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Sparaco M, Carbone L, Landi D, Ingrasciotta Y, Di Girolamo R, Vitturi G, Marfia GA, Alviggi C, Bonavita S. Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis. CNS Drugs 2023; 37:849-866. [PMID: 37679579 PMCID: PMC10570169 DOI: 10.1007/s40263-023-01036-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
Multiple sclerosis (MS) predominantly affects women of fertile age. Various aspects of MS could impact on fertility, such as sexual dysfunction, endocrine alterations, autoimmune imbalances, and disease-modifying therapies (DMTs). The proportion of women with MS (wMS) requesting infertility management and assisted reproductive technology (ART) is increasing over time. In this review, we report on data regarding ART in wMS and address safety issues. We also discuss the clinical aspects to consider when planning a course of treatment for infertility, and provide updated recommendations to guide neurologists in the management of wMS undergoing ART, with the goal of reducing the risk of disease activation after this procedure. According to most studies, there is an increase in relapse rate and magnetic resonance imaging activity after ART. Therefore, to reduce the risk of relapse, ART should be considered in wMS with stable disease. In wMS, especially those with high disease activity, fertility issues should be discussed early as the choice of DMT, and fertility preservation strategies might be proposed in selected cases to ensure both disease control and a safe pregnancy. For patients with stable disease taking DMTs compatible with pregnancy, treatment should not be interrupted before ART. If the ongoing therapy is contraindicated in pregnancy, then it should be switched to a compatible therapy. Prior to beginning fertility treatments in wMS, it would be reasonable to assess vitamin D serum levels, thyroid function and its antibody serum levels; start folic acid supplementation; and ensure smoking and alcohol cessation, adequate sleep, and food hygiene. Cervico-vaginal swabs for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis, as well as serology for viral hepatitis, HIV, syphilis, and cytomegalovirus, should be performed. Steroids could be administered under specific indications. Although the available data do not clearly show a definite raised relapse risk associated with a specific ART protocol, it seems reasonably safe to prefer the use of gonadotropin-releasing hormone (GnRH) antagonists for ovarian stimulation. Close clinical and radiological monitoring is reasonably recommended, particularly after hormonal stimulation and in case of pregnancy failure.
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Affiliation(s)
- Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University of Naples, Naples, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ylenia Ingrasciotta
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Raffaella Di Girolamo
- Department of Public Health, School of Medicine, Federico II University of Naples, Naples, Italy
| | - Giacomo Vitturi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Alviggi
- Department of Public Health, School of Medicine, Federico II University of Naples, Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy.
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Pourhaji F, Peyman N, Taraghdar MM, Jamali J, Tehrani H. Explaining the burden of psychosocial factors on the worsening symptoms of MS: a qualitative study of patients' experiences. BMC Neurol 2023; 23:98. [PMID: 36879228 PMCID: PMC9987086 DOI: 10.1186/s12883-023-03148-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND This study was conducted with the aim of identifying the burden of psychosocial factors on the worsening symptoms of multiple sclerosis. METHODS This as conducted with a qualitative approach and conventional content analysis among patients with Multiple sclerosis in Mashhad. Data were collected through semi-structured interviews with patients with Multiple sclerosis. Twenty-one patients with Multiple sclerosis were selected through purposive sampling and snowball sampling. The data were analyzed using Graneheim and Lundman method. Guba and Lincoln's criteria were used for evaluating research transferability. The data collection and management was performed by using the MAXQADA 10 software. RESULTS In explanation of the psychosocial factors of patients with Multiple sclerosis, one category (psychosocial tensions) and three subcategories of stress (physical symptoms, emotional symptoms, and behavioral symptoms), agitation (family disorder, treatment-related concerns, and social relationship concerns), and stigmatization (social stigma and internalized stigma) were extracted. CONCLUSION The results of this study show that patients with Multiple sclerosis are faced with concerns such as stress, agitation, and fear of stigma, and need support and understanding from the family and community to overcome these concerns. Society must base its health policies on addressing the challenges faced by patients. Accordingly, the authors argue that health policies, and consequently, healthcare systems, need to address patients' ongoing challenges as a priority in caring for patients with Multiple sclerosis.
