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Moura J, Granziera C, Marta M, Silva AM. Emerging imaging markers in radiologically isolated syndrome: implications for earlier treatment initiation. Neurol Sci 2024; 45:3061-3068. [PMID: 38374458 DOI: 10.1007/s10072-024-07402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
The presence of central nervous system lesions fulfilling the criteria of dissemination in space and time on MRI leads to the diagnosis of a radiologically isolated syndrome (RIS), which may be an early sign of multiple sclerosis (MS). However, some patients who do not fulfill the necessary criteria for RIS still evolve to MS, and some T2 hyperintensities that resemble demyelinating lesions may originate from mimics. In light of the recent recognition of the efficacy of disease-modifying therapy (DMT) in RIS, it is relevant to consider additional imaging features that are more specific of MS. We performed a narrative review on cortical lesions (CL), the central vein sign (CVS), and paramagnetic rim lesions (PRL) in patients with RIS. In previous RIS studies, the reported prevalence of CLs ranges between 20.0 and 40.0%, CVS + white matter lesions (WMLs) between 87.0 and 93.0% and PRLs between 26.7 and 63.0%. Overall, these imaging findings appear to be frequent in RIS cohorts, although not consistently taken into account in previous studies. The search for CLs, CVS + WML and PRLs in RIS patients could lead to earlier identification of patients who will evolve to MS and benefit from DMTs.
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Affiliation(s)
- João Moura
- Department of Neurology, Centro Hospitalar Universitário de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Monica Marta
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, London, UK
| | - Ana Martins Silva
- Department of Neurology, Centro Hospitalar Universitário de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- Unit of Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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Jacob A, Shatila AO, Inshasi J, Massouh J, Mir R, Noori S, Yamout B. Disease modifying treatment guidelines for multiple sclerosis in the United Arab Emirates. Mult Scler Relat Disord 2024; 88:105703. [PMID: 38924933 DOI: 10.1016/j.msard.2024.105703] [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: 01/21/2024] [Revised: 05/13/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
The newly constituted National Multiple Sclerosis (MS) Society (NMSS)of the United Arab Emirates (UAE), set up a scientific committee to create a MS disease modifying treatment (DMT) guideline for UAE. The committee considered several unique features of the MS community in UAE including large number of expatriate population, wide variations in health insurance coverage, physician and patient preferences for DMT. The overall goal of the treatment guideline is to facilitate the most appropriate DMT to the widest number of patients. To this end it has adapted recommendations from various health systems and regulatory authorities into a pragmatic amalgamation of best practices from across the world. Importantly where data is unavailable or controversial, a common sense approach is taken rather than leave physicians and patients in limbo. The committee classifies MS into subcategories and suggests appropriate treatment choices. It recommends treatment of RIS and CIS with poor prognostic factors. It largely equates the efficacy and safety of DMT with similar mechanisms of action or drug classes e.g. ocrelizumab is similar to rituximab. It allows early switching of treatment for unambiguous disease activity and those with progression independent of relapses. Autologous hematopoietic stem cell transplantation can be offered to patients who fail one high efficacy DMT. Pragmatic guidance on switching and stopping DMT, DMT choices in pregnancy, lactation and pediatric MS have been included. It is expected that these guidelines will be updated periodically as new data becomes available.
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Affiliation(s)
- Anu Jacob
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates; The Walton Centre, Liverpool, United Kingdom.
| | - Ahmed Osman Shatila
- Department of Neurology, Sheikh Shakhbout Medical City Abu Dhabi, United Arab Emirates
| | - Jihad Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Joelle Massouh
- Neurology Institute and Multiple Sclerosis Centre, Harley Street Medical centre, Abu Dhabi, United Arab Emirates
| | - Ruquia Mir
- Abu Dhabi stem Cell Clinic, United Arab Emirates
| | - Suzan Noori
- University Hospital Sharjah, United Arab Emirates
| | - Bassem Yamout
- Neurology Institute and Multiple Sclerosis Centre, Harley Street Medical centre, Abu Dhabi, United Arab Emirates; American University of Beirut, Lebanon
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3
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Epstein SE, Longbrake EE. Shifting our attention earlier in the multiple sclerosis disease course. Curr Opin Neurol 2024; 37:212-219. [PMID: 38546031 DOI: 10.1097/wco.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE OF REVIEW Revisions of multiple sclerosis (MS) diagnostic criteria enable clinicians to diagnose patients earlier in the biologic disease course. Prompt initiation of therapy correlates with improved clinical outcomes. This has led to increased attention on the earliest stages of MS, including the MS prodrome and radiologically isolated syndrome (RIS). Here, we review current understanding and approach to patients with preclinical MS. RECENT FINDINGS MS disease biology often begins well before the onset of typical MS symptoms, and we are increasingly able to recognize preclinical and prodromal stages of MS. RIS represents the best characterized aspect of preclinical MS, and its diagnostic criteria were recently revised to better capture patients at highest risk of conversion to clinical MS. The first two randomized control trials evaluating disease modifying therapy use in RIS also found that treatment could delay or prevent onset of clinical disease. SUMMARY Despite progress in our understanding of the earliest stages of the MS disease course, additional research is needed to systematically identify patients with preclinical MS as well as capture those at risk for developing clinical disease. Recent data suggests that preventive immunomodulatory therapies may be beneficial for high-risk patients with RIS; though management remains controversial.
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Preziosa P, Rocca MA, Filippi M. Radiologically isolated syndromes: to treat or not to treat? J Neurol 2024; 271:2370-2378. [PMID: 38502339 DOI: 10.1007/s00415-024-12294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to increased detection of individuals exhibiting asymptomatic brain and spinal cord lesions suggestive of multiple sclerosis (MS), defined as "radiologically isolated syndrome" (RIS). Specific criteria have been proposed and updated over time to identify individuals with RIS. Moreover, a younger age, the presence of infratentorial, spinal cord or gadolinium-enhancing lesions, as well as of cerebrospinal fluid-specific oligoclonal bands have been recognized as relevant risk factors for the occurrence of a first clinical event. Recent randomized controlled trials conducted in individuals with RIS have shown that dimethyl fumarate and teriflunomide significantly reduce the occurrence of clinical events in this population. These findings support the notion that early treatment initiation may positively influence the prognosis of these patients. However, several aspects should be taken into account before treating individuals with RIS in the real-world clinical setting, including an accurate identification of individuals with RIS to avoid misdiagnosis, a precise stratification of their risk of experiencing a first clinical event and further data supporting favorable balance between benefits and risks, even in the long term. This commentary provides an overview of the latest updates in RIS diagnosis, prognosis, and emerging treatment evidence.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Ontaneda D, Chitnis T, Rammohan K, Obeidat AZ. Identification and management of subclinical disease activity in early multiple sclerosis: a review. J Neurol 2024; 271:1497-1514. [PMID: 37864717 PMCID: PMC10972995 DOI: 10.1007/s00415-023-12021-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
IMPORTANCE Early treatment initiation in multiple sclerosis (MS) is crucial in preventing irreversible neurological damage and disability progression. The current assessment of disease activity relies on relapse rates and magnetic resonance imaging (MRI) lesion activity, but inclusion of other early, often "hidden," indicators of disease activity may describe a more comprehensive picture of MS. OBSERVATIONS Early indicators of MS disease activity other than relapses and MRI activity, such as cognitive impairment, brain atrophy, and fatigue, are not typically captured by routine disease monitoring. Furthermore, silent progression (neurological decline not clearly captured by standard methods) may occur undetected by relapse and MRI lesion activity monitoring. Consequently, patients considered to have no disease activity actually may have worsening disease, suggesting a need to revise MS management strategies with respect to timely initiation and escalation of disease-modifying therapy (DMT). Traditionally, first-line MS treatment starts with low- or moderate-efficacy therapies, before escalating to high-efficacy therapies (HETs) after evidence of breakthrough disease activity. However, multiple observational studies have shown that early initiation of HETs can prevent or reduce disability progression. Ongoing randomized clinical trials are comparing escalation and early HET approaches. CONCLUSIONS AND RELEVANCE There is an urgent need to reassess how MS disease activity and worsening are measured. A greater awareness of "hidden" indicators, potentially combined with biomarkers to reveal silent disease activity and neurodegeneration underlying MS, would provide a more complete picture of MS and allow for timely therapeutic intervention with HET or switching DMTs to address suboptimal treatment responses.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kottil Rammohan
- Division of Multiple Sclerosis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Jakimovski D, Bittner S, Zivadinov R, Morrow SA, Benedict RH, Zipp F, Weinstock-Guttman B. Multiple sclerosis. Lancet 2024; 403:183-202. [PMID: 37949093 DOI: 10.1016/s0140-6736(23)01473-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 11/12/2023]
Abstract
Multiple sclerosis remains one of the most common causes of neurological disability in the young adult population (aged 18-40 years). Novel pathophysiological findings underline the importance of the interaction between genetics and environment. Improvements in diagnostic criteria, harmonised guidelines for MRI, and globalised treatment recommendations have led to more accurate diagnosis and an earlier start of effective immunomodulatory treatment than previously. Understanding and capturing the long prodromal multiple sclerosis period would further improve diagnostic abilities and thus treatment initiation, eventually improving long-term disease outcomes. The large portfolio of currently available medications paved the way for personalised therapeutic strategies that will balance safety and effectiveness. Incorporation of cognitive interventions, lifestyle recommendations, and management of non-neurological comorbidities could further improve quality of life and outcomes. Future challenges include the development of medications that successfully target the neurodegenerative aspect of the disease and creation of sensitive imaging and fluid biomarkers that can effectively predict and monitor disease changes.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ralph Hb Benedict
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
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7
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Stavropoulou De Lorenzo S, Bakirtzis C, Konstantinidou N, Kesidou E, Parissis D, Evangelopoulos ME, Elsayed D, Hamdy E, Said S, Grigoriadis N. How Early Is Early Multiple Sclerosis? J Clin Med 2023; 13:214. [PMID: 38202221 PMCID: PMC10780129 DOI: 10.3390/jcm13010214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
The development and further optimization of the diagnostic criteria for multiple sclerosis (MS) emphasize the establishment of an early and accurate diagnosis. So far, numerous studies have revealed the significance of early treatment administration for MS and its association with slower disease progression and better late outcomes of the disease with regards to disability accumulation. However, according to current research results, both neuroinflammatory and neurodegenerative processes may exist prior to symptom initiation. Despite the fact that a significant proportion of individuals with radiologically isolated syndrome (RIS) progress to MS, currently, there is no available treatment approved for RIS. Therefore, our idea of "early treatment administration" might be already late in some cases. In order to detect the individuals who will progress to MS, we need accurate biomarkers. In this review, we present notable research results regarding the underlying pathology of MS, as well as several potentially useful laboratory and neuroimaging biomarkers for the identification of high-risk individuals with RIS for developing MS. This review aims to raise clinicians' awareness regarding "subclinical" MS, enrich their understanding of MS pathology, and familiarize them with several potential biomarkers that are currently under investigation and might be used in clinical practice in the future for the identification of individuals with RIS at high risk for conversion to definite MS.
