CLs. The aim of this study was to evaluate the NEDA3 + CL status in natalizumab- or fingolimod-treated relapsing remitting MS (RMS) patients. Methods: Natalizumab- or fingolimod-treated RMS patients were enrolled in a 2-year longitudinal study based on clinical and magnetic resonance imaging (MRI) evaluations performed respectively biannually and annually. CLs were detected by double inversion recovery. The NEDA3 + CL condition was evaluated at baseline (T0) and at the end of the first (T1) and second (T2) year. Results: Of the 137 RMS patients included in the study, 86 were propensity-matched. At T2, the annualized relapse rate was lower on natalizumab (p = 0.021), but the effect on white matter lesions (p = 0.29) and the proportion of NEDA-3 patients (p = 0.14) were similar in the two treatment arms. At T2, 11.6% natalizumab- and 62.8% fingolimod-treated patients had new CLs (p < 0.001) and a higher proportion of natalizumab-treated patients (55.8% versus 11.6%, p < 0.001) achieved the NEDA3 + CL status (hazard ratio 5.2, p < 0.001). Conclusion: The incorporation of CLs in the NEDA-3 definition highlighted the higher efficacy of natalizumab versus fingolimod in suppressing disease activity in RMS patients.
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Affiliation(s)
- Marco Puthenparampil
- Multiple Sclerosis Centre, Department of Neuroscience DNS, Univeristà Degli Studi di Padova, Via Giustinaini 2, 35128, Padova, Italy
| | - Chiara Cazzola
- Multiple Sclerosis Centre, Department of Neuroscience DNS, University of Padua, Padua, Italy
| | - Sofia Zywicki
- Multiple Sclerosis Centre, Department of Neuroscience DNS, University of Padua, Padua, Italy
| | - Lisa Federle
- Multiple Sclerosis Centre, Ospedale San Bortolo, ULSS8 Berica, Vicenza, Italy
| | - Erica Stropparo
- Multiple Sclerosis Centre, Department of Neuroscience DNS, University of Padua, Padua, Italy
| | | | | | - Paola Perini
- Neurology Clinic, University Hospital of Padua, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre, Department of Neuroscience DNS, University of Padua, Padua, Italy
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15
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Tiwari S, Lapierre J, Ojha CR, Martins K, Parira T, Dutta RK, Caobi A, Garbinski L, Ceyhan Y, Esteban-Lopez M, El-Hage N. Signaling pathways and therapeutic perspectives related to environmental factors associated with multiple sclerosis. J Neurosci Res 2018; 96:1831-1846. [PMID: 30204260 PMCID: PMC7167107 DOI: 10.1002/jnr.24322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) is an immune-mediated demyelinating disorder of unknown etiology. Both genetic-susceptibility and environment exposures, including vitamin D deficiency, Epstein-Barr viral and Herpesvirus (HHV-6) infections are strongly implicated in the activation of T cells and MS-pathogenesis. Despite precise knowledge of how these factors could be operating alone or in combination to facilitate and aggravate the disease progression, it is clear that prolonged induction of inflammatory molecules and recruitment of other immune cells by the activated T cells results in demyelination and axonal damage. It is imperative to understand the risk factors associated with MS progression and how these factors contribute to disease pathology. Understanding of the underlying mechanisms of what factors triggers activation of T cells to attack myelin antigen are important to strategize therapeutics and therapies against MS. Current review provides a detailed literature to understand the role of both pathogenic and non-pathogenic factors on the impact of MS.
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Affiliation(s)
- Sneham Tiwari
- Departments of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Jessica Lapierre
- Departments of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Chet Raj Ojha
- Departments of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Kyle Martins
- Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Tiyash Parira
- Departments of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Rajib Kumar Dutta
- Departments of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Allen Caobi
- Departments of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Luis Garbinski
- Cell Biology and Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Yasemin Ceyhan
- Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Maria Esteban-Lopez
- Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Nazira El-Hage
- Departments of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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16
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Scalfari A, Romualdi C, Nicholas RS, Mattoscio M, Magliozzi R, Morra A, Monaco S, Muraro PA, Calabrese M. The cortical damage, early relapses, and onset of the progressive phase in multiple sclerosis. Neurology 2018; 90:e2107-e2118. [PMID: 29769373 DOI: 10.1212/wnl.0000000000005685] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/02/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship among cortical radiologic changes, the number of early relapses (ERs), and the long-term course of multiple sclerosis (MS). METHODS In this cohort study, we assessed the number of cortical lesions (CLs) and white matter (WM) lesions and the cortical thickness (Cth) at clinical onset and after 7.9 mean years among 219 patients with relapsing remitting (RR) MS with 1 (Low-ER), 2 (Mid-ER), and ≥3 (High-ER) ERs during the first 2 years. Kaplan-Meier and Cox regression analyses investigated early factors influencing the risk of secondary progressive (SP) MS. RESULTS Fifty-nine patients (27%) converted to SPMS in 6.1 mean years. A larger number of CLs at onset predicted a higher risk of SPMS (hazard ratio [HR] 2.16, 4.79, and 12.3 for 2, 5, and 7 CLs, respectively, p < 0.001) and shorter latency to progression. The High-ER compared to the Low-ER and Mid-ER groups had a larger volume of WM lesions and CLs at onset, accrued more CLs, experienced more severe cortical atrophy over time, and entered the SP phase more rapidly. In the multivariate model, older age at onset (HR 1.97, p < 0.001), a larger baseline CL (HR 2.21, p = 0.005) and WM lesion (HR 1.32, p = 0.03) volume, early changes of global Cth (HR 1.36, p = 0.03), and ≥3 ERs (HR 6.08, p < 0.001) independently predicted a higher probability of SP. CONCLUSIONS Extensive cortical damage at onset is associated with florid inflammatory clinical activity and predisposes to a rapid occurrence of the progressive phase. Age at onset, the number of early attacks, and the extent of baseline focal cortical damage can identify groups at high risk of progression who may benefit from more active therapy.
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Affiliation(s)
- Antonio Scalfari
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Chiara Romualdi
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Richard S Nicholas
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Miriam Mattoscio
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Roberta Magliozzi
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Aldo Morra
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Salvatore Monaco
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Paolo A Muraro
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Massimiliano Calabrese
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy.
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17
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Taheri M, Sayad A. Investigating the exon 6 sequence changes of interleukin 7 receptor A (IL7RA) gene in patients with relapsing-remitting multiple sclerosis. Hum Antibodies 2018; 26:43-48. [PMID: 28582853 DOI: 10.3233/hab-170320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Interleukin 7 receptor alpha (IL7RA) gene that encodes a subunit of IL7 receptor has been reported to be associated with different immunologic disease. OBJECTIVE Multiple Sclerosis (MS) patients have shown an aberrant blood level of soluble form of IL7R protein. The genomic changes in the sequence of this gene have been suggested to be correlated with its altered splicing specially, variants in the exon 6 of the gene have been reported to influence the maintenance or skipping of this exon and control the soluble or insoluble form of the final product. In order to evaluate this changes in the IL7RA gene and to determine a possible correlation between these changes and the MS susceptibility the whole sequence of the exon 6 and 7 and their flanking sequences were analyzed. METHODS In this regard, we investigate the sequence changes of the exon 6 and 7 of the IL7RA gene in 75 relapsing-remitting MS patients and compare the results with 75 healthy control using sequence analyzing. RESULTS The results of the sequence analysis were used in two aspects. The allelic and genotypic estimated frequencies of a reported risk variant rs6897932 in patients and controls in our population confirmed its association with the disease (P= 0.009, OR = 6.273, for TT genotype). Also, we report a possible hazardous cutoff for changes in a potential exon splicing silencer element (ESS (nt. 20-24)) and its correlation with rs6897932 to confer the risk of developing MS. CONCLUSION In conclusion our results confirm the association between IL7RA exon 6 sequence changes and increased susceptibility for multiple sclerosis.