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Affiliation(s)
- Fahimeh Pourhaji
- Department of Health Education and Health Promotion, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mousa Mahdizadeh Taraghdar
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jamshid Jamali
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Tehrani
- Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Hosseini Z, Homayuni A, Etemadifar M. Barriers to quality of life in patients with multiple sclerosis: a qualitative study. BMC Neurol 2022; 22:174. [PMID: 35562707 PMCID: PMC9102679 DOI: 10.1186/s12883-022-02700-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system that affects the patients' quality of life. This research was conducted with the aim of identifying the barriers of quality of life in patients with MS. METHODS This qualitative study was conducted through a conventional content analysis approach. We used the purposeful sampling with maximum diversity in terms of gender, age, education, marital status and employment. Data were collected through semi-structured interviews with 18 patients with multiple sclerosis referred to the MS Association of Isfahan. Interviews were conducted to the point of information saturation. RESULTS Through the content analysis of the interviews, we identified 2 main categories and 11 sub-categories. The main categories include intrapersonal problems (physical problems, psychological disorders, turbulent future, functional limitations, job loss and pennilessness), and environmental barriers (disease and treatment process, fatigue of caregivers, information deficiency about MS, family tensions, lack of social support and fun and entertainment). CONCLUSIONS In order to improve the quality of life in these patients, there is a need for attention and practical measures in the field of identified factors. By removing barriers such as providing educational and counseling services to the patients and their families, adapting the urban structure, providing financial support and adequate insurance coverage, the authorities can take measures to ensure patients' health and improve their quality of life.
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Affiliation(s)
- Zahra Hosseini
- Health Education and Promotion, Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Atefeh Homayuni
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Masoud Etemadifar
- Neurology, Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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The Impact of Reproductive Issues on Preferences of Women with Relapsing Multiple Sclerosis for Disease-Modifying Treatments. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:583-597. [PMID: 32588337 DOI: 10.1007/s40271-020-00429-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Relapsing-remitting multiple sclerosis (RRMS) is an incurable disease characterised by relapses (periods of function loss) followed by full or partial recovery, and potential permanent disability over time. Many disease-modifying treatments (DMTs) exist that help reduce relapses and slow disease progression. Most are contraindicated during conception/pregnancy and some require a discontinuation period before trying to conceive. Although around three-quarters of people with RRMS are women, there is limited knowledge about how reproductive issues impact DMT preference. OBJECTIVE The aim of this study was to measure the preferences for DMTs of women with RRMS who are considering pregnancy. DESIGN An online discrete choice experiment (DCE). METHODS Participants chose between two hypothetical DMTs characterised by a set of attributes, then indicated if they preferred their choice to no treatment. Attributes were identified from interviews and focus groups with people with RRMS and MS professionals, as well as literature reviews, and included the probability of problems with pregnancy, discontinuation of DMTs, and breastfeeding safety. In each DCE task, participants were asked to imagine making decisions in three scenarios: now; when trying to conceive; and when pregnant. ANALYSIS Two mixed logit models were estimated, one to assess the statistical significance between scenarios and one in maximum acceptable risk space to allow comparison of the magnitudes of parameters between scenarios. SAMPLE Women with RRMS who were considering having a child in the future, recruited from a UK MS patient register. RESULTS Sixty respondents completed the survey. Participants preferred no treatment in 12.6% of choices in the 'now' scenario, rising significantly to 37.6% in the 'trying to conceive' scenario and 60.3% in the 'pregnant' scenario (Kruskal-Wallis p < 0.001). This pattern corresponds with results from models that included a no-treatment alternative-specific constant (ASC) capturing differences between taking and not taking a DMT not specified by the attributes. The ASC was lower in the trying to conceive scenario than in the now scenario, and lower still in the pregnant scenario, indicating an intrinsic preference for no treatment. Participants also placed relatively less preference on reducing relapses and avoiding disease progression in the trying to conceive and pregnant scenarios compared with a lower risk of problems with pregnancy. In the trying to conceive scenario, participants' preference for treatments with shorter washout periods increased. CONCLUSION Women with RRMS considering having a child prefer DMTs with more favourable reproduction-related attributes, even when not trying to conceive. Reproductive issues also influenced preferences for DMT attributes not directly related to pregnancy, with preferences dependent on the life circumstances in which choices were made. The design of the DCE highlights the benefits of considering the scenario in which participants make choices, as they may change over time.