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Affiliation(s)
- Sotiria Stavropoulou De Lorenzo
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Christos Bakirtzis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Natalia Konstantinidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Evangelia Kesidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Dimitrios Parissis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | | | - Dina Elsayed
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Eman Hamdy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Sameh Said
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Nikolaos Grigoriadis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
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Lebrun-Frenay C, Kantarci OH, Siva A, Pelletier D, Okuda DT. Reply: Do we need new MRI criteria for the diagnosis of radiologically isolated syndrome? Brain 2023; 146:e104-e106. [PMID: 37259177 DOI: 10.1093/brain/awad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Christine Lebrun-Frenay
- Neurologie CHU Nice, Hôpital Pasteur2, UMR2CA-URRIS, Université Côte d'Azur, 06002 Nice, France
| | | | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul 34098, Turkey
| | - Daniel Pelletier
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Darin T Okuda
- The University of Texas Southwestern Medical Center, Neuroinnovation Program, Multiple Sclerosis, and Neuroimmunology Imaging Program, Dallas, TX 75390, USA
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9
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De Stefano N, Rovira À. Do we need new MRI criteria for the diagnosis of radiologically isolated syndrome? Brain 2023; 146:e102-e103. [PMID: 37258492 DOI: 10.1093/brain/awad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Àlex Rovira
- Department of Radiology, Section of Neuroradiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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10
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Lebrun-Frenay C, Kantarci O, Siva A, Azevedo CJ, Makhani N, Pelletier D, Okuda DT. Radiologically isolated syndrome. Lancet Neurol 2023; 22:1075-1086. [PMID: 37839432 DOI: 10.1016/s1474-4422(23)00281-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 10/17/2023]
Abstract
Individuals can be deemed to have radiologically isolated syndrome (RIS) if they have incidental demyelinating-appearing lesions in their brain or spinal cord that are highly suggestive of multiple sclerosis but their clinical history does not include symptoms consistent with multiple sclerosis. Data from international longitudinal cohorts indicate that around half of people with RIS will develop relapsing or progressive symptoms of multiple sclerosis within 10 years, suggesting that in some individuals, RIS is a presymptomatic stage of multiple sclerosis. Risk factors for progression from RIS to clinical multiple sclerosis include younger age (ie, <35 years), male sex, CSF-restricted oligoclonal bands, spinal cord or infratentorial lesions, and gadolinium-enhancing lesions. Other imaging, biological, genetic, and digital biomarkers that might be of value in identifying individuals who are at the highest risk of developing multiple sclerosis need further investigation. Two 2-year randomised clinical trials showed the efficacy of approved multiple sclerosis immunomodulatory medications in preventing the clinical conversion to multiple sclerosis in some individuals with RIS. If substantiated in longer-term studies, these data have the potential to transform our approach to care for the people with RIS who are at the greatest risk of diagnosis with multiple sclerosis.
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Affiliation(s)
- Christine Lebrun-Frenay
- CRC-SEP Nice, Neurologie CHU Nice, Hôpital Pasteur 2, UMR2CA-URRIS, Université Côte d'Azur, Nice, France.
| | | | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkiye
| | - Christina J Azevedo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Naila Makhani
- Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Daniel Pelletier
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Darin T Okuda
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Abou Mrad T, Naja K, Khoury SJ, Hannoun S. Central vein sign and paramagnetic rim sign: From radiologically isolated syndrome to multiple sclerosis. Eur J Neurol 2023; 30:2912-2918. [PMID: 37350369 DOI: 10.1111/ene.15922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to an increase in incidental findings in the central nervous system. Radiologically isolated syndrome (RIS) is a condition where imaging reveals lesions suggestive of demyelinating disease without any clinical episodes consistent with multiple sclerosis (MS). The prognosis for RIS patients is uncertain, with some remaining asymptomatic while others progress to MS. Several risk factors for disease progression have been identified, including male sex, younger age at diagnosis, and spinal cord lesions. This article reviews two promising biomarkers, the central vein sign (CVS) and the paramagnetic rim sign (PRS), and their potential role in the diagnosis and prognosis of MS and RIS. Both CVS and PRS have been shown to be accurate diagnostic markers in MS, with high sensitivity and specificity, and have been useful in distinguishing MS from other disorders. Further research is needed to validate these findings and determine the clinical utility of these biomarkers in routine practice.
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Affiliation(s)
- Tatiana Abou Mrad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kim Naja
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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12
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Lebrun-Frénay C, Okuda DT, Siva A, Landes-Chateau C, Azevedo CJ, Mondot L, Carra-Dallière C, Zephir H, Louapre C, Durand-Dubief F, Le Page E, Bensa C, Ruet A, Ciron J, Laplaud DA, Casez O, Mathey G, de Seze J, Zeydan B, Makhani N, Tutuncu M, Levraut M, Cohen M, Thouvenot E, Pelletier D, Kantarci OH. The radiologically isolated syndrome: revised diagnostic criteria. Brain 2023; 146:3431-3443. [PMID: 36864688 PMCID: PMC11004931 DOI: 10.1093/brain/awad073] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 03/04/2023] Open
Abstract
The radiologically isolated syndrome (RIS) was defined in 2009 as the presence of asymptomatic, incidentally identified demyelinating-appearing white matter lesions in the CNS within individuals lacking symptoms typical of multiple sclerosis (MS). The RIS criteria have been validated and predict the transition to symptomatic MS reliably. The performance of RIS criteria that require fewer MRI lesions is unknown. 2009-RIS subjects, by definition, fulfil three to four of four criteria for 2005 dissemination in space (DIS) and subjects fulfilling only one or two lesions in at least one 2017 DIS location were identified within 37 prospective databases. Univariate and multivariate Cox regression models were used to identify predictors of a first clinical event. Performances of different groups were calculated. Seven hundred and forty-seven subjects (72.2% female, mean age 37.7 ± 12.3 years at the index MRI) were included. The mean clinical follow-up time was 46.8 ± 45.4 months. All subjects had focal T2 hyperintensities suggestive of inflammatory demyelination on MRI; 251 (33.6%) fulfilled one or two 2017 DIS criteria (designated as Groups 1 and 2, respectively), and 496 (66.4%) fulfilled three or four 2005 DIS criteria representing 2009-RIS subjects. Group 1 and 2 subjects were younger than the 2009-RIS group and were more likely to develop new T2 lesions over time (P < 0.001). Groups 1 and 2 were similar regarding survival distribution and risk factors for transition to MS. At 5 years, the cumulative probability for a clinical event was 29.0% for Groups 1 and 2 compared to 38.7% for 2009-RIS (P = 0.0241). The presence of spinal cord lesions on the index scan and CSF-restricted oligoclonal bands in Groups 1-2 increased the risk of symptomatic MS evolution at 5 years to 38%, comparable to the risk of development in the 2009-RIS group. The presence of new T2 or gadolinium-enhancing lesions on follow-up scans independently increased the risk of presenting with a clinical event (P < 0.001). The 2009-RIS subjects or Groups 1 and 2 with at least two of the risk factors for a clinical event demonstrated better sensitivity (86.0%), negative predictive value (73.1%), accuracy (59.8%) and area under the curve (60.7%) compared to other criteria studied. This large prospective cohort brings Class I evidence that subjects with fewer lesions than required in the 2009 RIS criteria evolve directly to a first clinical event at a similar rate when additional risk factors are present. Our results provide a rationale for revisions to existing RIS diagnostic criteria.
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Affiliation(s)
- Christine Lebrun-Frénay
- Neurology MS Clinic Nice, Pasteur 2 University Hospital, UR2CA-URRIS, Côte d’Azur University, Nice 06002, France
| | - Darin T Okuda
- Neuroinnovation Program, Multiple Sclerosis, and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, 34098 Istanbul, Turkey
| | - Cassandre Landes-Chateau
- Neurology MS Clinic Nice, Pasteur 2 University Hospital, UR2CA-URRIS, Côte d’Azur University, Nice 06002, France
| | - Christina J Azevedo
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Lydiane Mondot
- Neurology MS Clinic Nice, Pasteur 2 University Hospital, UR2CA-URRIS, Côte d’Azur University, Nice 06002, France
| | - Clarisse Carra-Dallière
- Neurology MS Clinic, Montpellier University Hospital, 34295 Montpellier, France
- University of Montpellier (MUSE), 34295 Montpellier, France
| | - Helene Zephir
- Inserm UMR-S 1172 LilNcog, Lille University, Lille University Hospital Precise, 59000 Lille, France
| | - Celine Louapre
- Department of Neurology, Sorbonne University, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Françoise Durand-Dubief
- Neurology MS Clinic, Neurological Hospital Pierre Wertheimer, Lyon University Hospital, 69500 Lyon/Bron, France
| | - Emmanuelle Le Page
- Neurology MS Clinic Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital, 35000 Rennes, France
| | | | - Aurélie Ruet
- Neurology MS Clinic Bordeaux, University Hospital, 33000 Bordeaux, France
- Neurocentre Magendie, Bordeaux University, INSERM, U1215, 33000 Bordeaux, France
| | - Jonathan Ciron
- Neurology MS Clinic, Toulouse University Hospital, 31300 Toulouse, France
- Infinity, INSERM UMR1291, CNRS UMR5051, Toulouse III University, 31300 Toulouse, France
| | - David A Laplaud
- Neurology, Nantes University Hospital, CIC1314 INSERM, 44000 Nantes, France
- CR2TI INSERM U1064, Nantes University, 44000 Nantes, France
| | - Olivier Casez
- Neurology MS Clinic Grenoble, Grenoble Alpes University Hospital, 38700 Grenoble, France
- T-RAIG, TIMC-IMAG, Grenoble Alpes University, 38700 Grenoble, France
| | - Guillaume Mathey
- Neurology, Nancy University Hospital, 54000 Nancy, France
- Vandoeuvre-Lès-Nancy, Lorraine University, EA 4360 APEMAC, 54000 Nancy, France
| | - Jerome de Seze
- Clinical Investigation Center, Neurology, Strasbourg University Hospital, INSERM 1434, 67200 Strasbourg, France
| | - Burcu Zeydan
- Neurology and Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Naila Makhani
- Pediatrics and Neurology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Melih Tutuncu
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, 34098 Istanbul, Turkey
| | - Michael Levraut
- Neurology MS Clinic Nice, Pasteur 2 University Hospital, UR2CA-URRIS, Côte d’Azur University, Nice 06002, France
| | - Mikael Cohen
- Neurology MS Clinic Nice, Pasteur 2 University Hospital, UR2CA-URRIS, Côte d’Azur University, Nice 06002, France
| | - Eric Thouvenot
- Neurology, Nîmes University Hospital, 30900 Nîmes, France
- IGF, Montpellier University, CNRS, INSERM, 34295 Montpellier, France
| | - Daniel Pelletier
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Solomon AJ, Arrambide G, Brownlee WJ, Flanagan EP, Amato MP, Amezcua L, Banwell BL, Barkhof F, Corboy JR, Correale J, Fujihara K, Graves J, Harnegie MP, Hemmer B, Lechner-Scott J, Marrie RA, Newsome SD, Rocca MA, Royal W, Waubant EL, Yamout B, Cohen JA. Differential diagnosis of suspected multiple sclerosis: an updated consensus approach. Lancet Neurol 2023; 22:750-768. [PMID: 37479377 DOI: 10.1016/s1474-4422(23)00148-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 07/23/2023]
Abstract
Accurate diagnosis of multiple sclerosis requires careful attention to its differential diagnosis-many disorders can mimic the clinical manifestations and paraclinical findings of this disease. A collaborative effort, organised by The International Advisory Committee on Clinical Trials in Multiple Sclerosis in 2008, provided diagnostic approaches to multiple sclerosis and identified clinical and paraclinical findings (so-called red flags) suggestive of alternative diagnoses. Since then, knowledge of disorders in the differential diagnosis of multiple sclerosis has expanded substantially. For example, CNS inflammatory disorders that present with syndromes overlapping with multiple sclerosis can increasingly be distinguished from multiple sclerosis with the aid of specific clinical, MRI, and laboratory findings; studies of people misdiagnosed with multiple sclerosis have also provided insights into clinical presentations for which extra caution is warranted. Considering these data, an update to the recommended diagnostic approaches to common clinical presentations and key clinical and paraclinical red flags is warranted to inform the contemporary clinical evaluation of patients with suspected multiple sclerosis.