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Affiliation(s)
- Mohammad Taheri
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Urogenital Stem Cell Research Center, Shahid Labbafi Nejad Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezou Sayad
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Rovaris M, Holtmannspötter M, Rocca MA, Iannucci G, Codella M, Viti B, Campi A, Comi G, Yousry TA, Filippi M. Contribution of cervical cord MRI and brain magnetization transfer imaging to the assessment of individual patients with multiple sclerosis: a preliminary study. Mult Scler 2017. [DOI: 10.1177/135245850200800110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was performed to assess how established diagnostic criteria for brain magnetic resonance imaging (MRI) interpretation in cases of suspected multiple sclerosis (MS) (Barkhofs criteria) would perform in the distinction of MS from other diseases and whether other MR techniques (cervical cord imaging and brain magnetization transfer imaging [MTI]), might help in the diagnostic work-up of these patients. We retrospectively identified 64 MS and 59 non-MS patients. The latter group included patients with systemic immune-mediated disorders (SID; n=44) and migraine (n=15). All patients had undergone MRI scans of the brain (dual echo and MTI) and of the cervical cord (fast short-tau inversion recovery). The number and location of brain T2-hyperintense lesions and the number and size of cervical cord lesions were assessed. Brain images were also postprocessed to quantify the total lesion volumes (TLV) and to create histograms of magnetization transfer ratio (MTR) values from the whole of the brain tissue. Barkhofs criteria correctly classified 108/123 patients, thus showing an accuracy of 87.8%. "False negative" MS patients were 13, while 2 patients with systemic lupus erythematosus (SLE) were considered as "false positives". Using brain T2 TLV, nine of the"false negative" patients were correctly classified. Correct classification of 10 MS patients and both the SLE patients was possible based upon the presence or absence of one cervical cord lesion. Two MS patients with negative Barkhofs criteria and no cervical cord lesions were correctly classified based on their brain MTR values. Overall, only one MS patient could not be correctly classified by any of the assessed MR quantities. These preliminary data support a more extensive use of cervical cord MRI and brain MTI to differentiate between MS and other disorders in case of inconclusive findings on T2-weighted MRI scans of the brain. Multiple Sclerosis (2002) 8, 52-58
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Affiliation(s)
- M. Rovaris
- Neuroimaging Research Unit, Scientific Institute and
University H San Raffaele, Milan, Italy
| | | | - MA Rocca
- Neuroimaging Research Unit, Scientific Institute and
University H San Raffaele, Milan, Italy
| | - G. Iannucci
- Neuroimaging Research Unit, Scientific Institute and
University H San Raffaele, Milan, Italy
| | - M. Codella
- Neuroimaging Research Unit, Scientific Institute and
University H San Raffaele, Milan, Italy
| | - B. Viti
- Neuroimaging Research Unit, Scientific Institute and
University H San Raffaele, Milan, Italy
| | - A. Campi
- Department of Neuroradiology, Scientific Institute and
University H San Raffaele, Milan, Italy
| | - G. Comi
- Clinical Trials Unit, Department of Neuroscience, Scientific
Institute and University H San Raffaele, Milan, Italy
| | - TA Yousry
- Department of Radiology, Klinikum Grosshadern, Munich,
Germany
| | - M. Filippi
- Neuroimaging Research Unit, Scientific Institute and
University H San Raffaele, Milan, Italy
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19
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Liu Y, Duan Y, Huang J, Ren Z, Liu Z, Dong H, Weiler F, Hahn HK, Shi FD, Butzkueven H, Barkhof F, Li K. Different patterns of longitudinal brain and spinal cord changes and their associations with disability progression in NMO and MS. Eur Radiol 2017; 28:96-103. [DOI: 10.1007/s00330-017-4921-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/28/2017] [Accepted: 05/31/2017] [Indexed: 12/31/2022]
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20
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Cerebellar volume as imaging outcome in progressive multiple sclerosis. PLoS One 2017; 12:e0176519. [PMID: 28437430 PMCID: PMC5402974 DOI: 10.1371/journal.pone.0176519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/12/2017] [Indexed: 11/21/2022] Open
Abstract
Background and purpose To assess whether cerebellar volumes changes could represent a sensitive outcome measure in primary-progressive MS. Material and methods Changes in cerebellar volumes over one-year follow-up, estimated in 26 primary-progressive MS patients and 20 controls with Freesurfer longitudinal pipeline, were assessed using Wilcoxon test and tested for their correlation with disability worsening by a logistic regression. Clinical worsening was defined as EDSS score increase or change of >20% for 25-foot walk test or 9-hole peg test scores at follow-up. Sample sizes for given treatment effects and power were calculated. The findings were validated in an independent cohort of 20 primary-progressive MS patients. Results Significant changes were detected in brain T1 lesion volume (p<0.01), cerebellar T2 and T1 lesion volume (p<0.01 and p<0.05), cerebellar volume, cerebellar cortex volume, and cerebellar WM volume (p<0.001). Only cerebellar volume and cerebellar cortex volume percentage change were significantly reduced in clinically progressed patients when compared to patients who did not progress (p<0.01; respectively AUC of 0.91 and 0.96). Cerebellar volume percentage changes were consistent in the exploration and validation cohorts (cerebellar volume -1.90±1.11% vs -1.47±2.30%; cerebellar cortex volume -1.68±1.41% vs -1.56±2.23%). Based on our results the numbers of patients required to detect a 30% effect are 81 per arm for cerebellar volume and 162 per arm for cerebellar cortex volume (90% power, type 1 error alpha = 0.05). Conclusions Our results suggest a role for cerebellar cortex volume and cerebellar volume as potential short-term imaging metrics to monitor treatment effect in primary-progressive MS clinical trials.
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21
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Mazdeh M, Noroozi R, Gharesouran J, Sayad A, Komaki A, Eftekharian MM, Habibi M, Toghi M, Taheri M. The Importance of VEGF-KDR Signaling Pathway Genes should Not Be Ignored When the Risk of Developing Multiple Sclerosis is Taken into Consideration. J Mol Neurosci 2017; 62:73-78. [PMID: 28401369 DOI: 10.1007/s12031-017-0912-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/21/2017] [Indexed: 12/29/2022]
Abstract
Vascular endothelial growth factor (VEGF) and its receptor kinase insert domain-containing receptor (KDR) pathway trigger the process of angiogenesis as well as inflammation, which contributes to the development and progression of demyelinating lesions in multiple sclerosis. This work is a case-control study comprising of a total of 400 subjects with multiple sclerosis and 400 healthy controls. Participants were subjected to neurological examination and peripheral blood sampling for genotyping. Polymorphisms in the VEGF and KDR genes were assessed using the restriction fragment length polymorphism (RFLP-PCR) method. A significantly higher frequency of the T allele and TT genotype of the VEGF 936C > T (rs3025039) polymorphism was found in the multiple sclerosis group than in the healthy control group (P = 0.01 [OR = 1.41] and P = 0.01 [OR = 3.12], respectively). In addition, VEGF 936C > T showed an association with patients in a recessive model. However, the KDR -604T > C (rs2071559) polymorphism showed no significant difference in either allelic or genotype frequency between the two groups. Taken together, the results of the present study suggests that the T allele of the rs3025039 in VEGF gene could be considered a risk factor for developing multiple sclerosis in the Iranian population.
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Affiliation(s)
- Mehrdokht Mazdeh
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rezvan Noroozi
- Young Researchers and Elite Club, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
| | - Jalal Gharesouran
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, 8th Floor, SBUMS Bldg., Next to Ayatollah Taleghani Hospital, Evin, Tehran, 198396-3113, Iran.,Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou Sayad
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, 8th Floor, SBUMS Bldg., Next to Ayatollah Taleghani Hospital, Evin, Tehran, 198396-3113, Iran
| | - Alireza Komaki
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mohsen Habibi
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, 8th Floor, SBUMS Bldg., Next to Ayatollah Taleghani Hospital, Evin, Tehran, 198396-3113, Iran
| | - Mehdi Toghi
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, 8th Floor, SBUMS Bldg., Next to Ayatollah Taleghani Hospital, Evin, Tehran, 198396-3113, Iran
| | - Mohammad Taheri
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, 8th Floor, SBUMS Bldg., Next to Ayatollah Taleghani Hospital, Evin, Tehran, 198396-3113, Iran. .,Urogenital Stem Cell Research Center, No 23, Shahid Labbafi Nejad Educational Hospital, Shahid Beheshti University of Medical Sciences, Amir Ebrahimi St, Pasdaran Ave, Tehran, Iran.