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Ashtari F, Mokhtari F, Valiani M, Soudavi M, Saadat H, Tolouei H, Mansourian M. Investigating the interaction between fertility, pregnancy, and multiple sclerosis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:220. [PMID: 34395657 PMCID: PMC8318175 DOI: 10.4103/jehp.jehp_1107_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/25/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease of the central nervous system. Most women with MS are diagnosed during their reproductive ages. The aim of this study was to evaluate the interaction between fertility, pregnancy, and MS. MATERIALS AND METHODS A retrospective descriptive-analytic study was conducted on 110 women suffering from MS with a history of pregnancy (between 2007 and 2017 years) in Isfahan, Iran. Samples were selected in a census model. Women completed a researcher-constructed questionnaire by telephone. The questionnaire consisted of three parts: demographic information, MS and its symptoms and treatment, and reproductive system and the history of pregnancy associated with MS. The data were analyzed by SPSS software version 16 using Chi-square, ANOVA, and t-test. RESULTS The mean age of women was 32.4 years. In this population, the average number of pregnancies was 1.61, the number of deliveries was 1.35, the number of abortions was 0.24, the history of ectopic pregnancy was 0.01, the number of alive children was 1.36, and the number of dead children was 0.01. The average time of the last MS attack before the pregnancy was 21.36 months. Fatigue (24.5%) was the most common symptom exacerbated during pregnancy. MS symptoms improved in 55.0% of women in the second trimester. CONCLUSIONS MS had no effect on the pregnancy status, such as the number of abortions, ectopic pregnancy, alive and dead children, and the duration of pregnancy. Symptoms of the disease improved during pregnancy. Therefore, pregnancy has a protective role against MS.
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Affiliation(s)
- Freshteh Ashtari
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Mokhtari
- MSc, Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboubeh Valiani
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Soudavi
- Deputy of Treatment, Diseases Management Department, Isfahan University of Medical Sciences Isfahan, Iran
| | - Homa Saadat
- Deputy of Treatment, Diseases Management Department, Isfahan University of Medical Sciences Isfahan, Iran
| | - Hamidreza Tolouei
- Deputy of Treatment, Isfahan University of Medical Sciences Isfahan, Iran
| | - Marjan Mansourian
- Assistant Professor, Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
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Alonso R, Patrucco L, Silva B, Quarracino C, Eizaguirre MB, Vrech C, López P, Carnero Contentti E, Deri N, Carrá A, Chercorff A, Tkachuk V, Balbuena ME, Pettinicchi JP, Tavolini D, Barboza A, Rojas JI, Cristiano E, Lázaro L, Garcea O, Fernández Liguori N. Family planning in Argentinian women with multiple sclerosis: An important yet seldom approached issue. Mult Scler J Exp Transl Clin 2021; 7:20552173211025312. [PMID: 34211724 PMCID: PMC8216353 DOI: 10.1177/20552173211025312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to assess family planning (FP) among women with multiple sclerosis (WwMS). Methods We invited 604 WwMS to answer a survey focused on FP: a) Temporal relationship between pregnancy and the diagnosis of multiple sclerosis; b) History of FP; c) Childbearing desire; d) Information on family planning. Comparisons between pregnancy and not pregnancy after MS, as well as, planned and unplanned pregnancy were analyzed. Multivariate and univariate analyses were used to assess the impact of independent variables and FP Result 428 (71.7%) WwMS completed the survey. A 19.1% got pregnant after MS diagnosis and we evaluated FP in the last pregnancy, 56.1% patients had a planned pregnancy. Professional addressing FP (OR = 0.27, 95%-CI 0.08-0.92, p = 0.03) and non-injection drug treatment before pregnancy (OR = 2.88, 95%-CI 1.01-8.21, p = 0.047) were independent predictors of unplanned pregnancy in our multivariate model. Among WwMS ≤ 40 years, 48.7% had future childbearing desire. Young age (p < 0.001), PDDS <3 (p = 0.018), disease duration <5 years (p = 0.02), not childbearing before MS diagnosis (p < 0.001) and neurologist addressing family planning (p = 0.01) were significantly associated with childbearing desire. Conclusions This research highlights that pregnancy remains an important concern among WwMS.