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Affiliation(s)
- Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, University Health Center, Burlington, VT, USA.
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wallace J Brownlee
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Eoin P Flanagan
- Departments of Neurology and Laboratory Medicine and Pathology and the Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Lilyana Amezcua
- Department of Neurology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Brenda L Banwell
- Department of Neurology, University of Pennsylvania, Division of Child Neurology, Philadelphia, PA, USA; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - John R Corboy
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jorge Correale
- Department of Neurology, Fleni Institute of Biological Chemistry and Physical Chemistry (IQUIFIB), Buenos Aires, Argentina; National Council for Scientific and Technical Research/University of Buenos Aires, Buenos Aires, Argentina
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Koriyama, Japan; Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Jennifer Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | | | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Medical Faculty, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology, Munich, Germany
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, NSW Australia; Hunter Medical Research Institute Neurology, University of Newcastle, Newcastle, NSW, Australia
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Walter Royal
- Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Emmanuelle L Waubant
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Bassem Yamout
- Neurology Institute, Harley Street Medical Center, Abu Dhabi, United Arab Emirates
| | - Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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14
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Bower A, Makhani N. Radiologically Isolated Syndrome and the Multiple Sclerosis Prodrome in Pediatrics: Early Features of the Spectrum of Demyelination. Semin Pediatr Neurol 2023; 46:101053. [PMID: 37451751 DOI: 10.1016/j.spen.2023.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/18/2023]
Abstract
Radiologically isolated syndrome refers to the clinical scenario in which individuals have imaging concerning for multiple sclerosis and would otherwise satisfy radiographic dissemination in space criteria, but do not have any attributable signs or symptoms. Radiologically isolated syndrome has been increasingly recognized in the pediatric population and it is understood certain individuals will transition to a formal diagnosis of multiple sclerosis over time. This review aims to outline the available data within this unique population including the diagnostic criteria, epidemiology, risk factors associated with transitioning to multiple sclerosis, and the current therapeutic landscape. Radiologically isolated syndrome will also be positioned within a broader spectrum of demyelinating disease as recent data has pointed towards a likely prodromal phase that precedes a first clinical event and diagnosis of multiple sclerosis. Characterizing the radiographic features, clinical symptoms, and biomarkers that constitute this prodromal phase of multiple sclerosis would help identify patients who may most benefit from early intervention in the future.
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Affiliation(s)
- Aaron Bower
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Naila Makhani
- Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Pediatrics, Yale School of Medicine, New Haven, CT.
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15
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Brauchle F, Rapp D, Senel M, Huss A, Dreyhaupt J, Klose V, Süße M, Stürner KH, Leypoldt F, Tumani H, Lewerenz J. Clinical associations and characteristics of the polyspecific intrathecal immune response in elderly patients with non-multiple sclerosis chronic autoimmune-inflammatory neurological diseases - a retrospective cross-sectional study. Front Neurol 2023; 14:1193015. [PMID: 37396770 PMCID: PMC10311206 DOI: 10.3389/fneur.2023.1193015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The polyspecific intrathecal immune response (PSIIR), aka MRZ reaction (M = measles, R = rubella, Z = zoster, optionally Herpes simplex virus, HSV) is defined as intrathecal immunoglobulin synthesis (IIS) for two or more unrelated viruses. Although an established cerebrospinal fluid (CSF) biomarker for multiple sclerosis (MS), a chronic autoimmune-inflammatory neurological disease (CAIND) of the central nervous system (CNS) usually starting in young adulthood, the full spectrum of CAINDs with a positive PSIIR remains ill defined. Methods In this retrospective, cross-sectional study, patients with CSF-positive oligoclonal bands (OCB) and - to enrich for non-MS diagnoses - aged ≥50 years were enrolled. Results Of 415 with PSIIR testing results (MRZ, HSV optional), 76 were PSIIR-positive. Of these, 25 (33%) did not meet the diagnostic criteria for MS spectrum diseases (MS-S) comprising clinically or radiologically isolated syndrome (CIS/RIS) or MS. PSIIR-positive non-MS-S phenotypes were heterogenous with CNS, peripheral nerve and motor neuron involvement and often defied unequivocal diagnostic classification. A rating by neuroimmunology experts suggested non-MS CAINDs in 16/25 (64%). Long-term follow-up available in 13 always showed a chronically progressive course. Four of five responded to immunotherapy. Compared to MS-S patients, non-MS CAIND patients showed less frequent CNS regions with demyelination (25% vs. 75%) and quantitative IgG IIS (31% vs. 81%). MRZ-specific IIS did not differ between both groups, while additional HSV-specific IIS was characteristic for non-MS CAIND patients. Discussion In conclusion, PSIIR positivity occurs frequently in non-MS-S patients ≥50 years. Although sometimes apparently coincidental, the PSIIR seems to represent a suitable biomarker for previously unnoticed chronic neurologic autoimmunities, which require further characterization.
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Affiliation(s)
| | - Daniel Rapp
- Department of Neurology, Ulm University, Ulm, Germany
| | - Makbule Senel
- Department of Neurology, Ulm University, Ulm, Germany
| | - André Huss
- Department of Neurology, Ulm University, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Veronika Klose
- German Center for Neurodegenerative Diseases (DNZE), Campus Ulm, Ulm, Germany
| | - Marie Süße
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Klarissa Hanja Stürner
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
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16
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Sforza G, Monte G, Voci A, Figà Talamanca L, Papetti L, Ferilli MAN, Proietti Checchi M, Valeriani M, Moavero R. A Case Report of Pediatric Patient with Tuberous Sclerosis and Radiologically Isolated Syndrome. J Clin Med 2023; 12:jcm12093284. [PMID: 37176724 PMCID: PMC10179347 DOI: 10.3390/jcm12093284] [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: 03/18/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disease with central nervous system (CNS) involvement. Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the CNS characterized by symptomatic episodes that occur months or years apart and affect different anatomic locations. In the absence of symptomatic episodes, radiologically isolated syndrome (RIS) could be diagnosed. Here, we report the case of a 10-year-old boy followed-up for TSC and diagnosed with RIS after a routine neuroimaging assessment. CASE DESCRIPTION The patient was diagnosed with TSC after seizure onset at the age of 4 years. The follow-up magnetic resonance imaging (MRI) showed multiple asymptomatic demyelinating lesions. Brain and spinal cord MRI was performed after 2 months and showed additional lesions in the right frontal white matter and left cerebral peduncle, the latter with contrast enhancement. Therefore, he received a diagnosis of RIS. Visual evoked potentials were normal. Cerebrospinal fluid examination showed oligoclonal bands. The search for AQP4-IgG and MOG-IgG antibodies was negative. He was treated with interferon beta-1a. Six months later, follow-up MRI revealed no new demyelinating lesions and resolution of contrast enhancement. CONCLUSION To the best of our knowledge, this is the third reported patient presenting a co-occurrence of TSC and demyelinating disease. Although we cannot state if the described comorbidity is casual or not, some clinical and preclinical data suggest that the mTOR complex might be the link between TSC and demyelinating disease.
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Affiliation(s)
- Giorgia Sforza
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Gabriele Monte
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Alessandra Voci
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | | | - Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | | | | | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Center for Sensory-Motor Interaction, Denmark Neurology Unit, Aalborg University, 922 Aalborg, Denmark
| | - Romina Moavero
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, 00133 Rome, Italy
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17
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Charabati M, Wheeler MA, Weiner HL, Quintana FJ. Multiple sclerosis: Neuroimmune crosstalk and therapeutic targeting. Cell 2023; 186:1309-1327. [PMID: 37001498 PMCID: PMC10119687 DOI: 10.1016/j.cell.2023.03.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/23/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system afflicting nearly three million individuals worldwide. Neuroimmune interactions between glial, neural, and immune cells play important roles in MS pathology and offer potential targets for therapeutic intervention. Here, we review underlying risk factors, mechanisms of MS pathogenesis, available disease modifying therapies, and examine the value of emerging technologies, which may address unmet clinical needs and identify novel therapeutic targets.
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Affiliation(s)
- Marc Charabati
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael A Wheeler
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Francisco J Quintana
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.
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18
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Present and future of the diagnostic work-up of multiple sclerosis: the imaging perspective. J Neurol 2023; 270:1286-1299. [PMID: 36427168 PMCID: PMC9971159 DOI: 10.1007/s00415-022-11488-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/26/2022]
Abstract
In recent years, the use of magnetic resonance imaging (MRI) for the diagnostic work-up of multiple sclerosis (MS) has evolved considerably. The 2017 McDonald criteria show high sensitivity and accuracy in predicting a second clinical attack in patients with a typical clinically isolated syndrome and allow an earlier diagnosis of MS. They have been validated, are evidence-based, simplify the clinical use of MRI criteria and improve MS patients' management. However, to limit the risk of misdiagnosis, they should be applied by expert clinicians only after the careful exclusion of alternative diagnoses. Recently, new MRI markers have been proposed to improve diagnostic specificity for MS and reduce the risk of misdiagnosis. The central vein sign and chronic active lesions (i.e., paramagnetic rim lesions) may increase the specificity of MS diagnostic criteria, but further effort is necessary to validate and standardize their assessment before implementing them in the clinical setting. The feasibility of subpial demyelination assessment and the clinical relevance of leptomeningeal enhancement evaluation in the diagnostic work-up of MS appear more limited. Artificial intelligence tools may capture MRI attributes that are beyond the human perception, and, in the future, artificial intelligence may complement human assessment to further ameliorate the diagnostic work-up and patients' classification. However, guidelines that ensure reliability, interpretability, and validity of findings obtained from artificial intelligence approaches are still needed to implement them in the clinical scenario. This review provides a summary of the most recent updates regarding the application of MRI for the diagnosis of MS.
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Longbrake EE, Hua LH, Mowry EM, Gauthier SA, Alvarez E, Cross AH, Pei J, Priest J, Raposo C, Hafler DA, Winger RC. The CELLO trial: Protocol of a planned phase 4 study to assess the efficacy of Ocrelizumab in patients with radiologically isolated syndrome. Mult Scler Relat Disord 2022; 68:104143. [PMID: 36031693 PMCID: PMC9772048 DOI: 10.1016/j.msard.2022.104143] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/21/2022] [Accepted: 08/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with radiologically isolated syndrome (RIS) exhibit CNS lesions suggestive of multiple sclerosis (MS) in the absence of overt neurological symptoms characteristic of the disease. They may have concurrent brain atrophy, subtle cognitive impairment, and intrathecal inflammation. At least half ultimately develop MS, cementing RIS as preclinical MS for many. However, high-quality data, including immunologic biomarkers, to guide treatment decisions in this population are lacking. Early intervention with ocrelizumab, a humanized monoclonal antibody approved for relapsing and primary progressive MS that targets CD20+ B-cells, may affect disease course and improve long-term outcomes. The objective of this study is to describe the protocol for CELLO, a clinical trial assessing the effect of ocrelizumab on RIS. METHODS The CELLO clinical trial, a phase 4, multicenter, randomized, double-blind, placebo-controlled study conducted as an academic-industry collaboration, aims to (1) assess the efficacy of ocrelizumab in patients with RIS and (2) identify biomarkers indicative of emerging autoimmunity as well as immune recovery after transient B-cell depletion. The study will enroll 100 participants across ≥15 sites. Participants will be aged 18 to 40 years, have RIS (defined as meeting 2017 revised McDonald criteria for dissemination in space), and have either been diagnosed with RIS within the last 5 years or have had new brain lesions identified within 5 years of study entry. A screening program of first-degree relatives of patients with MS will be used to boost recruitment. Eligible patients will be randomized 1:1 to receive 3 courses of ocrelizumab or placebo at baseline, week 24, and week 48. Patients will subsequently be followed up for ≥3 years. The primary outcome is time to development of new radiological or clinical evidence of MS. Secondary and exploratory objectives will investigate neuroimaging, serological and immunologic biomarkers, cognitive function, and patient-reported outcomes. A substudy using single-cell RNA sequencing to characterize blood and CSF immune cells will assess markers associated with conversion to clinical MS. CONCLUSION The CELLO study will improve the understanding of B-cell biology in early MS disease pathophysiology, characterize the emergence of CNS autoimmunity, and provide evidence to inform treatment decision-making for individuals with RIS. CLINICALTRIALS GOV: NCT04877457.