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22
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Eftekharian MM, Sayad A, Omrani MD, Ghannad MS, Noroozi R, Mazdeh M, Mirfakhraie R, Movafagh A, Roshanaei G, Azimi T, Inoko H, Taheri M. Single nucleotide polymorphisms in the FOXP3 gene are associated with increased risk of relapsing-remitting multiple sclerosis. Hum Antibodies 2017; 24:85-90. [PMID: 27792007 DOI: 10.3233/hab-160299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although Multiple Sclerosis (MS) is an autoimmune multifactorial disease with unknown etiology, various genetic and environmental factors are known to contribute to the pathogenesis of the disease. OBJECTIVE Recent studies have confirmed that the suppressive function of regulatory T cells (T (reg)) is impaired in MS patients and that the FOXP3 gene is a crucial transcription factor in the regulation of CD4+CD25+FOXP3+ Treg cells. Polymorphisms in the promoter region of the FOXP3 gene may alter the gene expression level and, therefore, contribute to the disease susceptibility. METHODS The present study aimed to investigate the possible association between single nucleotide polymorphisms (SNPs) rs3761548 and rs2232365 in the FOXP3 gene and predisposition to MS. We conducted a case-control study on 410 patients with sporadic MS and 446 healthy controls. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS Significant differences in distribution of both rs3761548 and rs2232365 A allele were found in MS patients in comparison to controls. Haplotype frequencies were also different among the studied groups. The A-A and C-G haplotype blocks showed a significant difference between case and controls. CONCLUSION we have provided further evidence for the association between genetic variations and haplotypes in FOXP3 and MS in Iranian population.
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Affiliation(s)
- Mohammad Mahdi Eftekharian
- Faculty of Paramedicine, Research Center for Molecular Medicine, Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arezou Sayad
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mir Davood Omrani
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafi Nejad Educational Hospital, Tehran, Iran
| | - Masoud Sabouri Ghannad
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafi Nejad Educational Hospital, Tehran, Iran
| | - Rezvan Noroozi
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdokht Mazdeh
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafi Nejad Educational Hospital, Tehran, Iran
| | - Reza Mirfakhraie
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Movafagh
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghodratollah Roshanaei
- Department of Neurology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tahereh Azimi
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hidetoshi Inoko
- Modeling of No communicable diseases Research center, Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafi Nejad Educational Hospital, Tehran, Iran
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23
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Rashid W, Davies GR, Chard DT, Griffin CM, Altmann DR, Thompson AJ, Miller DH. Relationship of triple dose contrast enhanced lesions with clinical measures and brain atrophy in early relapsing-remitting multiple sclerosis: a two-year longitudinal study. Mult Scler 2017; 13:178-85. [PMID: 17439882 DOI: 10.1177/1352458506070758] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gadolinium (Gd) enhancement of lesions indicates inflammatory lesion activity in multiple sclerosis (MS). The question arises whether early inflammatory lesion activity – measured sensitively using triple dose Gd – is related to the future clinical course, or to the development of brain atrophy that is thought to reflect the underlying pathological progression of the disease. In this study, 26 patients with early relapsing-remitting (RR) MS (median disease duration: 1.7 years) were followed up over two years. Associations were explored between their levels of Gd-lesion enhancement in the first six months and later clinical (Expanded Disability Status Scale (EDSS) and MS Functional Composite Score (MSFC)) and magnetic resonance imaging (MRI) (brain volume, T2 and T1 lesion volumes) measures. The extent of Gd-enhancement in the first six months correlated weakly with concurrent relapses (P = 0.041), but there was no consistent correlation with clinical and MRI outcomes at two years. More prolonged follow-up is warranted to clarify the relationship between early inflammatory lesions and long-term clinical course. Multiple Sclerosis 2007; 13: 178–185. http://msj.sagepub.com
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Affiliation(s)
- W Rashid
- Department of Neuroinflammation, MS NMR Research Unit, Institute of Neurology, University College London, Queen Square, London, UK
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24
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Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) characterized by loss of motor and sensory function that results from immune-mediated inflammation, demyelination, and subsequent axonal damage. Clinically, most MS patients experience recurrent episodes (relapses) of neurological impairment, but in most cases (60–80%) the course of the disease eventually becomes chronic and progressive, leading to cumulative motor, sensory, and visual disability, and cognitive deficits. The course of the disease is largely unpredictable and its clinical presentation is variable, but its predilection for certain parts of the CNS, which includes the optic nerves, the brain stem, cerebellum, and cervical spinal cord, provides a characteristic constellation of signs and symptoms. Several variants of MS have been nowadays defined with variable immunopathogenesis, course and prognosis. Many new treatments targeting the immune system have shown efficacy in preventing the relapses of MS and have been introduced to its management during the last decade.
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De Masi R, Orlando S, Conte A, Pasca S, Scarpello R, Spagnolo P, Muscella A, De Donno A. Transbulbar B-Mode Sonography in Multiple Sclerosis: Clinical and Biological Relevance. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:3037-3042. [PMID: 27639433 DOI: 10.1016/j.ultrasmedbio.2016.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/10/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
Optic nerve sheath diameter quantification by transbulbar B-mode sonography is a recently validated technique, but its clinical relevance in relapse-free multiple sclerosis patients remains unexplored. In an open-label, comparative, cross-sectional study, we aimed to assess possible differences between patients and healthy controls in terms of optic nerve sheath diameter and its correlation with clinical/paraclinical parameters in this disease. Sixty unselected relapse-free patients and 35 matched healthy controls underwent transbulbar B-mode sonography. Patients underwent routine neurologic examination, brain magnetic resonance imaging and visual evoked potential tests. The mean optic nerve sheath diameter 3 and 5 mm from the eyeball was 22-25% lower in patients than controls and correlated with the Expanded Disability Status Scale (r = -0.34, p = 0.048, and r = -0.32, p = 0.042, respectively). We suggest that optic nerve sheath diameter quantified by transbulbar B-mode sonography should be included in routine assessment of the disease as an extension of the neurologic examination.
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Affiliation(s)
- Roberto De Masi
- Laboratory of Neuroproteomics, Multiple Sclerosis Center, "F. Ferrari" Hospital, Casarano-Lecce, Italy; Multiple Sclerosis Center, "F. Ferrari" Hospital, Casarano-Lecce, Italy; Complex Operative Neurology-Stroke Unit, "F. Ferrari" Hospital, Casarano-Lecce, Italy.
| | - Stefania Orlando
- Laboratory of Neuroproteomics, Multiple Sclerosis Center, "F. Ferrari" Hospital, Casarano-Lecce, Italy; Department of Biological and Environmental Sciences and Technologies, Laboratory of Hygiene, University of the Salento-Lecce, Italy
| | - Aldo Conte
- Multiple Sclerosis Center, "F. Ferrari" Hospital, Casarano-Lecce, Italy
| | - Sergio Pasca
- Multiple Sclerosis Center, "F. Ferrari" Hospital, Casarano-Lecce, Italy
| | - Rocco Scarpello
- Complex Operative Neurology-Stroke Unit, "F. Ferrari" Hospital, Casarano-Lecce, Italy
| | - Pantaleo Spagnolo
- Division of Neuroradiology, "F. Ferrari" Hospital, Casarano-Lecce, Italy
| | - Antonella Muscella
- Department of Biological and Environmental Sciences and Technologies, Laboratory of Cell Physiology, University of Salento, Lecce, Italy
| | - Antonella De Donno
- Department of Biological and Environmental Sciences and Technologies, Laboratory of Hygiene, University of the Salento-Lecce, Italy
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Eftekharian MM, Noroozi R, Sayad A, Sarrafzadeh S, Toghi M, Azimi T, Komaki A, Mazdeh M, Inoko H, Taheri M, Mirfakhraie R. RAR-related orphan receptor A (RORA): A new susceptibility gene for multiple sclerosis. J Neurol Sci 2016; 369:259-262. [PMID: 27653902 DOI: 10.1016/j.jns.2016.08.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/29/2016] [Accepted: 08/22/2016] [Indexed: 12/19/2022]
Abstract
Retinoic acid receptor-related orphan receptor alpha (RORA) is proposed to promote Th17 cells differentiation that play a crucial role in many inflammatory diseases, including multiple sclerosis (MS). The gene is also involved in regulation of inflammatory responses and neuronal cell development. The aim of the present study is to determine if any relation exists between RORA rs11639084 and rs4774388 gene polymorphisms on the individual susceptibility of multiple sclerosis. 410 patients with clinically definite MS and 500 ethnically-matched healthy controls participated in this study. Genotyping was performed using tetra primer-amplification refractory mutation system-PCR (4P-ARMS-PCR) method for the mentioned polymorphisms in the RORA gene. Both variants showed significant differences in allele and genotype distributions between the studied groups. Genotypes were risk associated in additive (P-value of 0.0003 and odds ratio equal to 1.7 (95% CI: 1.27-2.26)), dominant (P-value of <0.0001 and odds ratio equal to 0.55 (95% CI: 0.41-0.73)) and recessive (P-value of 0.04 and odds ratio equal to 0.33 (95% CI: (0.12-0.96)) models for rs11639084. However, the rs4774388 genotypes were risk associated in recessive model with a P-value of 0.036 and an odds ratio of 0.62 (95% CI: (0.4-0.97)). To the best of our knowledge this is the first report concerning the association between RORΑ gene polymorphisms and MS. The further study of RORΑ related pathways and gene networks might result in the better understanding of the pathophysiology of MS and related symptoms.