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Affiliation(s)
- Ricardo Alonso
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Cecilia Quarracino
- Servicio de Neurología. Instituto Alfredo Lanari, Hospital Universitario, Buenos Aires, Argentina
| | - María Barbara Eizaguirre
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Pablo López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | - Norma Deri
- Centro de Investigaciones Diabaid, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
| | - Aníbal Chercorff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Sección de Esclerosis Múltiple y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - María Eugenia Balbuena
- Sección de Esclerosis Múltiple y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Luciana Lázaro
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Nora Fernández Liguori
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina.,Servicio de Neurología. Hospital Enrique Tornú, Buenos Aires, Argentina
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Yordanova IA, Ebner F, Schulz AR, Steinfelder S, Rosche B, Bolze A, Paul F, Mei HE, Hartmann S. The Worm-Specific Immune Response in Multiple Sclerosis Patients Receiving Controlled Trichuris suis Ova Immunotherapy. Life (Basel) 2021; 11:life11020101. [PMID: 33572978 PMCID: PMC7912101 DOI: 10.3390/life11020101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/19/2022] Open
Abstract
Considering their potent immunomodulatory properties, therapeutic applications of Trichuris suis ova (TSO) are studied as potential alternative treatment of autoimmune disorders like multiple sclerosis (MS), rheumatoid arthritis (RA), or inflammatory bowel disease (IBD). Clinical phase 1 and 2 studies have demonstrated TSO treatment to be safe and well tolerated in MS patients, however, they reported only modest clinical efficacy. We therefore addressed the cellular and humoral immune responses directed against parasite antigens in individual MS patients receiving controlled TSO treatment (2500 TSO p.o. every 2 weeks for 12 month). Peripheral blood mononuclear cells (PBMC) of MS patients treated with TSO (n = 5) or placebo (n = 6) were analyzed. A continuous increase of serum IgG and IgE antibodies specific for T. suis excretory/secretory antigens was observed up to 12 months post-treatment. This was consistent with mass cytometry analysis identifying an increase of activated HLA-DRhigh plasmablast frequencies in TSO-treated patients. While stable and comparable frequencies of total CD4+ and CD8+ T cells were detected in placebo and TSO-treated patients over time, we observed an increase of activated HLA-DR+CD4+ T cells in TSO-treated patients only. Frequencies of Gata3+ Th2 cells and Th1/Th2 ratios remained stable during TSO treatment, while Foxp3+ Treg frequencies varied greatly between individuals. Using a T. suis antigen-specific T cell expansion assay, we also detected patient-to-patient variation of antigen-specific T cell recall responses and cytokine production. In summary, MS patients receiving TSO treatment established a T. suis-specific T- and B-cell response, however, with varying degrees of T cell responses and cellular functionality across individuals, which might account for the overall miscellaneous clinical efficacy in the studied patients.
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Affiliation(s)
- Ivet A. Yordanova
- Institute of Immunology, Center for Infection Medicine, Freie Universität Berlin, D-14163 Berlin, Germany; (I.A.Y.); (F.E.)
| | - Friederike Ebner
- Institute of Immunology, Center for Infection Medicine, Freie Universität Berlin, D-14163 Berlin, Germany; (I.A.Y.); (F.E.)
| | - Axel Ronald Schulz
- German Rheumatism Research Center Berlin (DRFZ), a Leibniz Institute, D-10117 Berlin, Germany; (A.R.S.); (H.E.M.)
| | | | - Berit Rosche
- Department of Neurology and Experimental Neurology, Charité—Universitätsmedizin Berlin, D-10117 Berlin, Germany;
- Clinical and Experimental Multiple Sclerosis Research Center, Charité—Universitätsmedizin Berlin, D-10117 Berlin, Germany;
| | - Anna Bolze
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, D-10117 Berlin, Germany;
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, D-10117 Berlin, Germany
| | - Friedemann Paul
- Clinical and Experimental Multiple Sclerosis Research Center, Charité—Universitätsmedizin Berlin, D-10117 Berlin, Germany;
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, D-10117 Berlin, Germany;
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, D-10117 Berlin, Germany
| | - Henrik E. Mei
- German Rheumatism Research Center Berlin (DRFZ), a Leibniz Institute, D-10117 Berlin, Germany; (A.R.S.); (H.E.M.)
| | - Susanne Hartmann
- Institute of Immunology, Center for Infection Medicine, Freie Universität Berlin, D-14163 Berlin, Germany; (I.A.Y.); (F.E.)