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Affiliation(s)
- Erin E Longbrake
- Department of Neurology, Yale School of Medicine, New Haven, CT.
| | - Le H Hua
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV
| | - Ellen M Mowry
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Enrique Alvarez
- Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Anne H Cross
- Washington University School of Medicine, St Louis, MO
| | | | | | | | - David A Hafler
- Department of Neurology, Yale School of Medicine, New Haven, CT
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20
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Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:78-99. [PMID: 36322548 PMCID: PMC9714524 DOI: 10.7705/biomedica.6366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 12/04/2022]
Abstract
Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.
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21
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Ricigliano VAG, Louapre C, Poirion E, Colombi A, Yazdan Panah A, Lazzarotto A, Morena E, Martin E, Bottlaender M, Bodini B, Seilhean D, Stankoff B. Imaging Characteristics of Choroid Plexuses in Presymptomatic Multiple Sclerosis: A Retrospective Study. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/6/e200026. [PMID: 36229188 PMCID: PMC9562043 DOI: 10.1212/nxi.0000000000200026] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022]
Abstract
Background and Objectives Recent imaging studies have suggested a possible involvement of the choroid plexus (CP) in multiple sclerosis (MS). Here, we investigated whether CP changes are already detectable at the earliest stage of MS, preceding symptom onset. Methods This study is a retrospective analysis of 27 patients with presymptomatic MS, 97 patients with clinically definite MS (CDMS), and 53 healthy controls (HCs) who underwent a cross-sectional 3T-MRI acquisition; of which, 22 MS, 19 HCs, and 1 presymptomatic MS (evaluated 8 months before conversion to CDMS) also underwent translocator protein (TSPO) 18F-DPA-714 PET and were included in the analysis. CPs were manually segmented on 3D T1-weighted images for volumetric analysis. CP 18F-DPA-714 uptake, reflecting inflammation, was calculated as the average standardized uptake value (SUV). Multivariable regressions adjusted for age, sex, and ventricular and brain volume were fitted to test CP volume differences between presymptomatic patients and MS or HCs. For the presymptomatic case who also had 18F-DPA-714 PET, CP SUV differences with MS and HCs were assessed through Crawford-Howell tests. To provide further insight into the interpretation of 18F-DPA-714-PET uptake at the CP level, a postmortem analysis of CPs in MS vs HCs was performed to characterize the cellular localization of TSPO expression. Results Compared with HCs, patients with presymptomatic MS had 32% larger CPs (β = 0.38, p = 0.001), which were not dissimilar to MS CPs (p = 0.69). Moreover, in the baseline scan of the presymptomatic case who later on developed MS, TSPO PET showed 33% greater CP inflammation vs HCs (p = 0.04), although no differences in 18F-DPA-714 uptake were found in parenchymal regions vs controls. CP postmortem analysis identified a population of CD163+ mononuclear phagocytes expressing TSPO in MS, possibly contributing to the increased 18F-DPA-714 uptake. Discussion We identified an imaging signature in CPs at the presymptomatic MS stage using MRI; in addition, we found an increased CP inflammation with PET in a single presymptomatic patient. These findings suggest a role of CP imaging as an early biomarker and argue for the involvement of the blood-CSF barrier dysfunction in disease development. Trial Registration Information APHP-20210727144630, EudraCT-Number: 2008-004174-40; ClinicalTrials.gov: NCT02305264, NCT01651520, and NCT02319382.
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Affiliation(s)
- Vito A G Ricigliano
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Céline Louapre
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Emilie Poirion
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Annalisa Colombi
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Arya Yazdan Panah
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Andrea Lazzarotto
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Emanuele Morena
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Elodie Martin
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Michel Bottlaender
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Benedetta Bodini
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Danielle Seilhean
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France
| | - Bruno Stankoff
- From the Sorbonne Université (V.A.G.R., C.L., E.P., A.C., A.Y.P., A.L., Emanuele Morena, Elodie Martin, B.B., D.S., B.S.), Paris Brain Institute, ICM, CNRS, Inserm; Neurology Department (V.A.G.R., A.L., B.B., B.S.), St Antoine Hospital, APHP-Sorbonne, Paris; Neurology Department (C.L.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris; Service D'Imagerie Médicale (E.P.), Hôpital Fondation Adolphe de Rothschild, Paris; Université Paris-Saclay (M.B.), CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, Orsay; and Neuropathology Department (D.S.), Pitié-Salpêtrière Hospital, APHP-Sorbonne, Paris, France.
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22
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Immunopathogenesis, Diagnosis, and Treatment of Multiple Sclerosis. Neurol Clin 2022; 41:87-106. [DOI: 10.1016/j.ncl.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Amato MP, De Stefano N, Inglese M, Morena E, Ristori G, Salvetti M, Trojano M. Secondary Prevention in Radiologically Isolated Syndromes and Prodromal Stages of Multiple Sclerosis. Front Neurol 2022; 13:787160. [PMID: 35359637 PMCID: PMC8964010 DOI: 10.3389/fneur.2022.787160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Following the extraordinary progress in the treatment of multiple sclerosis (MS), two major unmet needs remain: understanding the etiology of the disease and, hence, designing definitive cures (this perspective is neither at hand, nor it can be taken for granted that the etiologic targets will be readily treatable); the prevention of an overt and disabling disease, which seems to be a more realistic and pragmatic perspective, as the integration of genetic data with endophenotypes, MRI, and other biomarkers ameliorates our ability to identify early neuroinflammation. Radiologically isolated syndrome (RIS; diagnosed when the unanticipated MRI finding of brain spatial dissemination of focal white matter lesions highly suggestive of MS occurs in subjects without symptoms of MS, and with normal neurological examinations) and the recently focused “prodromal MS” are conditions at risk of conversion toward overt disease. Here, we explore the possibility of secondary prevention approaches in these early stages of neuroinflammation. RIS and prodromal MS are rare conditions, which suggest the importance of Study Groups and Disease Registry to implement informative clinical trials. We summarize ongoing preventive approaches in the early stages of the demyelinating process, especially in RIS conditions. Moreover, we highlight the importance of the biomarkers and the predictors of evolution to overt disease, which may be useful to select the individuals at risk of conversion to clinically isolated syndrome (CIS) and/or clinically definite MS. Finally, we illustrate the importance of the endophenotypes to test the frontline immunomodulatory approach for preventive strategies. Future investigations, especially in relatives of patients, based on MRI techniques and biological studies (better with integrated approaches) may provide opportunities to understand the MS early causal cascade and may help to identify a “therapeutic window” to potentially reverse early disease processes.
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Affiliation(s)
- Maria Pia Amato
- Department of Neurosciences, Psycology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,San Martino Hospital-IRCCS, Genoa, Italy
| | - Emanuele Morena
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy
| | - Giovanni Ristori
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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24
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Reith W, Hausmann A, Kettner M. [New MRI guidelines for multiple sclerosis]. Radiologe 2022; 62:322-326. [PMID: 35316355 DOI: 10.1007/s00117-022-00991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND To improve the efficient use of magnetic resonance imaging (MRI) in routine clinical practice, an expert panel has revised the guidelines for its use in the diagnosis and monitoring of multiple sclerosis (MS). OBJECTIVES The revised guidelines now take into account new developments and relevant advances in knowledge, such as the ongoing debate about safety related to intravenous gadolinium-based contrast agents. The value of spinal cord MRI for diagnostic, prognostic, and surveillance purposes has been re-evaluated. Standardization of brain and spinal cord MRI protocols for diagnosis, assessment of prognosis, and monitoring of therapy, as well as the use of 3D-FLAIR (three-dimensional fluid-attenuated inversion recovery) as the most important sequence in the diagnosis of lesions in the brain have been included, as this allows better interpretation and comparability, e.g., in follow-up assessments.
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Affiliation(s)
- Wolfgang Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland.
| | - Alena Hausmann
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland
| | - Michael Kettner
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland
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25
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Salimi Z, Tazi R, Hazim A, Bouknani N, Aasfara J. A Unique Case of Radiologically Isolated Syndrome Diagnosed During a Follow-up of Cytomegalovirus Meningoencephalitis. Cureus 2022; 14:e22191. [PMID: 35308714 PMCID: PMC8924854 DOI: 10.7759/cureus.22191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/05/2022] Open
Abstract
Radiologically isolated syndrome (RIS) refers to an entity in which an MRI of the brain, spine, or both demonstrates incidental white matter lesions that are characteristic of a demyelinating disease in morphology and location. High-risk RIS may require disease-modifying treatment (DMT). A complex interaction among genetic and environmental factors leads to self-reactive immune mechanisms, which are believed to have a pivotal role in the pathogenesis of demyelinating diseases. Viruses are possible triggers to this mechanism. Unlike Epstein-Barr virus (EBV) infection, which is a well-known risk factor for multiple sclerosis (MS), the association between cytomegalovirus (CMV) infection and MS remains uncertain, with some studies indicating a protective effect of CMV on autoimmune diseases. We report a unique case of RIS diagnosed during the follow-up of CMV meningoencephalitis in a patient who presented with generalized seizure onset.
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26
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Siger M, Owidzka M, Świderek-Matysiak M, Omulecki W, Stasiołek M. Optical Coherence Tomography in the Differential Diagnosis of Patients with Multiple Sclerosis and Patients with MRI Nonspecific White Matter Lesions. SENSORS 2021; 21:s21217127. [PMID: 34770434 PMCID: PMC8588219 DOI: 10.3390/s21217127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Abstract
In the differential diagnosis of nonspecific white matter lesions (NSWMLs) detected on magnetic resonance imaging (MRI), multiple sclerosis (MS) should be taken into consideration. Optical coherence tomography (OCT) is a promising tool applied in the differential diagnostic process of MS. We tested whether OCT may be useful in distinguishing between MS and NSWMLs patients. In patients with MS (n = 41) and NSWMLs (n = 19), the following OCT parameters were measured: thickness of the peripapillary Retinal Nerve Fibre Layer (pRNFL) in superior, inferior, nasal, and temporal segments; thickness of the ganglion cell-inner plexiform layer (GCIPL); thickness of macular RNFL (mRNFL); and macular volume (MV). In MS patients, GCIPL was significantly lower than in NSWMLs patients (p = 0.024). Additionally, in MS patients, mRNFL was significantly lower than in NSWMLs patients (p = 0.030). The average segmental pRNFL and MV did not differ between MS and NSWMLs patients (p > 0.05). GCIPL and macular RNFL thinning significantly influenced the risk of MS (18.6% [95% CI 2.7%, 25.3%]; 27.4% [95% CI 4.5%, 62.3%]), and reduced GCIPL thickness appeared to be the best predictor of MS. We conclude that OCT may be helpful in the differential diagnosis of MS and NSWMLs patients in real-world settings.
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Affiliation(s)
- Małgorzata Siger
- Department of Neurology, Medical University of Lodz, 90-419 Lodz, Poland; (M.Ś.-M.); (M.S.)