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Affiliation(s)
- Mohammad Mahdi Eftekharian
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; Molecular Immunology research group, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rezvan Noroozi
- Department of Medical Genetics, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Arezou Sayad
- Department of Medical Genetics, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Shaghayegh Sarrafzadeh
- Department of Medical Genetics, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Mehdi Toghi
- Department of Medical Genetics, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Tahereh Azimi
- Department of Medical Genetics, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Alireza Komaki
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehrdokht Mazdeh
- Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mohammad Taheri
- Department of Medical Genetics, Shahid Beheshti University of Medical sciences, Tehran, Iran; Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, No 23, Shahid Labbafi Nejad Educational Hospital, Amir Ebrahimi St, Pasdaran Ave, Tehran, Iran.
| | - Reza Mirfakhraie
- Department of Medical Genetics, Shahid Beheshti University of Medical sciences, Tehran, Iran; Genomic Research Center, Shahid Beheshti University of Medical sciences, Tehran, Iran.
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Harel A, Ceccarelli A, Farrell C, Fabian M, Howard J, Riley C, Miller A, Lublin F, Inglese M. Phase-Sensitive Inversion-Recovery MRI Improves Longitudinal Cortical Lesion Detection in Progressive MS. PLoS One 2016; 11:e0152180. [PMID: 27002529 PMCID: PMC4803340 DOI: 10.1371/journal.pone.0152180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/09/2016] [Indexed: 11/19/2022] Open
Abstract
Previous studies comparing phase sensitive inversion recovery (PSIR) to double inversion recovery (DIR) have demonstrated that use of PSIR improves cross-sectional in vivo detection of cortical lesions (CL) in multiple sclerosis. We studied the utility of PSIR in detection/characterization of accrual of CL over time in a 1-year longitudinal study in primary progressive multiple sclerosis (PPMS) compared to DIR. PSIR and DIR images were acquired with 3T magnetic resonance imaging (MRI) in 25 patients with PPMS and 19 healthy controls at baseline, and after 1 year in 20 patients with PPMS. CL were classified as intracortical, leucocortical or juxtacortical. Lesion counts and volumes were calculated for both time points from both sequences and compared. Correlations with measures of physical and cognitive disability were determined as well as new CL counts and volumes. Compared to DIR, PSIR led to detection of a higher number of CL involving a larger proportion of patients with PPMS both cross-sectionally (p = 0.006, 88%) and longitudinally (p = 0.007, 95%), and led to the reclassification of a third of CL seen on DIR at each time point. Interestingly, PSIR was more sensitive to new CL accumulation over time compared to DIR. PSIR is a promising technique to monitor cortical damage and disease progression in patients with PPMS over a short-term follow-up.
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Affiliation(s)
- Asaff Harel
- Department of Neurology, Mount Sinai Hospital, New York, New York, United States of America
| | - Antonia Ceccarelli
- Department of Neurology, Mount Sinai Hospital, New York, New York, United States of America
| | - Colleen Farrell
- Department of Neurology, Mount Sinai Hospital, New York, New York, United States of America
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Michelle Fabian
- Department of Neurology, Mount Sinai Hospital, New York, New York, United States of America
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jonathan Howard
- Department of Neurology, New York University, Langone Medical Center, New York, New York, United States of America
| | - Claire Riley
- Department of Neurology, The Neurological Institute of New York, Columbia University, New York, New York, United States of America
| | - Aaron Miller
- Department of Neurology, Mount Sinai Hospital, New York, New York, United States of America
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Fred Lublin
- Department of Neurology, Mount Sinai Hospital, New York, New York, United States of America
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Matilde Inglese
- Department of Neurology, Mount Sinai Hospital, New York, New York, United States of America
- Department of Radiology, Mount Sinai Hospital, New York, New York, United States of America
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
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Rahimdel A, Zeinali A, Mellat A. Evaluating the Role of Corticosteroid Pulse Therapy in Patients With Secondary Progressive Multiple Sclerosis Receiving Mitoxantrone: A Double Blind Randomized Controlled Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e30618. [PMID: 26566454 PMCID: PMC4636858 DOI: 10.5812/ircmj.30618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/29/2015] [Accepted: 09/20/2015] [Indexed: 11/16/2022]
Abstract
Background: Multiple sclerosis (MS) is a central nervous system disorder with periods of recurrence and recovery. Mitoxantrone has been approved for secondary progressive MS (SPMS) treatment but data lacks the role of corticosteroid pulse therapy in SPMS. Objectives: To evaluate the role of corticosteroid pulse therapy in patients with SPMS receiving mitoxantrone. Patients and Methods: A double blind randomized controlled clinical trial was performed on 71 patients with SPMS referred to Shahid Sadoughi Hospital (Yazd, Iran) for receiving mitoxantrone in two groups. The first group (35 patients) received 20 mg mitoxantrone plus 500 mg methylprednisolone monthly for six months. The second group (36 patients) received the same dosage of mitoxantrone plus 100 CC of 5% dextrose water monthly for six months. Expanded disability status scale (EDSS), MRI plaques in both groups before and after the treatment completion and six months after the end of trial were compared together. Results: 28 men and 43 women enrolled in the study. MRI plaques number reduced in groups significantly (2.29 vs. 2.17) without significant difference between the groups (P = 0.782). Six months after trial completion, plaques number increased in groups without significantly difference (0.72 vs. 0.77, P = 0.611). The mean value of EDSS showed significant reduction at the end of treatment in groups (0.79 and 0.53) without significant difference between the groups (P = 0.953). Six months after trial completion, EDSS increased in groups without significant difference (0.35 vs. 0.43, P = 0.624). Conclusions: Corticosteroid pulse therapy in SPMS was effective in inflammatory process, but could not postpone or decline the neurodegenerative process and besides the imposing side effects could not result in significant improvement in EDSS and MRI plaques number in long term.
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Affiliation(s)
- Abolghasem Rahimdel
- Neurology Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
| | - Ahmad Zeinali
- Neurology Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
| | - Ali Mellat
- Neurology Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
- Corresponding Author: Ali Mellat, Neurology Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran. Tel: +98-3538224001, Fax: +98-3538224100, E-mail:
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29
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Calabrese M, Reynolds R, Magliozzi R, Castellaro M, Morra A, Scalfari A, Farina G, Romualdi C, Gajofatto A, Pitteri M, Benedetti MD, Monaco S. Regional Distribution and Evolution of Gray Matter Damage in Different Populations of Multiple Sclerosis Patients. PLoS One 2015; 10:e0135428. [PMID: 26267665 PMCID: PMC4534410 DOI: 10.1371/journal.pone.0135428] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/21/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Both gray-matter (GM) atrophy and lesions occur from the earliest stages of Multiple Sclerosis (MS) and are one of the major determinants of long-term clinical outcomes. Nevertheless, the relationship between focal and diffuse GM damage has not been clarified yet. Here we investigate the regional distribution and temporal evolution of cortical thinning and how it is influenced by the local appearance of new GM lesions at different stages of the disease in different populations of MS patients. METHODS We studied twenty MS patients with clinically isolated syndrome (CIS), 27 with early relapsing-remitting MS (RRMS, disease duration <5 years), 29 with late RRMS (disease duration ≥ 5 years) and 20 with secondary-progressive MS (SPMS). The distribution and evolution of regional cortical thickness and GM lesions were assessed during 5-year follow-up. RESULTS The results showed that new lesions appeared more frequently in hippocampus and parahippocampal gyri (9.1%), insula (8.9%), cingulate cortex (8.3%), superior frontal gyrus (8.1%), and cerebellum (6.5%). The aforementioned regions showed the greatest reduction in thickness/volume, although (several) differences were observed across subgroups. The correlation between the appearance of new cortical lesions and cortical thinning was stronger in CIS (r2 = 50.0, p<0.001) and in early RRMS (r2 = 52.3, p<0.001), compared to late RRMS (r2 = 25.5, p<0.001) and SPMS (r2 = 6.3, p = 0.133). CONCLUSIONS We conclude that GM atrophy and lesions appear to be different signatures of cortical disease in MS having in common overlapping spatio-temporal distribution patterns. However, the correlation between focal and diffuse damage is only moderate and more evident in the early phase of the disease.