- Correspondence:
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Dalmau J, Dalakas MC, Kolson DL, Paul F, Zamvil SS. N2 year in review. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 8:8/1/e925. [PMID: 33411673 PMCID: PMC7757781 DOI: 10.1212/nxi.0000000000000925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | - Marinos C Dalakas
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Dennis L Kolson
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Friedemann Paul
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Scott S Zamvil
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
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Houtchens MK, Edwards NC, Hayward B, Mahony MC, Phillips AL. Live birth rates, infertility diagnosis, and infertility treatment in women with and without multiple sclerosis: Data from an administrative claims database. Mult Scler Relat Disord 2020; 46:102541. [PMID: 33296964 DOI: 10.1016/j.msard.2020.102541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/28/2020] [Accepted: 09/27/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Real-world data regarding live birth rates (LBRs) and infertility in women with multiple sclerosis (MS) are lacking. This study compared LBRs, infertility diagnoses, and infertility treatments in women with and without MS. METHODS Using a retrospective US administrative claims database, patients 18-55 years with MS were matched 1:1 to patients without MS to compare LBRs, infertility diagnoses, and infertility treatments used between cohorts. RESULTS Overall LBRs were lower in women with MS (n=96,937) versus women without (n=96,937; 5.0% vs 7.0%; p<0.0001). A greater proportion of women with MS than without had a diagnosis of infertility (8.5% vs 8.1%; p=0.0006). Fewer women with MS than without used any infertility treatment (1.0% vs 1.2%; p=0.0002). Among women with or without MS who received infertility treatments, no significant difference was observed in LBRs with oral (32.2% vs 31.5%; p=0.8536) or injectable (44.0% vs 49.3%; p=0.2603) treatment. CONCLUSION Women with MS had a lower LBR, received more infertility diagnoses, and were less likely to receive infertility treatment than women without MS. There was no difference in LBRs following infertility treatment. Claims-data studies provide valuable exploratory analyses that reflect interactions between patients and the healthcare system.
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Affiliation(s)
- Maria K Houtchens
- Brigham and Women's Hospital, Harvard Medical School, Brookline, MA, USA.
| | | | - Brooke Hayward
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Mary C Mahony
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Amy L Phillips
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
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Is Fertility Affected in Women of Childbearing Age with Multiple Sclerosis or Neuromyelitis Optica Spectrum Disorder? J Mol Neurosci 2020; 70:1829-1835. [PMID: 32740781 DOI: 10.1007/s12031-020-01576-x] [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] [Received: 02/27/2020] [Accepted: 04/30/2020] [Indexed: 01/05/2023]
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease of the central nervous system (CNS), which is more prevalent among women of childbearing age. Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune disease of the CNS with similar prevalence features to MS and has recently been considered a different entity from MS. Measuring ovarian reserve is one way of evaluating fertility. Anti-Müllerian hormone (AMH) is a peptide hormone produced by ovarian granulosa cells of early follicles and is considered to be a marker for ovarian reserve. With MS and NMOSD predominance in young women, the present study aimed to address the possibility of these diseases affecting fertility by measuring AMH levels in MS and NMOSD patients and comparing it with healthy controls. The present study included 23 relapsing-remitting MS (RRMS) patients, 23 seronegative NMOSD patients, and 23 healthy age-matched controls between 18 and 45 years of age. Serum samples of the three groups were collected, and the AMH levels were measured with AMH Gen II Enzyme-Linked Immunosorbent Assay, Beckman Coulter kit. In the present study, the AMH levels did not differ significantly between the groups (p = 0.996). The mean AMH in the RRMS group was 3.59 ± 0.55 ng/ml compared with the mean of 3.60 ± 0.50 ng/ml in healthy controls. The mean AMH levels in the NMOSD group were 3.66 ± 0.61 ng/ml. Lower levels of AMH were found to be negatively associated with annualized relapse rate (in both groups of patients) and MS severity score. However, the difference was not significant. In NMOSD patients, the serum levels of AMH were negatively associated with disease duration (r = - 0.42, p = 0.023). There had been a significant negative correlation between mean AMH serum levels with Expanded Disability Status Scale (EDSS) at the time of diagnosis and at the time of study in the NMOSD group (r = - 0.402, p = 0.03 and r = - 0.457, p = 0.014, respectively). There was not a significant difference in mean serum AMH levels between RRMS and NMOSD patients compared with that of healthy controls. Further studies with larger sample sizes should be conducted, which take more variables affecting fertility in women with either RRMS or NMOSD into account to put an end to the controversial issue of fertility in this area.