- Correspondence:
| | - Marta Owidzka
- Department of Eye Disease, Medical University of Lodz, 90-419 Lodz, Poland; (M.O.); (W.O.)
| | | | - Wojciech Omulecki
- Department of Eye Disease, Medical University of Lodz, 90-419 Lodz, Poland; (M.O.); (W.O.)
| | - Mariusz Stasiołek
- Department of Neurology, Medical University of Lodz, 90-419 Lodz, Poland; (M.Ś.-M.); (M.S.)
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27
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Accumulative risk of clinical event in high-risk radiologically isolated syndrome in Argentina: data from the nationwide registry RelevarEM. J Neurol 2021; 269:2073-2079. [PMID: 34491406 DOI: 10.1007/s00415-021-10791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We aimed to analyze the accumulative risk of MRI and OB factors for evolution from RIS to MS in subjects included in the Argentinean MS registry (NCT03375177). METHODS RIS subjects were identified according to RIS diagnosis criteria. Subjects were longitudinally followed with clinical and MRI at intervals of 6 months. Time from RIS identification to the first clinical event was estimated using Kaplan-Meier. Multivariable Cox regression models were created to assess the independent predictive value of demographic characteristics, as well as clinical, OB and MRI data on time to the first clinical event. The single and increased risk factor of evolution of RIS was quantified. RESULTS A total of 88 RIS subjects, mean follow-up time 42 ± 4 months were included. 39 (44.3%) and 23 (26.1%) had a new MRI lesion or a clinical event, respectively, during the follow-up. OB (HR 5.9, 95% CI 1.29-10.1, p = 0.004), infratentorial lesions (HR 3.7, 95% CI 1.09-7.5) and spinal cord lesions (HR 5.3, 95% CI 1.4-8.2, p = 0.01) at RIS identification were independent predictors associated with a subsequent clinical event. The accumulative risk showed that when two of the three factors (OB, infratentorial or spinal cord lesions) were present the HR was 10.4, 95% CI 4.4-22, p < 0.001, and when three factors were present, it was HR 15.6, 95% CI 5.7-28, p < 0.001 for a relapse. CONCLUSION The presence of three factors significantly increased the risk of clinical event; high-risk subjects should probably be managed by a different approach than those used for individuals without high-risk factors.
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28
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Marin CE, Callegaro D, Lana-Peixoto MA, Fernández O, Gomes Neto AP, Vasconcelos CCF, d'Almeida JAC, Gonçalves MVM, Mendes MF, Parolin MKF, Nascimento O, Gama PDD, Dias-Carneiro RPC, Dias RM, Damasceno A, Becker J. Evaluation of diagnosis and treatment practices of Brazilian neurologists among patients with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:598-606. [PMID: 34468497 DOI: 10.1590/0004-282x-anp-2020-0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent changes to the diagnostic criteria for multiple sclerosis (MS) and new medications have had a major impact on the way in which specialists manage the disease. OBJECTIVE To investigate factors considered by Brazilian neurologists in managing MS, and to identify how these contribute to diagnosis and treatment. METHODS Potential participants were selected by a steering committee (MS experts who developed this survey). Only MS specialists were included in the study (neurologists who had completed a neuroimmunology fellowship or who were treating more than 30 MS patients). Links to the online questionnaire were distributed between March 2019 and January 2020. This questionnaire was composed of sections with hypothetical MS scenarios. RESULTS Neurologists from 13 Brazilian states responded to the survey (n = 94). In the clinically isolated syndrome (CIS) scenario, the respondents agreed to treat patients with a high risk of MS diagnosis, whereas in the radiologically isolated syndrome (RIS) half of the respondents opted not to treat, even among high-risk patients. In cases of low-activity relapsing-remitting MS (RRMS), the choice of treatment was distributed among interferon beta, glatiramer acetate and teriflunomide, which were changed to fingolimod and natalizumab, as RRMS severity increased. The topics in which disagreement was found included practices regarding use of disease-modifying therapy (DMT) for pregnant patients and the washout period required for some DMTs. CONCLUSIONS This study enabled identification of areas of agreement and disagreement about MS treatment among Brazilian neurologists, which can be used to update future protocols and improve patient management.
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Affiliation(s)
- Cássia Elisa Marin
- Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil
| | - Dagoberto Callegaro
- Universidade de São Paulo, Faculdade de Medicina de São Paulo, Hospital das Clínicas, São Paulo SP, Brazil
| | - Marco Aurélio Lana-Peixoto
- Universidade Federal de Minas Gerais, Faculdade de Medicina de Minas Gerais Hospital das Clínicas, Belo Horizonte MG, Brazil
| | - Oscar Fernández
- University of Malaga, Hospital Universitário Regional de Málaga, Malaga, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Jefferson Becker
- Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.,Universidade Federal Fluminense, Rio de Janeiro RJ, Brazil
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29
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George IC, Rice DR, Chibnik LB, Mateen FJ. Radiologically isolated syndrome: A single-center, retrospective cohort study. Mult Scler Relat Disord 2021; 55:103183. [PMID: 34365315 DOI: 10.1016/j.msard.2021.103183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/10/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiologically Isolated Syndrome (RIS) likely represents the earliest detectable form of multiple sclerosis (MS). There are recognized risk factors for conversion of RIS to clinically definite central nervous system (CNS) demyelinating disease. We aim to characterize a new clinical cohort with RIS and to analyze previously established risk factors for conversion to clinically definite disease. METHODS A medical records search was performed for patients who were diagnosed with RIS by their treating neurologist at our institution in Boston, USA, from January 2005 to April 2020. Demographic data, clinical outcomes, and treatment courses were analyzed. The time to first clinical event representing a demyelinating disease attack or last follow up without clinically definite disease was calculated for each person. Hazard ratios (HRs) for known risk factors for the conversion of RIS to clinically definite disease were calculated using Cox proportional hazards models. RESULTS Of 89 patients, the median age at RIS diagnosis was 41.0 years (76% female, 8% with a family history of MS and 16% of any autoimmune disorder, 66% never smokers, 40% BMI >30 kg/m2, 45% with spinal cord MRI lesions). Clinically definite disease was observed in 16 patients (18%) during follow-up (median time to first event 3.4 years; median follow-up duration of full cohort 3.8 years). Median EDSS for those who developed clinically definite disease was 1.25 (range: 0-4) at most recent follow up. Of 84 patients with longitudinal brain imaging, 42 (50%) had new demyelinating lesions. Gadolinium-enhancing lesions were seen in 36 patients (43%) at either baseline (n=24) or follow-up (n=12). Most patients had at least one T1-hypointense lesion (n=70, 83%). Five patients underwent ultra-high field MRI (7 Tesla); all were positive for central vein sign, two demonstrated leptomeningeal enhancement, and one was found to have cortical lesions. Out of 30 patients with susceptibility-weighted imaging acquired during routine clinical care, 8 had at least one paramagnetic rim positive lesion. Previously reported risk factors for conversion to MS were not significant: age ≤37 years HR 1.3 (95% confidence interval (CI), 0.47-3.5), male sex 1.5 (95% CI, 0.41-5.2), and spinal cord lesions 1.3 (0.47-3.4). Nearly one-third of RIS patients (n=26) took a disease modifying therapy (DMT) for MS (median total treatment duration on any DMT=2.7 years). The sub-cohort treated with a DMT had a statistically significantly greater number of recognized risk factors for conversion to clinically definite disease compared with the untreated group (p=0.028). Most patients took a DMT for MRI changes demonstrating new demyelinating disease activity (n=16). Dimethyl fumarate (n=9) and glatiramer acetate (n=7) were the most frequently prescribed DMTs. A second-line DMT was started in 10 patients. CONCLUSION We characterize a new cohort of RIS patients, demonstrating time to clinically evident demyelinating disease from RIS diagnosis of approximately 3.4 years. Our data suggest that early use of a DMT in RIS may mitigate the impact of recognized risk factors on the occurrence of clinically evident disease and reduce the likelihood of conversion to clinically definite CNS demyelinating disease in high-risk individuals.
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Affiliation(s)
- Ilena C George
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Dylan R Rice
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | - Lori B Chibnik
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA; T.H. Chan Harvard School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Farrah J Mateen
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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30
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Gelibter S, Pisa M, Croese T, Finardi A, Mandelli A, Sangalli F, Colombo B, Martinelli V, Comi G, Filippi M, Furlan R. Spinal Fluid Myeloid Microvesicles Predict Disease Course in Multiple Sclerosis. Ann Neurol 2021; 90:253-265. [PMID: 34216397 DOI: 10.1002/ana.26154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In vivo measures of myeloid activity are promising biomarkers in multiple sclerosis. We previously demonstrated that cerebrospinal fluid (CSF) myeloid microvesicles are markers of microglial/macrophage activity and neuroinflammation in multiple sclerosis. Here, we aimed at investigating the diagnostic and prognostic value of myeloid microvesicles in a clinical setting. METHODS Six hundred one patients discharged with a diagnosis of neuroinflammatory, neurodegenerative, or no neurological disease were enrolled. Myeloid microvesicles were measured with flow cytometry as isolectin B4-positive events in fresh CSF. Clinical, demographical, and magnetic resonance imaging (MRI) data were collected at diagnosis (all patients) and during follow-up (n = 176). RESULTS CSF myeloid microvesicles were elevated in neuroinflammatory patients compared to the neurodegenerative and control groups. In multiple sclerosis, microvesicles were higher in patients with MRI disease activity and their concentration increased along with the number of enhancing lesions (p < 0.0001, Jonckheere-Terpstra test). CSF myeloid microvesicles were also higher in patients with higher disease activity in the month and year preceding diagnosis. Microvesicles excellently discriminated between the relapsing-remitting and control groups (receiver operator characteristic curve, area under the curve = 0.939, p < 0.0001) and between radiologically isolated syndrome and unspecific brain lesions (0.942, p < 0.0001). Furthermore, microvesicles were independent predictors of prognosis for both the relapsing-remitting and progressive groups. Microvesicles independently predicted future disease activity in relapsing-remitting patients (hazard ratio [HR] = 1.967, 95% confidence interval [CI] = 1.147-3.372), correcting for prognostic factors of standard clinical use. In the progressive group, microvesicles were independent predictors of disability accrual (HR = 10.767, 95% CI = 1.335-86.812). INTERPRETATION Our results confirm that CSF myeloid microvesicles are a clinically meaningful biomarker of neuroinflammation and microglial/macrophage activity in vivo. These findings may support a possible use in clinical practice during diagnostic workup and prognostic assessment. ANN NEUROL 2021;90:253-265.
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Affiliation(s)
- Stefano Gelibter
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Pisa
- Vita-Salute San Raffaele University, Milan, Italy
| | - Tommaso Croese
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy.,Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Mandelli
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
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31
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Mortazavi M, Hizarci Ö, Gerdes LA, Havla J, Kümpfel T, Hohlfeld R, Stöcklein S, Keeser D, Ertl-Wagner B. Multiple sclerosis and subclinical neuropathology in healthy individuals with familial risk: A scoping review of MRI studies. NEUROIMAGE-CLINICAL 2021; 31:102734. [PMID: 34171607 PMCID: PMC8234346 DOI: 10.1016/j.nicl.2021.102734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/11/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
MRI evidence of MS pathology in healthy individuals reflects a subclinical period. First-degree relatives of MS patients are ideal to study MS subclinical neuropathology. MRI found WM focal inflammation in a substantial proportion of these healthy relatives. Diffuse tissue damage is also found by MRI in healthy relatives of MS patients. MS prodromal phase can be characterized by studying healthy subjects at high risk.