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Affiliation(s)
- Massimiliano Calabrese
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
- Neuroimaging Unit, Euganea Medica, Padova, Italy
- * E-mail:
| | - Richard Reynolds
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Roberta Magliozzi
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
- Department of Cell Biology and Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Castellaro
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Aldo Morra
- Neuroimaging Unit, Euganea Medica, Padova, Italy
| | - Antonio Scalfari
- Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories, Imperial College London, London, United Kingdom
| | - Gabriele Farina
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | | | - Alberto Gajofatto
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Pitteri
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Donata Benedetti
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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30
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Chua AS, Egorova S, Anderson MC, Polgar-Turcsanyi M, Chitnis T, Weiner HL, Guttmann CRG, Bakshi R, Healy BC. Using multiple imputation to efficiently correct cerebral MRI whole brain lesion and atrophy data in patients with multiple sclerosis. Neuroimage 2015; 119:81-8. [PMID: 26093330 DOI: 10.1016/j.neuroimage.2015.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/22/2015] [Accepted: 06/11/2015] [Indexed: 11/24/2022] Open
Abstract
Automated segmentation of brain MRI scans into tissue classes is commonly used for the assessment of multiple sclerosis (MS). However, manual correction of the resulting brain tissue label maps by an expert reader remains necessary in many cases. Since automated segmentation data awaiting manual correction are "missing", we proposed to use multiple imputation (MI) to fill-in the missing manually-corrected MRI data for measures of normalized whole brain volume (brain parenchymal fraction-BPF) and T2 hyperintense lesion volume (T2LV). Automated and manually corrected MRI measures from 1300 patients enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB) were identified. Simulation studies were conducted to assess the performance of MI with missing data both missing completely at random and missing at random. An imputation model including the concurrent automated data as well as clinical and demographic variables explained a high proportion of the variance in the manually corrected BPF (R(2)=0.97) and T2LV (R(2)=0.89), demonstrating the potential to accurately impute the missing data. Further, our results demonstrate that MI allows for the accurate estimation of group differences with little to no bias and with similar precision compared to an analysis with no missing data. We believe that our findings provide important insights for efficient correction of automated MRI measures to obviate the need to perform manual correction on all cases.
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Affiliation(s)
- Alicia S Chua
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Svetlana Egorova
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Mark C Anderson
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Charles R G Guttmann
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian C Healy
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
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Disease-modifying drugs reduce cortical lesion accumulation and atrophy progression in relapsing-remitting multiple sclerosis: results from a 48-month extension study. Mult Scler Int 2015; 2015:369348. [PMID: 25802758 PMCID: PMC4353660 DOI: 10.1155/2015/369348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/03/2015] [Indexed: 12/29/2022] Open
Abstract
Cortical lesions (CLs) and atrophy are pivotal in multiple sclerosis (MS) pathology. This study determined the effect of disease modifying drugs (DMDs) on CL development and cortical atrophy progression in patients with relapsing-remitting MS (RRMS) over 48 months. Patients (n = 165) were randomized to sc IFN β-1a 44 μg, im IFN β-1a 30 μg, or glatiramer acetate 20 mg. The reference population comprised 50 DMD-untreated patients with RRMS. After 24 months, 43 of the untreated patients switched to DMDs. The four groups of patients were followed up for an additional 24 months. At 48 months the mean standard deviation number of new CLs was significantly lower in patients treated with sc IFN β-1a (1.4 ± 1.0, range 0–5) compared with im IFN β-1a (2.3 ± 1.3, range 0–6, P = 0.004) and glatiramer acetate (2.2 ± 1.5, range 0–7, P = 0.03). Significant reductions in CL accumulation and new white matter and gadolinium-enhancing lesions were also observed in the 43 patients who switched to DMDs after 24 months, compared with the 24 months of no treatment. Concluding, this study confirms that DMDs significantly reduce CL development and cortical atrophy progression compared with no treatment.
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32
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Skoloudik D, Kuliha M, Roubec M, Havelka J, Langova K, Herzig R. Comparison of brain vessel imaging from transtemporal and transcondylar approaches using contrast-enhanced transcranial color-coded duplex sonography and Virtual Navigator. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 159:595-600. [PMID: 25485528 DOI: 10.5507/bp.2014.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 11/18/2014] [Indexed: 11/23/2022] Open
Abstract
AIMS The transcondylar approach is a new and used for detection of chronic cerebro-spinal venous insufficiency (CCSVI) and intracranial venous reflux in patients with multiple sclerosis. The aim of this study was to assess the ability of native and contrast enhanced (CE-) transcranial color-coded duplex sonography (TCCS) to detect flow and reflux in deep cerebral veins and intracranial venous sinuses from transcondylar and transtemporal approaches. METHODS Brain magnetic resonance imaging and TCCS from transtemporal and transcondylar approaches using the new technology - Fusion Imaging - in 8 volunteers and 5 patients with multiple sclerosis. RESULTS Using TCCS and CE-TCCS, the arteries of the circle of Willis could be detected from the transtemporal approach in 13/13 subjects in both examinations, while detection of the venous system was possible in 7/13 and 9/13 subjects, respectively. However, the arteries of the circle of Willis and venous system were detected through the transcondylar approach in only 5/13 (P=0.041) and 1/13 (P=0.031) subjects using TCCS, and in 12/13 (P=0.921) and 7/13 (P=0.687) subjects using CE-TCCS, respectively. CONCLUSIONS The results reveal that the TCCS transcondylar approach has serious limitations for the standard detection of intracranial venous reflux.
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Affiliation(s)
- David Skoloudik
- Department of Neurology, University Hospital, Ostrava, Czech Republic.,Department of Nursing, Faculty of Health Science, Palacky University Olomouc and University Hospital Olomouc.,Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc
| | - Martin Kuliha
- Department of Neurology, University Hospital, Ostrava, Czech Republic
| | - Martin Roubec
- Department of Neurology, University Hospital, Ostrava, Czech Republic
| | | | - Katerina Langova
- Department of Biophysics, Faculty of Medicine and Dentistry and Institute of Molecular and Translational Medicine, Palacky University Olomouc
| | - Roman Herzig
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc
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Sumowski JF, Rocca MA, Leavitt VM, Dackovic J, Mesaros S, Drulovic J, DeLuca J, Filippi M. Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS. Neurology 2014; 82:1776-83. [PMID: 24748670 DOI: 10.1212/wnl.0000000000000433] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Based on the theories of brain reserve and cognitive reserve, we investigated whether larger maximal lifetime brain growth (MLBG) and/or greater lifetime intellectual enrichment protect against cognitive decline over time. METHODS Forty patients with multiple sclerosis (MS) underwent baseline and 4.5-year follow-up evaluations of cognitive efficiency (Symbol Digit Modalities Test, Paced Auditory Serial Addition Task) and memory (Selective Reminding Test, Spatial Recall Test). Baseline and follow-up MRIs quantified disease progression: percentage brain volume change (cerebral atrophy), percentage change in T2 lesion volume. MLBG (brain reserve) was estimated with intracranial volume; intellectual enrichment (cognitive reserve) was estimated with vocabulary. We performed repeated-measures analyses of covariance to investigate whether larger MLBG and/or greater intellectual enrichment moderate/attenuate cognitive decline over time, controlling for disease progression. RESULTS Patients with MS declined in cognitive efficiency and memory (p < 0.001). MLBG moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.122), with larger MLBG protecting against decline. MLBG did not moderate memory decline (p = 0.234, ηp (2) = 0.039). Intellectual enrichment moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.126) and memory (p = 0.037, ηp (2) = 0.115), with greater intellectual enrichment protecting against decline. MS disease progression was more negatively associated with change in cognitive efficiency and memory among patients with lower vs higher MLBG and intellectual enrichment. CONCLUSION We provide longitudinal support for theories of brain reserve and cognitive reserve in MS. Larger MLBG protects against decline in cognitive efficiency, and greater intellectual enrichment protects against decline in cognitive efficiency and memory. Consideration of these protective factors should improve prediction of future cognitive decline in patients with MS.