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11
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Weygandt M, Behrens J, Brasanac J, Söder E, Meyer-Arndt L, Wakonig K, Ritter K, Brandt AU, Bellmann-Strobl J, Gold SM, Haynes JD, Paul F. Neural mechanisms of perceptual decision-making and their link to neuropsychiatric symptoms in multiple sclerosis. Mult Scler Relat Disord 2019; 33:139-145. [PMID: 31195338 DOI: 10.1016/j.msard.2019.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision-making (DM) capabilities are impaired in multiple sclerosis (MS). A variety of researchers hypothesized that this impairment is associated with reduced quality of life (QoL) and neuropsychiatric symptoms. Studies explicitly testing this hypothesis, however, are rare, provided inconclusive results, or evaluated only a limited selection of DM domains. Consequently, we conducted the first MS study on perceptual DM (e.g. deciding whether a car will fit into a parking lot based on a visual percept) to test this assumption. METHODS Specifically, we used an fMRI task that measured brain activity in 30 MS patients and 19 healthy controls (HCs) while the participants repeatedly decided whether objects referenced indirectly via their written object names would fit into a shoebox to investigate neural mechanisms of perceptual DM. The objects varied in size and thus decision difficulty. From these data, we determined voxel-wise brain activity parameters reflecting (i) decision difficulty and (ii) decision speed and related them to behavioral DM performance, QoL, mild to moderate depressive symptoms, and fatigue. RESULTS Patients showed reduced DM performance. Activity reflecting decision difficulty in the middle temporal gyrus was negatively related to DM performance across MS patients and HCs; activity reflecting decision speed in MS patients was associated with depressive symptoms and fatigue in areas of the dorsal visual stream. CONCLUSION The study shows that the perceptual DM capacity is reduced in MS. Moreover, the link between neural mechanisms of perceptual DM and neuropsychiatric symptoms suggests that an impairment in this domain is clinically relevant.
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Affiliation(s)
- Martin Weygandt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Department of Neurology, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Bernstein Center for Computational Neuroscience, Berlin 10117, Germany.
| | - Janina Behrens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Berlin 10117, Germany
| | - Jelena Brasanac
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin 12203, Germany
| | - Eveline Söder
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
| | - Lil Meyer-Arndt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany
| | - Katharina Wakonig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany
| | - Kerstin Ritter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Department of Neurology, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Bernstein Center for Computational Neuroscience, Berlin 10117, Germany
| | - Alexander U Brandt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany
| | - Judith Bellmann-Strobl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin 13125, Germany
| | - Stefan M Gold
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin 12203, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center, Hamburg 20251, Germany
| | - John-Dylan Haynes
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Department of Neurology, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Bernstein Center for Computational Neuroscience, Berlin 10117, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Excellence Cluster NeuroCure, Berlin 10117, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Berlin 10117, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin 13125, Germany
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12
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Van Der Walt A, Nguyen A, Jokubaitis V. Family planning, antenatal and post partum care in multiple sclerosis: a review and update. Med J Aust 2019; 211:230-236. [DOI: 10.5694/mja2.50113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Anneke Van Der Walt
- Monash University Melbourne VIC
- University of Melbourne Melbourne VIC
- Alfred Health Melbourne VIC
- Royal Melbourne Hospital Melbourne VIC
| | - Ai‐Lan Nguyen
- University of Melbourne Melbourne VIC
- Royal Melbourne Hospital Melbourne VIC
| | - Vilija Jokubaitis
- Monash University Melbourne VIC
- University of Melbourne Melbourne VIC
- Alfred Health Melbourne VIC
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13
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Lavorgna L, Esposito S, Lanzillo R, Sparaco M, Ippolito D, Cocco E, Fenu G, Borriello G, De Mercanti S, Frau J, Capuano R, Trojsi F, Rosa L, Clerico M, Laroni A, Morra VB, Tedeschi G, Bonavita S. Factors interfering with parenthood decision-making in an Italian sample of people with multiple sclerosis: an exploratory online survey. J Neurol 2019; 266:707-716. [PMID: 30649617 DOI: 10.1007/s00415-019-09193-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Little is known about the influence of multiple sclerosis (MS) diagnosis on parenthood attitude in people with MS (pwMS). OBJECTIVE To investigate the impact of diagnosis, clinical features and external disease-related influences on parenthood decision-making in Italian pwMS. METHODS A web-based survey was posted on SMsocialnetwork.com to investigate clinical status, parenthood desire, influences on family planning, pregnancy outcomes, abortions and adoptions of pwMS. RESULTS 33/395 respondents never wanted to become parent because of MS ("anti-parenthood after diagnosis"). 362 declared to be in favor of parenthood. 51% pwMS having a child by the survey time had already received the MS diagnosis at first childbirth. The frequency of a second child in pwMS after diagnosis was 38% compared to 67% in people without yet MS diagnosis. 16% of pwMS were discouraged to become parent after diagnosis, mainly by medical personnel. In 71% of respondents, diagnosis did not delay the decision to become parent and only 39% were counseled by treating physician to plan pregnancy. Patients' distribution according to the clinical phenotype (exclusively relapsing vs exclusively progressive) showed a higher proportion of progressive patients in the "anti-parenthood after diagnosis" subgroup. CONCLUSION MS diagnosis impacted dramatically on the life project of 7% of pwMS that decided not to have children because of the disease and in pro-parenthood pwMS impacted especially on having the second child. Only a minority was counseled to plan pregnancy. A worse disease course driving to a progressive phenotype at survey time might have negatively impacted on parenthood desire.