Multiple genetic and non-heritable factors have been linked to the risk of multiple sclerosis (MS). These factors seem to contribute to disease pathogenesis before the onset of clinical symptoms, as suggested by incidental MRI evidence of subclinical MS neuropathology in individuals without clinical symptoms. Individuals with high familial risk for MS, such as first-degree relatives of patients with MS, can be studied by MRI to characterize the neuropathology during a subclinical period of MS. 16 studies published in English, which performed brain MRI on healthy individuals with high familial risk of MS were included in this scoping review. Studies suggest either no conclusive (5), or inconclusive yet considerable (4), or conclusive evidence (7) for the incidence of subclinical neuropathology, including focal and diffuse tissue damage. Across all studies, white matter lesions fulfilling MS criteria were observed in 86 of 613 individuals (14%). Future research is needed to evaluate the longitudinal dynamics and clinical relevance of preclinical imaging abnormalities in MS.
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Affiliation(s)
- Matin Mortazavi
- Department of Radiology, LMU Klinikum, Munich, Germany; Department of Psychiatry and Psychotherapy, LMU Klinikum, Munich, Germany.
| | - Öznur Hizarci
- Department of Radiology, LMU Klinikum, Munich, Germany; Department of Psychiatry and Psychotherapy, LMU Klinikum, Munich, Germany
| | - Lisa Ann Gerdes
- Institute of Clinical Neuroimmunology, LMU Klinikum, Munich, Germany; Munich Cluster of Systems Neurology, 81377 Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Klinikum, Munich, Germany; Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Klinikum, Munich, Germany
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, LMU Klinikum, Munich, Germany; Munich Cluster of Systems Neurology, 81377 Munich, Germany
| | | | - Daniel Keeser
- Department of Radiology, LMU Klinikum, Munich, Germany; Department of Psychiatry and Psychotherapy, LMU Klinikum, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, LMU Klinikum, Munich, Germany; Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Wattjes MP, Ciccarelli O, Reich DS, Banwell B, de Stefano N, Enzinger C, Fazekas F, Filippi M, Frederiksen J, Gasperini C, Hacohen Y, Kappos L, Li DKB, Mankad K, Montalban X, Newsome SD, Oh J, Palace J, Rocca MA, Sastre-Garriga J, Tintoré M, Traboulsee A, Vrenken H, Yousry T, Barkhof F, Rovira À. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol 2021; 20:653-670. [PMID: 34139157 DOI: 10.1016/s1474-4422(21)00095-8] [Citation(s) in RCA: 280] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
The 2015 Magnetic Resonance Imaging in Multiple Sclerosis and 2016 Consortium of Multiple Sclerosis Centres guidelines on the use of MRI in diagnosis and monitoring of multiple sclerosis made an important step towards appropriate use of MRI in routine clinical practice. Since their promulgation, there have been substantial relevant advances in knowledge, including the 2017 revisions of the McDonald diagnostic criteria, renewed safety concerns regarding intravenous gadolinium-based contrast agents, and the value of spinal cord MRI for diagnostic, prognostic, and monitoring purposes. These developments suggest a changing role of MRI for the management of patients with multiple sclerosis. This 2021 revision of the previous guidelines on MRI use for patients with multiple sclerosis merges recommendations from the Magnetic Resonance Imaging in Multiple Sclerosis study group, Consortium of Multiple Sclerosis Centres, and North American Imaging in Multiple Sclerosis Cooperative, and translates research findings into clinical practice to improve the use of MRI for diagnosis, prognosis, and monitoring of individuals with multiple sclerosis. We recommend changes in MRI acquisition protocols, such as emphasising the value of three dimensional-fluid-attenuated inversion recovery as the core brain pulse sequence to improve diagnostic accuracy and ability to identify new lesions to monitor treatment effectiveness, and we provide recommendations for the judicious use of gadolinium-based contrast agents for specific clinical purposes. Additionally, we extend the recommendations to the use of MRI in patients with multiple sclerosis in childhood, during pregnancy, and in the post-partum period. Finally, we discuss promising MRI approaches that might deserve introduction into clinical practice in the near future.
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Affiliation(s)
- Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Olga Ciccarelli
- Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicola de Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria; Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jette Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, University Hospital of Copenhagen, Glostrup, Denmark
| | - Claudio Gasperini
- Department of Neurology, San Camillo-Forlanini Hospital, Roma, Italy
| | - Yael Hacohen
- Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Ludwig Kappos
- Department of Neurology and Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital of Basel and University of Basel, Basel, Switzerland
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children, London, UK
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiwon Oh
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, London, UK; Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands; Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Gasperi C, Hapfelmeier A, Daltrozzo T, Schneider A, Donnachie E, Hemmer B. Systematic Assessment of Medical Diagnoses Preceding the First Diagnosis of Multiple Sclerosis. Neurology 2021; 96:e2977-e2988. [PMID: 33903190 DOI: 10.1212/wnl.0000000000012074] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/15/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the occurrence of diseases and symptoms in the 5 years before diagnosis in patients with multiple sclerosis (MS) in a case-control study. METHODS Using ambulatory claims data, we systematically assessed differences in the occurrence of diseases and symptoms in the 5 years before first diagnosis in patients with MS (n = 10,262) compared to patients with 2 other autoimmune diseases, Crohn disease (n = 15,502) and psoriasis (n = 98,432), and individuals without these diseases (n = 73,430). RESULTS Forty-three ICD-10 codes were recorded more frequently for patients with MS before diagnosis compared to controls without autoimmune disease. Many of these findings were confirmed in a comparison to the other control groups. A high proportion of these ICD-10 codes represent symptoms suggestive of demyelinating events or other neurologic diagnoses. In a sensitivity analysis excluding patients with such recordings before first diagnosis, no association remained significant. Seven ICD-10 codes were associated with lower odds ratios of MS, 4 of which represent upper respiratory tract infections. Here, the relations with MS were even more pronounced in the sensitivity analysis. CONCLUSIONS Our analyses suggest that patients with MS are frequently not diagnosed at their first demyelinating event but often years later. Symptoms and physician encounters before MS diagnosis seem to be related to already ongoing disease rather than a prodrome. The observed association of upper respiratory tract infections with lower odds ratios of MS diagnosis suggests a link between protection from infection and MS that, however, needs to be validated and further investigated.
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Affiliation(s)
- Christiane Gasperi
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Alexander Hapfelmeier
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Tanja Daltrozzo
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Antonius Schneider
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Ewan Donnachie
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Bernhard Hemmer
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany.
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Editorial: Challenges in the diagnosis and treatment of multiple sclerosis. Curr Opin Neurol 2021; 34:275-276. [PMID: 33935216 DOI: 10.1097/wco.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Early multiple sclerosis: diagnostic challenges in clinically and radiologically isolated syndrome patients. Curr Opin Neurol 2021; 34:277-285. [PMID: 33661162 DOI: 10.1097/wco.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW With the introduction of new diagnostic criteria, the sensibility for multiple sclerosis (MS) diagnosis increased and the number of cases with the clinically isolated syndrome (CIS) decreased. Nevertheless, a misdiagnosis might always be around the corner, and the exclusion of a 'better explanation' is mandatory.There is a pressing need to provide an update on the main prognostic factors that increase the risk of conversion from CIS or from radiologically isolated syndrome (RIS) to MS, and on the potential 'red flags' to consider during the diagnostic workup. RECENT FINDINGS We discuss diagnostic challenges when facing patients presenting with a first demyelinating attack or with a RIS, with a focus on recently revised diagnostic criteria, on other neuroinflammatory conditions to be considered in the differential diagnosis and on factors distinguishing patients at risk of developing MS.A correct definition of a 'typical' demyelinating attack, as well as a correct interpretation of MRI findings, remains crucial in the diagnostic process. The cerebrospinal fluid examination is warmly recommended to confirm the dissemination in time of the demyelinating process and to increase the diagnostic accuracy. SUMMARY An early and accurate diagnosis of MS requires careful consideration of all clinical, paraclinical and radiological data, as well the reliable exclusion of other mimicking pathological conditions. This is advocated to promptly initiate an appropriate disease-modifying therapy, which can impact positively on the long-term outcome of the disease.
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Carvalho V, Soares C, Gomes I, Carvalho A, Serrazina F, Rodrigues SG, Pinheiro J, Marques IB, Correia F, Correia AS, de Sá J, Sousa L, Vale J, Sá MJ, Sousa C, Ferreira J. RISCOP-Cognitive profile in a Portuguese cohort of radiological isolated syndrome patients: A case-control study. Mult Scler Relat Disord 2021; 50:102832. [PMID: 33596492 DOI: 10.1016/j.msard.2021.102832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/31/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Radiologically isolated syndrome (RIS) refers to the incidental discovery of white matter lesions suggestive of MS, on brain MRI, in asymptomatic patients. Recent studies suggest similar features of cognitive impairment between RIS and MS patients. Also, lower levels of health-related quality of life (QOL) and fatigue are reported in such patients. AIMS characterize and compare the cognitive profile of a multicentric Portuguese cohort of RIS patients with a control group. METHODS multicentric comparative study of a cohort of adult patients with RIS, and age and gender-matched controls followed in the headache outpatient clinic with prior MRI not fulfilling criteria for RIS diagnosis. We conducted interviews with participants, collected clinical data and applied the BICAMS battery and self-reported questionnaires (HADS, MFIS, MSQOL-54). RESULTS we evaluated 31 patients with RIS (median age 46 years, IQR [(Dusankova et al., 2012-52], 72% women) and 19 control individuals (median age 32 years, IQR [(O'Jile et al., 2005-48], 71% women). Prevalence of cognitive impairment did not differ between groups (16% of the RIS and 10% of the controls, p=0.579). We found no differences between groups on the BICAMS tests, although the results of the California Verbal Learning Test (CVLT-II) score presented a trend to significance, with a lower value on the RIS group (53.9 vs. 59.3, p=0.066). There were no significant differences regarding fatigue, QOL, anxiety/depression scores. CONCLUSION this is the first study on a Portuguese cohort of RIS patients assessing cognitive profile with BICAMS. A non-neglectable part of our cohort presented cognitive impairment. Our findings add to previous studies in suggesting that a more pronounced impairment of verbal memory and learning, evaluated by CVLT-II, may be present in RIS patients compared to controls. BICAMS should be assessed on future studies with larger cohorts.
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Affiliation(s)
- Vanessa Carvalho
- Department of Neurology, Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
| | - Carolina Soares
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Inês Gomes
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andreia Carvalho
- Department of Neurology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Filipa Serrazina
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | | | - Joaquim Pinheiro
- Department of Neurology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Filipe Correia
- Department of Neurology, Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Ana Sofia Correia
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - João de Sá
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Lívia Sousa
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Vale
- Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Health Sciences Faculty, Universidade Fernando Pessoa, Porto, Portugal
| | - Cláudia Sousa
- Department of Psychology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - João Ferreira
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
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Radiologically isolated syndrome: from biological bases to practical management. Neurol Sci 2021; 42:1335-1344. [PMID: 33496891 DOI: 10.1007/s10072-021-05069-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Technological advances and greater availability of magnetic resonance imaging have prompted an increment on incidental and unexpected findings within the central nervous system. The concept of radiologically isolated syndrome characterizes a group of subjects with images suggestive of demyelinating disease in the absence of a clinical episode compatible with multiple sclerosis. Since the description of this entity, many questions have arisen; some have received responses but others remain unanswered. A panel of experts met with the objective of performing a critical review of the currently available evidence. Definition, prevalence, biological bases, published evidence, and implications on patient management were reviewed. Thirty to 50% of subjects with radiologically isolated syndrome will progress to multiple sclerosis in 5 years. Male sex, age < 37 years old, and spinal lesions increase the risk. These subjects should be evaluated by a multiple sclerosis specialist, carefully excluding alternative diagnosis. An initial evaluation should include a brain and complete spine magnetic resonance, visual evoked potentials, and identification of oligoclonal bands in cerebrospinal fluid. Disease-modifying therapies could be considered when oligoclonal bands or radiological progression is present. CONCLUSION At present time, radiologically isolated syndrome cannot be considered a part of the multiple sclerosis spectrum. However, a proportion of patients may evolve to multiple sclerosis, meaning it represents much more than just a radiological finding.