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Affiliation(s)
- James F Sumowski
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia.
| | - Maria A Rocca
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Victoria M Leavitt
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Dackovic
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Sarlota Mesaros
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Drulovic
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - John DeLuca
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
| | - Massimo Filippi
- From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia
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Hashemi H, Behzadi S, Ghanaati H, Harirchian MH, Yaghoobi M, Shakiba M, Jalali AH, Firouznia K. Evaluation of plaque detection and optimum time of enhancement in acute attack multiple sclerosis after contrast injection. Acta Radiol 2014; 55:218-24. [PMID: 23975149 DOI: 10.1177/0284185113495831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is important in the early diagnosis of novel or relapsing multiple sclerosis (MS). In addition, the optimal MRI protocol plays an important role in detecting MS plaques. PURPOSE To find the best time to detect MS plaques on MRI after Gadobutrol injection. MATERIAL AND METHODS Sixty-two relapsing-remitting type MS patients, (56 women, 6 men) with the mean age of 31 ± 7 years were enrolled into this study. The patients underwent T1-weighted MRI scan without contrast agents. Subsequently, Gadobutrol was injected (0.1 mmol/kg) and MRI scanning was repeated after 30 s, 5, 10, 15, and 30 min of Gadobutrol injection. The size, signal intensity, and enhancement pattern were determined for each plaque by contrast-enhanced T1-weighted images. RESULTS Enhancing plaques were seen in 42 out of 62 patients. The mean number of enhancing plaques was 4 ± 8 plaques after 30 s of contrast injection. This figure increased to 7 ± 13 plaques after 15 min and 6 ± 10 plaques after 30 min. The signal intensity and size of plaques increased progressively, and the maximum signal intensity and plaque size were seen after 30 min (P < 0.001). CONCLUSION The maximum number of enhancing plaques in MS patients was detected 15 min after contrast agent administration and the size and signal intensity of the lesions also increased remarkably at this time.
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Affiliation(s)
- Hassan Hashemi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Behzadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Yaghoobi
- Iranian Center of Neurological Research, Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
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Dolezal O, Gabelic T, Horakova D, Bergsland N, Dwyer MG, Seidl Z, Krasensky J, Ramasamy DP, Vaneckova M, Havrdova E, Zivadinov R. Development of gray matter atrophy in relapsing–remitting multiple sclerosis is not gender dependent: Results of a 5-year follow-up study. Clin Neurol Neurosurg 2013; 115 Suppl 1:S42-8. [DOI: 10.1016/j.clineuro.2013.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
It is widely accepted that the main common pathogenetic pathway in multiple sclerosis (MS) involves an immune-mediated cascade initiated in the peripheral immune system and targeting CNS myelin. Logically, therefore, the therapeutic approaches to the disease include modalities aiming at downregulation of the various immune elements that are involved in this immunologic cascade. Since the introduction of interferons in 1993, which were the first registered treatments for MS, huge steps have been made in the field of MS immunotherapy. More efficious and specific immunoactive drugs have been introduced and it appears that the increased specificity for MS of these new treatments is paralleled by greater efficacy. Unfortunately, this seemingly increased efficacy has been accompanied by more safety issues. The immunotherapeutic modalities can be divided into two main groups: those affecting the acute stages (relapses) of the disease and the long-term treatments that are aimed at preventing the appearance of relapses and the progression in disability. Immunomodulating treatments may also be classified according to the level of the 'immune axis' where they exert their main effect. Since, in MS, a neurodegenerative process runs in parallel and as a consequence of inflammation, early immune intervention is warranted to prevent progression of relapses of MS and the accumulation of disability. The use of neuroimaging (MRI) techniques that allow the detection of silent inflammatory activity of MS and neurodegeneration has provided an important tool for the substantiation of the clinical efficacy of treatments and the early diagnosis of MS. This review summarizes in detail the existing information on all the available immunotherapies for MS, old and new, classifies them according to their immunologic mechanisms of action and proposes a structured algorithm/therapeutic scheme for the management of the disease.
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Calabrese M, Romualdi C, Poretto V, Favaretto A, Morra A, Rinaldi F, Perini P, Gallo P. The changing clinical course of multiple sclerosis: a matter of gray matter. Ann Neurol 2013; 74:76-83. [PMID: 23494723 DOI: 10.1002/ana.23882] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/18/2013] [Accepted: 03/01/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Clinical and neuroimaging parameters predictive of the changing clinical course of multiple sclerosis (MS) from relapsing-remitting to secondary progressive have not been clarified yet. We specifically designed a prospective 5-year longitudinal study aimed at assessing demographic, clinical, and magnetic resonance imaging (MRI) parameters that could predict the changing clinical course of MS. METHODS At study entry and after 5 years, clinical and MRI (ie, gray matter and white matter lesions, including spinal cord lesions, and global and regional cortical thinning) parameters were assessed in a training set of 334 consecutive relapsing-remitting MS patients and in an independent validation set of 84 relapsing-remitting MS patients. RESULTS Sixty-six (19.7%) relapsing-remitting MS patients changed their clinical course during the study and entered into the secondary progressive phase. Age (p = 0.001, odds ratio [OR] = 1.2), cortical lesion volume (p < 0.001, OR = 1.7), and cerebellar cortical volume (p < 0.001, OR = 0.2) at study entry were found to predict the changing clinical course. The model including only these 3 variables correctly identified 252 of 268 (94.0%) patients who maintained the relapsing-remitting course and 58 of 66 (87.8%) patients who became secondary progressive (cross-validated error rate = 7.2%). When applied on the validation set, the model obtained a similar error rate (8.4%). INTERPRETATION A prediction model based on age, cortical lesion load, and cerebellar cortical volume suitably explains the probability of relapsing-remitting MS patients evolving into the progressive phase. Gray matter damage appears to play a pivotal role in determining the changing clinical course of MS.
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Affiliation(s)
- Massimiliano Calabrese
- First Neurological Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy; Neuroimaging Unit, Euganea Medica, Padua, Italy
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Abstract
BACKGROUND This is an updated Cochrane review of the previous published version.Mitoxantrone (MX) has been shown to be moderately effective in reducing the clinical outcome measures of disease activity in multiple sclerosis (MS) patients. OBJECTIVES The main objective was to assess the efficacy and safety of MX compared to a control group in relapsing-remitting (RRMS), progressive relapsing (PRMS) and secondary progressive (SPMS) MS participants. SEARCH METHODS We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Specialised Register (June 2012) and reference lists of articles. We also undertook handsearching and contacted trialists and pharmaceutical companies. SELECTION CRITERIA Randomised, double-blinded, controlled trials (RCTs) comparing the administration of MX versus placebo or MX plus steroids treatment versus placebo plus steroids treatment were included. DATA COLLECTION AND ANALYSIS The review authors independently selected articles for inclusion. They independently extracted clinical, safety and magnetic resonance imaging (MRI) data, resolving disagreements by discussion. Risk of bias was evaluated to assess the quality of the studies. Treatment effect was measured using odds ratios (OR) with 95% confidence intervals (CI) for the binary outcomes and mean differences (MD) with 95% CI for the continuous outcomes. If heterogeneity was absent, a fixed-effect model was used. MAIN RESULTS Three trials were selected and 221 participants were included in the analyses. MX reduced the progression of disability at two years follow-up (proportion of participants with six months confirmed progression of disability (OR 0.30, 95% CI 0.09 to 0.99 and MD -0.36, 95% CI- 0.70 to -0.02; P = 0.04)). Significant results were found regarding the reduction in annualised relapse rate (MD -0.85, 95% CI -1.47 to -0.23; P = 0.007), the proportion of patients free from relapses at one year (OR 7.13, 95% CI 2.06 to 24.61; P = 0.002) and two years (OR 2.82, 95% CI 1.54 to 5.19; P = 0.0008), and the number of patients with active MRI lesions at six months or one year only (OR 0.24, 95% CI 0.10 to 0.57; P = 0.001). Side effects reported in the trials (amenorrhoea, nausea and vomiting, alopecia and urinary tract infections) were more frequent in treated patients than in controls, while no major adverse events have been reported. These results should be considered with caution because of the heterogeneous characteristics of included trials in term of drug dosage, inclusion criteria and quality of included trials. Moreover, it was not possible to estimate the long-term efficacy and safety of MX. AUTHORS' CONCLUSIONS MX shows a significant but partial efficacy in reducing the risk of MS progression and the frequency of relapses in patients affected by worsening RRMS, PRMS and SPMS in the short-term follow-up (two years). No major neoplastic events or symptomatic cardiotoxicity related to MX have been reported; however studies with longer follow-up (not included in this review) have raised concerns about the risk of systolic disfunction (˜12%) and therapy-related acute leukaemias (0.8%), which are increasingly reported in the literature.MX should be limited to treating patients with worsening RRMS and SPMS and with evidence of persistent inflammatory activity after a careful assessment of the individual patients' risk and benefit profiles. Assessment should also consider the present availability of alternative therapies with less severe adverse events.