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Affiliation(s)
- L Lavorgna
- First Division of Neurology, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy.
| | - S Esposito
- First Division of Neurology, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - R Lanzillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | - M Sparaco
- First Division of Neurology, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - D Ippolito
- First Division of Neurology, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - E Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Centre, Binaghi Hospital, University of Cagliari, Cagliari, Italy
| | - G Fenu
- Department of Medical Sciences and Public Health, Multiple Sclerosis Centre, Binaghi Hospital, University of Cagliari, Cagliari, Italy
| | - G Borriello
- Department of Neurology and Psychiatry, S. Andrea MS Center, Sapienza University, Rome, Italy
| | - S De Mercanti
- Clinical and Biological Sciences Department, University of Torino, Turin, Italy
| | - J Frau
- Department of Medical Sciences and Public Health, Multiple Sclerosis Centre, Binaghi Hospital, University of Cagliari, Cagliari, Italy
| | - R Capuano
- First Division of Neurology, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - F Trojsi
- First Division of Neurology, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - L Rosa
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | - M Clerico
- Clinical and Biological Sciences Department, University of Torino, Turin, Italy
| | - A Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - V Brescia Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | - G Tedeschi
- First Division of Neurology, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
- Neurological Institute for Diagnosis and Care "Hermitage Capodimonte", MRI Center SUN-FISM, Naples, Italy
| | - S Bonavita
- First Division of Neurology, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
- Neurological Institute for Diagnosis and Care "Hermitage Capodimonte", MRI Center SUN-FISM, Naples, Italy
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14
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Oertel FC, Zimmermann HG, Brandt AU, Paul F. Novel uses of retinal imaging with optical coherence tomography in multiple sclerosis. Expert Rev Neurother 2018; 19:31-43. [PMID: 30587061 DOI: 10.1080/14737175.2019.1559051] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Multiple Sclerosis (MS) is the most common chronic autoimmune neuroinflammatory condition in young adults. It is often accompanied by optic neuritis (ON) and retinal neuro-axonal damage causing visual disturbances. Optical coherence tomography (OCT) is a sensitive non-invasive method for quantifying intraretinal layer volumes. Recently, OCT not only showed to be a reliable marker for ON-associated damage, but also proved its high prognostic value for functional outcome and disability accrual in patients with MS. Consequently, OCT is discussed as a potential marker for monitoring disease severity and therapeutic response in individual patients. Areas covered: This article summarizes our current understanding of structural retinal changes in MS and describes the future potential of OCT for differential diagnosis, monitoring of the disease course and for clinical trials. Expert commentary: Today, OCT is used in clinical practice in specialized MS centers. Standardized parameters across devices are urgently needed for supporting clinical utility. Novel parameters are desirable to increase sensitivity and specificity in terms of MS.