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Miguel JM, Roldán M, Pérez-Rico C, Ortiz M, Boquete L, Blanco R. Using advanced analysis of multifocal visual-evoked potentials to evaluate the risk of clinical progression in patients with radiologically isolated syndrome. Sci Rep 2021; 11:2036. [PMID: 33479457 PMCID: PMC7820316 DOI: 10.1038/s41598-021-81826-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to assess the role of multifocal visual-evoked potentials (mfVEPs) as a guiding factor for clinical conversion of radiologically isolated syndrome (RIS). We longitudinally followed a cohort of 15 patients diagnosed with RIS. All subjects underwent thorough ophthalmological, neurological and imaging examinations. The mfVEP signals were analysed to obtain features in the time domain (SNRmin: amplitude, Latmax: monocular latency) and in the continuous wavelet transform (CWT) domain (bmax: instant in which the CWT function maximum appears, Nmax: number of CWT function maximums). The best features were used as inputs to a RUSBoost boosting-based sampling algorithm to improve the mfVEP diagnostic performance. Five of the 15 patients developed an objective clinical symptom consistent with an inflammatory demyelinating central nervous system syndrome during follow-up (mean time: 13.40 months). The (SNRmin) variable decreased significantly in the group that converted (2.74 ± 0.92 vs. 4.07 ± 0.95, p = 0.01). Similarly, the (bmax) feature increased significantly in RIS patients who converted (169.44 ± 24.81 vs. 139.03 ± 11.95 (ms), p = 0.02). The area under the curve analysis produced SNRmin and bmax values of 0.92 and 0.88, respectively. These results provide a set of new mfVEP features that can be potentially useful for predicting prognosis in RIS patients.
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Affiliation(s)
- J M Miguel
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, 28805, Alcalá de Henares, Madrid, Spain
| | - M Roldán
- Department of Ophthalmology, Príncipe de Asturias University Hospital, Madrid, Spain
| | - C Pérez-Rico
- Department of Ophthalmology, Príncipe de Asturias University Hospital, Madrid, Spain.,Department of Surgery, Medical and Social Sciences, University of Alcalá, Carretera Alcalá-Meco S/N, 28805, Alcalá de Henares, Madrid, Spain
| | - M Ortiz
- School of Physics, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - L Boquete
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, 28805, Alcalá de Henares, Madrid, Spain
| | - R Blanco
- Department of Surgery, Medical and Social Sciences, University of Alcalá, Carretera Alcalá-Meco S/N, 28805, Alcalá de Henares, Madrid, Spain. .,Ramón Y Cajal Health Research Institute (IRYCIS), 28034, Madrid, Spain.
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Cohen M, Mondot L, Fakir S, Landes C, Lebrun C. Digital biomarkers can highlight subtle clinical differences in radiologically isolated syndrome compared to healthy controls. J Neurol 2020; 268:1316-1322. [PMID: 33078309 DOI: 10.1007/s00415-020-10276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the use of digital biomarkers to distinguish healthy controls (HC) from subjects with a radiologically isolated syndrome (RIS). METHODS We developed a smartphone application called MS Screen Test (MSST) to explore several dimensions of the neurological exam such as finger tapping speed, agility, hand synchronization, low contrast vision and cognition during a short evaluation. This app was tested on a cohort of healthy volunteers including a subset of subjects who underwent two evaluations on the same day to assess reproducibility. In a second step, the app was tested on a cohort of RIS subjects. Performances of RIS subjects were compared with age and genre-matched HC. RESULTS HC underwent two consecutive evaluations on MSST. The analysis showed good reproducibility for all measures. Then 21 RIS subjects were compared to 32 matched HC. Compared to HC, we found that RIS subjects had a lower finger tapping speed on the dominant hand (5.6 versus 6.5 taps per second; p = 0.005), a longer inter hand interval during the hand synchronization task (14.4 versus 11.3 ms; p = 0.03) and significantly poorer scores on the low contrast vision and cognition tests. CONCLUSION MSST only requires a smartphone to obtain digital biomarkers relative to several dimensions of the neurological examination. Our results highlighted subtle differences between HC and RIS subjects. We plan to evaluate this tool in MS patients, which will allow us to get a much larger sample of subjects, to determine whether digital biomarkers can predict disease course.
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Affiliation(s)
- Mikael Cohen
- Service de Neurologie, CRC SEP, Unité de Recherche Clinique Cote D'Azur (UR2CA-URRIS), Centre Hospitalier Universitaire Pasteur 2, 30 Voie Romaine, 06002, Nice, Cedex, France.
| | - Lydiane Mondot
- Service de Radiologie, Unité de Recherche Clinique Cote D'Azur (UR2CA - URRIS), Centre Hospitalier Universitaire Pasteur 2, 30 Voie Romaine, 06002, Nice, Cedex, France
| | - Salim Fakir
- Service de Neurologie, CRC SEP, Unité de Recherche Clinique Cote D'Azur (UR2CA-URRIS), Centre Hospitalier Universitaire Pasteur 2, 30 Voie Romaine, 06002, Nice, Cedex, France
| | - Cassandre Landes
- Service de Neurologie, CRC SEP, Unité de Recherche Clinique Cote D'Azur (UR2CA-URRIS), Centre Hospitalier Universitaire Pasteur 2, 30 Voie Romaine, 06002, Nice, Cedex, France
| | - Christine Lebrun
- Service de Neurologie, CRC SEP, Unité de Recherche Clinique Cote D'Azur (UR2CA-URRIS), Centre Hospitalier Universitaire Pasteur 2, 30 Voie Romaine, 06002, Nice, Cedex, France
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40
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Leguy S, Combès B, Bannier E, Kerbrat A. Prognostic value of spinal cord MRI in multiple sclerosis patients. Rev Neurol (Paris) 2020; 177:571-581. [PMID: 33069379 DOI: 10.1016/j.neurol.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis [MS] is a common inflammatory, demyelinating and neurodegenerative disease of the central nervous system that affects both the brain and the spinal cord. In clinical practice, spinal cord MRI is performed far less frequently than brain MRI, mainly owing to technical limitations and time constraints. However, improvements of acquisition techniques, combined with a strong diagnosis and prognostic value, suggest an increasing use of spinal cord MRI in the near future. This review summarizes the current data from the literature on the prognostic value of spinal cord MRI in MS patients in the early and later stages of their disease. Both conventional and quantitative MRI techniques are discussed. The prognostic value of spinal cord lesions is clearly established at the onset of disease, underlining the interest of spinal cord conventional MRI at this stage. However, studies are currently lacking to affirm the prognostic role of spinal cord lesions later in the disease, and therefore the added value of regular follow-up with spinal cord MRI in addition to brain MRI. Besides, spinal cord atrophy, as measured by the loss of cervical spinal cord area, is also associated with disability progression, independently of other clinical and MRI factors including spinal cord lesions. Although potentially interesting, this measurement is not currently performed as a routine clinical procedure. Finally, other measures extracted from quantitative MRI have been established as valuable for a better understanding of the physiopathology of MS, but still remain a field of research.
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Affiliation(s)
- S Leguy
- CHU de Rennes, Neurology department, 2, Rue Henri-le-Guilloux, 35000 Rennes, France; University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France
| | - B Combès
- University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France
| | - E Bannier
- University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France; CHU de Rennes, Radiology department, Rennes, France
| | - A Kerbrat
- CHU de Rennes, Neurology department, 2, Rue Henri-le-Guilloux, 35000 Rennes, France; University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France.
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41
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Benedict RHB, Amato MP, DeLuca J, Geurts JJG. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. Lancet Neurol 2020; 19:860-871. [PMID: 32949546 PMCID: PMC10011205 DOI: 10.1016/s1474-4422(20)30277-5] [Citation(s) in RCA: 289] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis is a chronic, demyelinating disease of the CNS. Cognitive impairment is a sometimes neglected, yet common, sign and symptom with a profound effect on instrumental activities of daily living. The prevalence of cognitive impairment in multiple sclerosis varies across the lifespan and might be difficult to distinguish from other causes in older age. MRI studies show that widespread changes to brain networks contribute to cognitive dysfunction, and grey matter atrophy is an early sign of potential future cognitive decline. Neuropsychological research suggests that cognitive processing speed and episodic memory are the most frequently affected cognitive domains. Narrowing evaluation to these core areas permits brief, routine assessment in the clinical setting. Owing to its brevity, reliability, and sensitivity, the Symbol Digit Modalities Test, or its computer-based analogues, can be used to monitor episodes of acute disease activity. The Symbol Digit Modalities Test can also be used in clinical trials, and data increasingly show that cognitive processing speed and memory are amenable to cognitive training interventions.
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Affiliation(s)
- Ralph H B Benedict
- Department of Neurology and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | - Maria Pia Amato
- Department of Neurology, University of Florence, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Section Clinical Neuroscience, Amsterdam UMC, Location VUmc, Vrije Universiteit, Amsterdam, Netherlands
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42
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Kabaeva AR, Boyko AN, Kulakova OG, Favorova OO. [Radiologically isolated syndrome: prognosis and predictors of conversion to multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:7-12. [PMID: 32844624 DOI: 10.17116/jnevro20201200727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased sensitivity and availability of magnetic resonance imaging (MRI) in neurological routine practice led to the fact that more and more experts began to encounter changes typical for multiple sclerosis (MS) according to MRI in the absence of anamnestic and clinical indications of damage to the central nervous system (CNS). This nosological form has been defined as a radiologically isolated syndrome (RIS). More and more RIS cases convert to MS (up to 30% in the first 5 years after RIS diagnosis). At the moment, there are no biological markers that allow combining RIS and MS into one pathological process and early treatment with disease-modifying drugs (DMT). Prospective studies are actively being conducted to identify demographic, clinical, neuroimaging and biochemical conversion predictors. The identification of the molecular biological RIS features, combining these changes with MS, is an urgent scientific task and will allow timely initiation of therapy of the pathological process already at the subclinical stage.
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Affiliation(s)
- A R Kabaeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Cerebrovascular Pathology and Stroke, Moscow, Russia
| | - O G Kulakova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Institute of Experimental Cardiology of National Medical Research Center of Cardiology, Moscow, Russia
| | - O O Favorova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Institute of Experimental Cardiology of National Medical Research Center of Cardiology, Moscow, Russia
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43
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Hosseiny M, Newsome SD, Yousem DM. Radiologically Isolated Syndrome: A Review for Neuroradiologists. AJNR Am J Neuroradiol 2020; 41:1542-1549. [PMID: 32763896 DOI: 10.3174/ajnr.a6649] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 12/24/2022]
Abstract
Radiologically isolated syndrome refers to an entity in which white matter lesions fulfilling the criteria for multiple sclerosis occur in individuals without a history of a clinical demyelinating attack or alternative etiology. Since its introduction in 2009, the diagnostic criteria of radiologically isolated syndrome and its clinical relevance have been widely debated by neurologists and radiologists. The aim of the present study was to review the following: 1) historical evolution of radiologically isolated syndrome criteria, 2) clinical and imaging findings in adults and children with radiologically isolated syndrome, 3) imaging features of patients with radiologically isolated syndrome at high risk for conversion to MS, and 4) challenges and controversies for work-up, management, and therapeutic interventions of patients with radiologically isolated syndrome.
