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Johnson TR, Gandelman S, Serafin LR, Charles JY, Jacobs D. Rehabilitation Outcomes in Multiple Sclerosis Patients on Ocrelizumab Diagnosed With West Nile Virus Encephalitis. Cureus 2024; 16:e57063. [PMID: 38681299 PMCID: PMC11052554 DOI: 10.7759/cureus.57063] [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] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Multiple sclerosis (MS) has a global prevalence exceeding two million people and is a leading cause of non-traumatic physical disability. MS can be treated with ocrelizumab, an anti-CD20 monoclonal antibody. West Nile virus (WNV) is the most common cause of mosquito-borne viral encephalitis in North America. It can lead to neuroinvasive WNV disease (WNND) affecting the brain and peripheral nervous system, especially in immunocompromised patients, such as those being treated with ocrelizumab for MS. WNND is exceedingly rare and reported in less than 1% of cases of WNV. It has been established that inpatient rehabilitation improves functional outcomes in patients with MS and those with WNND. However, the inpatient rehabilitation outcomes in patients diagnosed with both WNND and MS have not been reported. In this study, we aimed to examine the rehabilitation outcomes of MS patients on ocrelizumab diagnosed with WNND. We performed a retrospective chart review of patients with MS treated with ocrelizumab, who were diagnosed with WNND and admitted to a single facility. Rehabilitation outcomes were assessed using functional independence measure (FIM) scores on admission and discharge. Three patients met the inclusion criteria; two in acute rehab, and one in the long-term acute care hospital (LTACH). Both patients admitted to acute inpatient rehabilitation showed an improvement in FIM scores from admission to discharge, one patient from 9 to 16 and the other from 14 to 54. However, the patient admitted to the LTACH had no improvement in FIM score from admission to discharge. Patients admitted to acute rehab were ultimately discharged home, while the patient admitted to the LTACH required discharge to a subacute rehabilitation facility. Based on our findings, intense and prolonged comprehensive inpatient rehabilitation is associated with improved functional outcomes and increased likelihood of discharge to home in this population suffering from both central and peripheral nervous system involvement due to MS and WNND.
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Affiliation(s)
- Taylor R Johnson
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
| | | | - Lauren R Serafin
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Jeremy Y Charles
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Dina Jacobs
- Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA
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Ehling R, Seebacher B, Harsányi A, Ganzbiller N, Papez S, Haider B, Hoertenhuber D, Kranz G, Tarasiewicz R, Spatt J, Moser H, Klein W, Barth C, Kubik W, Kronberger E, Winkler A, Brenneis C. Successful long-term management of spasticity in people with multiple sclerosis using a software application: Results from a randomized-controlled, multicenter study. Eur J Neurol 2022; 29:1697-1707. [PMID: 35122365 DOI: 10.1111/ene.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/20/2022] [Accepted: 02/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Successful long-term treatment of spasticity in people with multiple sclerosis (pwMS) is challenging. We investigated the effects of multidisciplinary inpatient rehabilitation (MIR) and an individualized self-training program delivered by an App on spasticity in pwMS. METHODS First we assessed the efficacy of 4-weeks MIR in ambulatory pwMS (EDSS<7.0) with moderate to severe lower limb spasticity (defined by ≥4 points on the Numeric Rating Scale for spasticity (NRSs)) in a cohort of 115 pwMS in 7 rehabilitation centers in Austria. In case of a clinically relevant improvement in spasticity of ≥20% on the NRSs following MIR (n=94), pwMS were randomly allocated in a 1:1 ratio to either a newly designed "MS-spasticity App" or to a paper-based self-training program for 12 weeks. The primary outcome was change in NRSs (DRKS00023960). RESULTS MIR led to a significant reduction of 2.0 points on the NRSs (95% Confidence Interval (CI) 2.5 to 2.0; p<0.000). MIR was further associated with a statistically significant improvement in spasticity on the modified Ashworth scale, strength and all mobility outcomes. Following MIR, self-training with "MS-spasticity App" was associated with a sustained positive effect on the NRSs, while paper-based self-training led to a worsening in spasticity (median NRSs difference 1.0; 95% CI 1.7 to 0.3; p=0.009). "MS-spasticity App" was also associated with a significantly better adherence to self-training (95% versus 72% completion rate; p<0.001). CONCLUSION In pwMS, MIR is able to significantly improve lower-limb spasticity, strength and mobility. Following MIR, an individually tailored anti-spasticity program delivered by an App leads to sustained positive long-term management.
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Affiliation(s)
- Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria.,Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Barbara Seebacher
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria.,Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Andrea Harsányi
- Department of Neurological Rehabilitation, Clinic Pirawarth, Bad Pirawarth, Austria
| | - Nicole Ganzbiller
- Department of Neurological Rehabilitation, Clinic Pirawarth, Bad Pirawarth, Austria
| | - Stephanie Papez
- Department of Neurological Rehabilitation, Clinic Pirawarth, Bad Pirawarth, Austria
| | - Bernhard Haider
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Enns, Enns, Austria
| | - Doris Hoertenhuber
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Enns, Enns, Austria
| | - Gottfried Kranz
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Rosenhuegel, Vienna, Austria
| | - Roland Tarasiewicz
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Rosenhuegel, Vienna, Austria
| | - Josef Spatt
- Department of Neurology, Evangelisches Krankenhaus, Vienna, Austria
| | - Hermann Moser
- Neurological Therapy Center Gmundnerberg, Clinic for Rehabilitation, Altmuenster am Traunsee, Austria.,Ludwig Boltzmann Institute, Rehabilitation Research, Vienna, Austria
| | - Wolfhard Klein
- Neurological Therapy Center Gmundnerberg, Clinic for Rehabilitation, Altmuenster am Traunsee, Austria
| | - Cosmas Barth
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Radkersburg, Bad Radkersburg, Austria
| | - Wolfgang Kubik
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Radkersburg, Bad Radkersburg, Austria
| | - Eva Kronberger
- Department of Neurological Rehabilitation, Clinic for Rehabilitation Lassnitzhoehe, Lassnitzhoehe, Austria
| | - Andreas Winkler
- Department of Neurological Rehabilitation, Clinic Pirawarth, Bad Pirawarth, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria.,Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
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