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Rocca MA, Mesaros S, Preziosa P, Pagani E, Stosic-Opincal T, Dujmovic-Basuroski I, Drulovic J, Filippi M. Wallerian and trans-synaptic degeneration contribute to optic radiation damage in multiple sclerosis: a diffusion tensor MRI study. Mult Scler 2013; 19:1610-7. [DOI: 10.1177/1352458513485146] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Optic radiation (OR) damage occurs in multiple sclerosis (MS). Objectives: The purpose of this study was to explore the contribution of local and distant mechanisms associated with OR damage in MS. Methods: Diffusion tensor (DT) magnetic resonance imaging (MRI) tractography probability maps of the ORs were derived from 102 MS patients and 11 controls. Between-group differences of OR normal-appearing white matter (NAWM) damage and topographical distribution of OR damage were assessed using quantitative and voxel-wise analyses, considering the influence of previous optic neuritis (ON+) and T2 OR lesions (T2 OR+). Results: OR NAWM diffusivity abnormalities were more severe in ON+ patients vs patients without previous optic neuritis (ON–) and T2 OR+ vs T2 OR– patients. Damage to the anterior portions of the ORs was more severe in ON+ vs ON– patients. Compared to controls and T2 OR– patients, T2 OR+ patients experienced a more distributed pattern of DT MRI abnormalities along the ORs, with an increased axial diffusivity limited to the anterior portions of the ORs. In T2 OR+ group, ON+ vs ON– patients showed DT MRI abnormalities in the middle portion of the ORs, in correspondence with focal lesions. OR damage correlated with OR T2 lesion volume, visual dysfunction and optic nerve atrophy. Conclusions: Both trans-synaptic degeneration secondary to optic nerve damage and Wallerian degeneration due to local T2 lesions contribute to OR damage in MS.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Vita-Salute San Raffaele University, Italy
- Department of Neurology, Vita-Salute San Raffaele University, Italy
| | - Sarlota Mesaros
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Paolo Preziosa
- Neuroimaging Research Unit, Vita-Salute San Raffaele University, Italy
- Department of Neurology, Vita-Salute San Raffaele University, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Vita-Salute San Raffaele University, Italy
| | | | | | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Vita-Salute San Raffaele University, Italy
- Department of Neurology, Vita-Salute San Raffaele University, Italy
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Calabrese M, Favaretto A, Poretto V, Romualdi C, Rinaldi F, Mattisi I, Morra A, Perini P, Gallo P. Low degree of cortical pathology is associated with benign course of multiple sclerosis. Mult Scler 2012; 19:904-11. [PMID: 23069877 DOI: 10.1177/1352458512463767] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although a more favorable course of multiple sclerosis is associated with a low degree of cortical pathology, only longitudinal studies could definitely confirm this association. MATERIALS AND METHODS We followed 95 early relapsing-remitting MS (RRMS; median Expanded Disability Status Scale (EDSS) = 1.5, mean disease duration = 3.1 ± 1.3 years) and 45 benign MS patients (EDSS ≤ 3.0, disease duration ≥ 15 years, normal cognition) for 6 years, with EDSS evaluations every 6 months and brain magnetic resonance imaging (MRI) at baseline and then yearly. RESULTS At baseline, we detected 406 cortical lesions (CLs) in 67/95 (70.5%) early RRMS and in 24/45 (53.3%) benign MS patients (p = 0.046). After 6 years, the appearance of new CLs was observed in 80/95 (84.2%; 518 CLs) of our early RRMS and in 25/45 (55.5%; 63 CLs; p < 0.001) benign MS patients. At baseline, after corrections for age and disease duration, we observed a cortical thinning of several frontal and temporal regions in our RRMS study patients, compared to the benign MS patients (p ranging between 0.001-0.05). After 6 years, the cortical thinning had increased significantly in several cortices of RRMS patients, but only in the occipital-temporal (p = 0.036) and superior parietal gyrus (p = 0.035) of those with benign MS. Stepwise regression analysis revealed the CL volume (p = 0.006) and the cortical thickness of the temporal middle (p < 0.001), insular long (p < 0.001), superior frontal (p < 0.001) and middle frontal gyri (p < 0.001) as the most sensitive independent predictors of a favorable disease course. CONCLUSIONS Our data confirmed that a significantly milder cortical pathology characterizes the most favorable clinical course of MS. Measures of focal and diffuse grey matter should be combined to increase the accuracy in the identification of a benign MS course.
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Affiliation(s)
- Massimiliano Calabrese
- The Multiple Sclerosis Centre of the Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padova, Italy.
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Calabrese M, Poretto V, Favaretto A, Alessio S, Bernardi V, Romualdi C, Rinaldi F, Perini P, Gallo P. Cortical lesion load associates with progression of disability in multiple sclerosis. Brain 2012; 135:2952-61. [DOI: 10.1093/brain/aws246] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Laganà MM, Forzoni L, Viotti S, De Beni S, Baselli G, Cecconi P. Assessment of the cerebral venous system from the transcondylar ultrasound window using virtual navigator technology and MRI. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:579-82. [PMID: 22254376 DOI: 10.1109/iembs.2011.6090108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Chronic Cerebro-Spinal Venous Insufficiency, recently described as a possible role in Multiple Sclerosis pathogenesis, is diagnosed and classified with Echo Color Doppler (ECD) examination of the extra- and intra-cranial veins. As to the intracranial examination, the presence of reflux in the deep cerebral veins (DCVs) or in the dural sinuses is inspected, with a new insonation approach, i.e. the transcondylar window. This work describes a procedure for the co-registration of anatomical Proton Density-weighted Magnetic Resonance Images (MRI) with the intracranial ECD obtained through the transcondylar window. The procedure, preliminarily tested on 10 volunteers, allowed to assess what are the DCVs visible from this new insonation approach and their position relative to the surrounding brain tissues.
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Rinaldi F, Calabrese M, Seppi D, Puthenparampil M, Perini P, Gallo P. Natalizumab strongly suppresses cortical pathology in relapsing-remitting multiple sclerosis. Mult Scler 2012; 18:1760-7. [PMID: 22570359 DOI: 10.1177/1352458512447704] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since cortical pathology has been indicated to play a relevant role in the physical and cognitive disability of multiple sclerosis (MS) patients, this study aims to analyze the efficacy of natalizumab in slowing down its progression. METHODS A total of 120 relapsing-remitting MS patients completed a 2-year prospective study: 35 received natalizumab, 50 received interferon beta-1a or glatiramer acetate (immunomodulatory agents - IMA) and 35 remained untreated. Forty healthy subjects constituted the reference population. Clinical and magnetic resonance imaging (MRI) evaluations (including cortical lesions and atrophy) were performed at baseline and after 2 years. RESULTS Natalizumab significantly reduced accumulation of new cortical lesions (0.2±0.6,range 0-3) compared to immunomodulatory agents (1.3±1.1 togli spazio, range 1-6, p=0.001) and no treatment (2.9±1.5, range 1-8, p<0.001). The percentage of patients with new cortical lesions was also lower in natalizumab-treated patients (20%) compared to IMA-treated and untreated patients (68.0% and 74.2%; p<0.001 for both comparisons). Furthermore, the progression of cortical atrophy was significantly reduced by natalizumab (% change=1.7%) compared to IMA (3.7%, p=0.003) and no therapy (4.6%, p<0.001). Finally, a greater percentage (51.4%) of natalizumab-treated patients remained disease-free (no clinical or MRI evidence of disease activity or progression) compared to IMA-treated (18%, p=0.001) and untreated patients (5.7%, p<0.001). CONCLUSIONS Natalizumab treatment significantly decreases cortical lesion accumulation and cortical atrophy progression in severe relapsing-remitting MS. While supporting the inflammatory origin of cortical lesions, our results highlight the significant impact of natalizumab on cortical pathology.