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Affiliation(s)
- M Hosseiny
- From the Department of Radiological Sciences (M.H.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - S D Newsome
- Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D M Yousem
- Russell H. Morgan Department of Radiology and Radiological Sciences (D.M.Y.), Johns Hopkins Medical Institution, Baltimore, Maryland.
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44
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Sorensen PS, Sellebjerg F, Hartung HP, Montalban X, Comi G, Tintoré M. The apparently milder course of multiple sclerosis: changes in the diagnostic criteria, therapy and natural history. Brain 2020; 143:2637-2652. [DOI: 10.1093/brain/awaa145] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
In the past decade, changes have occurred in the spectrum of multiple sclerosis courses. The natural history of multiple sclerosis appears milder from the first sign of demyelinating disease to the progressive course, probably as a result of an interplay between several factors including changes in the diagnostic criteria, changes in the epidemiology of multiple sclerosis, impact of early and appropriate disease-modifying treatment and improvement of the general state of health in the population. It has been suggested to regard incidental findings of demyelinating lesions in MRI in individuals without any history of clinical symptoms consistent with neurological dysfunction, so-called radiological isolated syndrome, as the initial course of multiple sclerosis. New diagnostic criteria have enabled the multiple sclerosis diagnosis in many patients at the first clinical demyelinating event, clinically isolated syndrome. The remaining patients with clinically isolated syndrome have a more benign prognosis, and for relapsing-remitting multiple sclerosis, the prognosis has become more favourable. Reduced disease activity in patients with relapsing-remitting multiple sclerosis can partly be ascribed to more efficacious new disease-modifying therapies but decrease in disease activity has also be seen in placebo-treated patients in clinical trials. This may be explained by several factors: change in the diagnostic criteria, more explicit inclusion criteria, exclusion of high-risk patients e.g. patients with co-morbidities, and more rigorous definitions of relapses and disease worsening. However, these factors also make the disease course in patients treated with disease-modifying therapies seem more favourable. In addition, change in the therapeutic target to stable disease (no evidence of disease activity = no relapses, no disease worsening and no MRI activity) could by itself change the course in relapsing-remitting multiple sclerosis. The effectiveness of disease-modifying drugs has reduced the transition from relapsing-remitting to secondary progressive multiple sclerosis. The concept of progressive multiple sclerosis has also evolved from two very distinct categories (primary progressive and secondary progressive multiple sclerosis) to a unified category of progressive multiple sclerosis, which can then be split into the categories of active or inactive. Also, an increasing tendency to treat progressive multiple sclerosis with disease-modifying therapies may have contributed to change the course in progressive multiple sclerosis. In conclusion, during the past decade the entire course of multiple sclerosis from the first sign of a demyelinating disorder through the progressive course appears to be milder due to a complex interplay of several factors.
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Affiliation(s)
- Per Soelberg Sorensen
- Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Hans-Peter Hartung
- Department of Neurology, University Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Xavier Montalban
- Department of Neurology, Hospital General Universitari Vall D’Hebron, Cemcat, Barcelona, Spain
- Division of Neurology, University of Toronto, St. Michael’s Hospital, Toronto, Canada
| | - Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mar Tintoré
- Department of Neurology, Hospital General Universitari Vall D’Hebron, Cemcat, Barcelona, Spain
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45
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Aly L, Havla J, Lepennetier G, Andlauer TFM, Sie C, Strauß EM, Hoshi MM, Kümpfel T, Hiltensperger M, Mitsdoerffer M, Mühlau M, Zimmer C, Hemmer B, Korn T, Knier B. Inner retinal layer thinning in radiologically isolated syndrome predicts conversion to multiple sclerosis. Eur J Neurol 2020; 27:2217-2224. [PMID: 32589804 DOI: 10.1111/ene.14416] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with radiologically isolated syndrome (RIS) are at increased risk of converting to multiple sclerosis (MS). Early identification of later converters is crucial for optimal treatment decisions. The purpose of this study was to assess the predictive potential of optical coherence tomography (OCT) measures in individuals with RIS regarding conversion to MS. METHODS This prospective observational cohort study included 36 individuals with RIS and 36 healthy controls recruited from two German MS centers. All individuals received baseline OCT and clinical examination and were longitudinally followed over up to 6 years. The primary outcome measure was the conversion to MS. RESULTS During clinical follow-up of 46 (26-58) months (median, 25%-75% interquartile range), eight individuals with RIS converted to MS. Individuals converting to MS showed a thinning of the peripapillary retinal nerve fiber layer (pRNFL) and the common ganglion cell and inner plexiform layer (GCIP) at baseline and during follow-up. Individuals with a pRNFL of 99 µm or lower or a GCIP of 1.99 mm3 or lower were at a 7.5- and 8.0-fold risk for MS conversion, respectively, compared to individuals with higher measures. After correction for other known risk factors, Cox proportional hazards regression revealed a hazard ratio of 1.08 for conversion to MS for each 1 µm decline in pRNFL. CONCLUSIONS Reduction of the pRNFL might be a novel and independent risk factor for conversion to MS in individuals with RIS. OCT might be useful for risk stratification and therapeutic decision-making in individuals with RIS.
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Affiliation(s)
- L Aly
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - J Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany
| | - G Lepennetier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - T F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Sie
- Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - E-M Strauß
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M-M Hoshi
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Marianne-Strauß-Klinik, Berg, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - M Hiltensperger
- Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M Mitsdoerffer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - T Korn
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Knier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
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46
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Lebrun-Frenay C, Kantarci O, Siva A, Sormani MP, Pelletier D, Okuda DT. Radiologically Isolated Syndrome: 10-Year Risk Estimate of a Clinical Event. Ann Neurol 2020; 88:407-417. [PMID: 32500558 DOI: 10.1002/ana.25799] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We have previously identified male sex, younger age, and the presence of spinal cord lesions as independent factors that increase the 5-year risk for evolution from radiologically isolated syndrome (RIS) to multiple sclerosis. Here, we investigate risk factors for the development of a clinical event using a 10-year, multinational, retrospectively identified RIS dataset. METHODS RIS subjects were identified according to 2009 RIS criteria and followed longitudinally as part of a worldwide cohort study. We analyzed data from 21 individual databases from 5 different countries. Associations between clinical and magnetic resonance imaging (MRI) characteristics and the risk of developing a first clinical event were determined using multivariate Cox regression models. RESULTS Additional follow-up data were available in 277 of 451 RIS subjects (86% female). The mean age at RIS diagnosis was 37.2 years (range, 11-74 years), with a median clinical follow-up of 6.7 years. The cumulative probability of a first clinical event at 10 years was 51.2%. Age, positive cerebrospinal fluid for oligoclonal bands, infratentorial lesions on MRI, and spinal cord lesions, were baseline independent predictors associated with a subsequent clinical event. The presence of gadolinium-enhanced lesions during follow-up was also associated with the risk of a seminal event. The reason for MRI and gadolinium-enhancing lesions at baseline did not influence the risk of a subsequent clinical event. INTERPRETATION Approximately half of all individuals with RIS experience a first clinical event within 10 years of the index MRI. The identification of independent predictors of risk for symptom onset may guide education and clinical management of individuals with RIS. ANN NEUROL 2020;88:407-417.
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Affiliation(s)
| | | | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Maria P Sormani
- Statistic Unit, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | | | - Darin T Okuda
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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47
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Beltrán E, Gerdes LA, Hansen J, Flierl-Hecht A, Krebs S, Blum H, Ertl-Wagner B, Barkhof F, Kümpfel T, Hohlfeld R, Dornmair K. Early adaptive immune activation detected in monozygotic twins with prodromal multiple sclerosis. J Clin Invest 2020; 129:4758-4768. [PMID: 31566584 DOI: 10.1172/jci128475] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/01/2019] [Indexed: 12/31/2022] Open
Abstract
Multiple sclerosis (MS) is a disabling disease of the CNS. Inflammatory features of MS include lymphocyte accumulations in the CNS and cerebrospinal fluid (CSF). The preclinical events leading to established MS are still enigmatic. Here we compared gene expression patterns of CSF cells from MS-discordant monozygotic twin pairs. Six "healthy" co-twins, who carry a maximal familial risk for developing MS, showed subclinical neuroinflammation (SCNI) with small MRI lesions. Four of these subjects had oligoclonal bands (OCBs). By single-cell RNA sequencing of 2752 CSF cells, we identified clonally expanded CD8+ T cells, plasmablasts, and, to a lesser extent, CD4+ T cells not only from MS patients but also from subjects with SCNI. In contrast to nonexpanded T cells, clonally expanded T cells showed characteristics of activated tissue-resident memory T (TRM) cells. The TRM-like phenotype was detectable already in cells from SCNI subjects but more pronounced in cells from patients with definite MS. Expanded plasmablast clones were detected only in MS and SCNI subjects with OCBs. Our data provide evidence for very early concomitant activation of 3 components of the adaptive immune system in MS, with a notable contribution of clonally expanded TRM-like CD8+ cells.
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Affiliation(s)
- Eduardo Beltrán
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital
| | - Lisa Ann Gerdes
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital
| | - Julia Hansen
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital
| | | | - Stefan Krebs
- Laboratory for Functional Genome Analysis (LAFUGA), Gene Center; and
| | - Helmut Blum
- Laboratory for Functional Genome Analysis (LAFUGA), Gene Center; and
| | - Birgit Ertl-Wagner
- Department of Radiology, Grosshadern Medical Campus; Ludwig Maximilian University of Munich, Munich, Germany.,Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands.,UCL Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Klaus Dornmair
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
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48
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Preziosa P, Rocca MA, Filippi M. Current state-of-art of the application of serum neurofilaments in multiple sclerosis diagnosis and monitoring. Expert Rev Neurother 2020; 20:747-769. [DOI: 10.1080/14737175.2020.1760846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A. Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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49
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Mazoyer J, Louapre C, Shor N, Lubetzki C, Maurs L, Maillart E. Headache and multifocal white matter lesions: Radiologically Isolated Syndrome or CADASIL? Rev Neurol (Paris) 2020; 176:880-881. [PMID: 32312497 DOI: 10.1016/j.neurol.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Affiliation(s)
- J Mazoyer
- AP-HP, Neurology Department, Pitié-Salpêtrière hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - C Louapre
- AP-HP, Neurology Department, Pitié-Salpêtrière hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; Sorbonne University, Paris, France
| | - N Shor
- Sorbonne University, Paris, France; AP-HP, Neuroradiology Department, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - C Lubetzki
- AP-HP, Neurology Department, Pitié-Salpêtrière hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; Sorbonne University, Paris, France
| | - L Maurs
- AP-HP, Neuroradiology Department, Pitié-Salpêtrière Hospital, 75013, Paris, France; Neurology, New-Caledonia
| | - E Maillart
- AP-HP, Neurology Department, Pitié-Salpêtrière hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
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50
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Abstract
PURPOSE OF REVIEW This review provides the reader with updated information needed to make an accurate diagnosis of radiologically isolated syndrome (RIS), discusses controversies and considerations related to therapeutic intervention in RIS, and summarizes ongoing clinical intervention trials. RECENT FINDINGS Individuals with RIS lack clinical neurological symptoms but are at risk for the subsequent development of a first clinical neurological event consistent with a diagnosis of multiple sclerosis. There are two ongoing clinical intervention trials to determine whether disease-modifying treatments for multiple sclerosis can delay or prevent a first clinical event in individuals with RIS. If clinical trials demonstrate a beneficial effect of disease-modifying therapy, such interventions should be considered in individuals with RIS.
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