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Affiliation(s)
- F Rinaldi
- The Multiple Sclerosis Centre of Veneto Region, Department of Neurology, University Hospital of Padova, Italy
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Filippi M, Riccitelli G, Mattioli F, Capra R, Stampatori C, Pagani E, Valsasina P, Copetti M, Falini A, Comi G, Rocca MA. Multiple sclerosis: effects of cognitive rehabilitation on structural and functional MR imaging measures--an explorative study. Radiology 2012; 262:932-40. [PMID: 22357892 DOI: 10.1148/radiol.11111299] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate brain changes after cognitive rehabilitation in patients with clinically stable relapsing-remitting (RR) multiple sclerosis (MS) by using neuropsychologic assessment and structural and functional magnetic resonance (MR) imaging techniques. MATERIALS AND METHODS The study was conducted with approval of the involved institutional review boards. Written informed consent was obtained from each participant. Twenty patients with RR MS and cognitive deficits at baseline were randomly assigned to undergo treatment (n = 10), which entailed computer-assisted cognitive rehabilitation of attention and information processing and executive functions, or to serve as a control subjects (n = 10) without cognitive rehabilitation. All patients underwent a standardized neuropsychologic assessment and MR imaging at baseline and after 12 weeks. Changes in gray matter (GM) volumes on three-dimensional T1-weighted images and changes in normal-appearing white matter (NAWM) architecture on diffusion-weighted images were assessed. Changes in functional activity at functional MR imaging during the Stroop task and at rest were also investigated by using linear models. RESULTS As compared with their performance at baseline, the patients in the treatment group improved at tests of attention and information processing and executive functions. Neither structural modifications to GM volume nor modifications to NAWM architecture were detected at follow-up in both groups. Functional MR imaging demonstrated modifications of the activity of the posterior cingulate cortex (PCC)/precuneus and dorsolateral prefrontal cortex (PFC) during the Stroop task, as well as modifications of the activity of the anterior cingulum, PCC and/or precuneus, left dorsolateral PFC, and right inferior parietal lobule at rest in the treatment group compared with the control group. In the treatment group, functional MR imaging changes were correlated with cognitive improvement (P < .0001 to .01). CONCLUSION Rehabilitation of attention and information processing and executive functions in RR MS may be effected through enhanced recruitment of brain networks subserving the trained functions.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Department of Neurology, Division of Neuroscience, and Scientific Institute and Vita-Salute University, Hospital San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
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Barkhof F, Simon JH, Fazekas F, Rovaris M, Kappos L, de Stefano N, Polman CH, Petkau J, Radue EW, Sormani MP, Li DK, O'Connor P, Montalban X, Miller DH, Filippi M. MRI monitoring of immunomodulation in relapse-onset multiple sclerosis trials. Nat Rev Neurol 2011; 8:13-21. [DOI: 10.1038/nrneurol.2011.190] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mesaros S, Rocca MA, Pagani E, Sormani MP, Petrolini M, Comi G, Filippi M. Thalamic damage predicts the evolution of primary-progressive multiple sclerosis at 5 years. AJNR Am J Neuroradiol 2011; 32:1016-20. [PMID: 21393412 DOI: 10.3174/ajnr.a2430] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Reliable markers to monitor PPMS are still needed. We investigated whether conventional and DTI measures of thalamic damage are predictive of long-term disability accumulation in PPMS. MATERIALS AND METHODS Brain conventional and DTI scans were obtained at baseline and after a mean follow-up of 15 months in 54 patients with PPMS and 8 healthy controls. Patients were reassessed clinically after 5 years. At baseline and follow-up, measures of lesion load, brain atrophy, and NTV were obtained. MD and FA histograms of the NAWM, the whole GM without the thalami, and the thalami were obtained. A multivariate analysis evaluated the predictors of long-term neurologic deterioration. RESULTS At follow-up, 35 patients showed disability worsening. At baseline, compared with healthy controls, patients with PPMS had lower NTV (P < .001) and thalamic FA (P = .002) and higher thalamic (P = .002) and whole GM without the thalami (P = .005) MD. During follow-up, the change of thalamic FA was higher in PPMS versus healthy controls (P = .01). Baseline NTV and thalamic DTI quantities differed significantly between patients with PPMS with and without thalamic lesions. Baseline thalamic quantities were significantly correlated with the extent of brain T2 lesions and the severity of NAWM damage. The multivariate model included average NAWM MD (OR = 1.46, P = .005) and FA thalamic change (OR = 0.84, P = .02) as independent predictors of EDSS score deterioration (Nagelkerke R(2) = 0.55). CONCLUSIONS Short-term accrual of thalamic damage and the severity of NAWM involvement predict the long-term accumulation of disability in PPMS.
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Affiliation(s)
- S Mesaros
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, University Ospedale San Raffaele, Milan, Italy
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Cadavid D, Kim S, Peng B, Skurnick J, Younes M, Hill J, Wolansky LJ, Cook SD. Clinical consequences of MRI activity in treated multiple sclerosis. Mult Scler 2011; 17:1113-21. [DOI: 10.1177/1352458511405375] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Inflammation on brain MRI is the most sensitive marker of disease activity in multiple sclerosis (MS) but its clinical consequences remain controversial. Objective: Here we investigated the clinical consequences of MRI activity in MS subjects treated with two different first line disease modifying agents. Methods: Seventy-five treatment-naïve subjects with relapsing–remitting MS ( N = 61) or clinically isolated syndromes at risk of MS ( N = 14) from the BECOME study that had been randomized to interferon beta-1b ( N = 39) or glatiramer acetate ( N = 36) and followed for up to two years by monthly brain MRI optimized to detect inflammatory activity were studied for the clinical consequences of lack of MRI remission. Results: MRI remission occurred in 46.4% of participants transiently and in 23.2% completely while it was never achieved in 30.4%. There was no difference by treatment in MRI remission, progression of physical disability, or cognitive function. The percentage of relapse-free subjects was 87.5% for the group in complete MRI remission, 47.6% in the group never in remission and 59.4% in the group in transient remission ( p = 0.017). Similar differences were observed for six-month-confirmed worsening of ambulatory function as measured by the timed 25 foot walk ( p = 0.026) and by Expanded Disability Status Scale (EDSS) ( p = 0.10). Cognitive function was lowest at baseline for the group that never reached MRI remission on treatment; this group improved the least upon repeated cognitive testing during the two years of treatment ( p < 0.001). Conclusions: Lack of MRI remission during treatment with interferon beta-1b or glatiramer acetate is associated with higher relapse rate and worsening of physical and cognitive function.
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Affiliation(s)
- Diego Cadavid
- Department of Neurology and Neuroscience, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
| | - Soyeon Kim
- Department of Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
| | - Bo Peng
- Department of Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
| | - Joan Skurnick
- Department of Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
| | - Maha Younes
- Department of Neurology and Neuroscience, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
| | - James Hill
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
| | - Leo J Wolansky
- Department of Radiology, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
| | - Stuart D Cook
- Department of Neurology and Neuroscience, University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, USA
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Tian W, Zhu T, Zhong J, Liu X, Rao P, Segal BM, Ekholm S. Progressive decline in fractional anisotropy on serial DTI examinations of the corpus callosum: a putative marker of disease activity and progression in SPMS. Neuroradiology 2011; 54:287-97. [DOI: 10.1007/s00234-011-0885-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
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Hladikova M, Vašků A, Štourač P, Benešová Y, Bednařík J. Two frequent polymorphisms of angiotensinogen and their association with multiple sclerosis progression rate. J Neurol Sci 2011; 303:31-4. [DOI: 10.1016/j.jns.2011.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/03/2010] [Accepted: 01/19/2011] [Indexed: 10/18/2022]
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50
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Glatiramer acetate recovers microscopic tissue damage in patients with multiple sclerosis. A case–control diffusion imaging study. PATHOPHYSIOLOGY 2011; 18:61-8. [DOI: 10.1016/j.pathophys.2010.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 03/16/2010] [Accepted: 04/08/2010] [Indexed: 11/17/2022] Open
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