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Affiliation(s)
- Frederike C Oertel
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Hanna G Zimmermann
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Alexander U Brandt
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,b Department of Neurology , University of California Irvine , Irvine , CA , USA
| | - Friedemann Paul
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,c Department of Neurology , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,d Experimental and Clinical Research Center , Max-Delbrück-Centrum für Molekulare Medizin and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
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15
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Rasche L, Paul F. Ozanimod for the treatment of relapsing remitting multiple sclerosis. Expert Opin Pharmacother 2018; 19:2073-2086. [PMID: 30407868 DOI: 10.1080/14656566.2018.1540592] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Ozanimod is a selective sphingosine 1-phosphate receptor 1 and 5 modulator under development by Celgene, for the treatment of relapsing remitting multiple sclerosis. Extensive clinical experience has become available for the related compound fingolimod, favoring the sphingosine 1-phosphate therapeutic concept. Off-target effects have been attributed to its low receptor specificity and have prompted the development of next generation sphingosine 1-phosphate receptor modulators. Areas covered: The authors evaluate the literature of ozanimod, using the PubMed database as well as repositories of the European Committee for Treatment and Research in Multiple Sclerosis and the American and European Academy of Neurology. Specifically, the authors cover and discuss the preclinical data on ozanimod, pharmacokinetics and dynamics, and data on efficacy and safety from the pivotal trials. Expert opinion: Superiority of ozanimod over intramuscular interferon β-1a with regard to reduction in annualized relapse rate and magnetic resonance imaging outcomes has been shown in two phase III trials. The beneficial effect on brain volume and gray matter loss are encouraging and in line with data on other newer immunomodulators. Ozanimod is a valuable contribution to the therapeutic armamentarium in MS, although the effect on disability progression is unclear and requires further investigations.
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Affiliation(s)
- Ludwig Rasche
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health , Berlin , Germany
| | - Friedemann Paul
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health , Berlin , Germany.,b Experimental and Clinical Research Center , Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health , Berlin , Germany.,c Department of Neurology , Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
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16
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Houtchens MK, Edwards NC, Schneider G, Stern K, Phillips AL. Pregnancy rates and outcomes in women with and without MS in the United States. Neurology 2018; 91:e1559-e1569. [PMID: 30266889 PMCID: PMC6205683 DOI: 10.1212/wnl.0000000000006384] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To compare pregnancy prevalence and complications in women with and without multiple sclerosis (MS). METHODS This retrospective US administrative claims study used data from January 1, 2006, to June 30, 2015. All data for women with MS were included. A nationally representative 5% random sample from approximately 58 million women without MS was used to compute the dataset. Annual pregnancy rates, identified via diagnosis/procedure codes and adjusted for covariates, were estimated via logistic regression. Claims for pregnancy and labor/delivery complications were compared using propensity score matching. RESULTS From 2006 to 2014, the adjusted proportion of women with MS and pregnancy increased from 7.91% to 9.47%; the adjusted proportion without MS and with pregnancy decreased from 8.83% to 7.75%. The difference in linear trend (0.17% increase and 0.15% decrease in per-annum pregnancy rates) was significant (t statistic = 7.8; p < 0.0001). After matching (n = 2,115 per group), a higher proportion of women with MS than without had claims for premature labor (31.4% vs 27.4%; p = 0.005), infection (13.3% vs 10.9%; p = 0.016), cardiovascular disease (3.0% vs 1.9%; p = 0.028), anemia/acquired coagulation disorders (2.5% vs 1.3%; p = 0.007), neurologic complications (1.6% vs 0.6%; p = 0.005), sexually transmitted diseases (0.4% vs 0.1%; p = 0.045), acquired fetal damage (27.8% vs 23.5%; p = 0.002), and congenital fetal malformations (13.2% vs 10.3%; p = 0.004). CONCLUSIONS Pregnancy rates in this population of women with MS have been increasing. High rates of claims for several peripartum complications were observed in women with and those without MS. Claims data provide knowledge of interactions patients have with the health care system and are valuable initial exploratory analyses.
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Affiliation(s)
- Maria K Houtchens
- From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; formerly with Boston Health Economics, Inc. (G.S.), Waltham; Boston Health Economics (K.S.), Waltham; and EMD Serono, Inc. (A.L.P.), Rockland, MA.
| | - Natalie C Edwards
- From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; formerly with Boston Health Economics, Inc. (G.S.), Waltham; Boston Health Economics (K.S.), Waltham; and EMD Serono, Inc. (A.L.P.), Rockland, MA
| | - Gary Schneider
- From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; formerly with Boston Health Economics, Inc. (G.S.), Waltham; Boston Health Economics (K.S.), Waltham; and EMD Serono, Inc. (A.L.P.), Rockland, MA
| | - Kevin Stern
- From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; formerly with Boston Health Economics, Inc. (G.S.), Waltham; Boston Health Economics (K.S.), Waltham; and EMD Serono, Inc. (A.L.P.), Rockland, MA
| | - Amy L Phillips
- From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; formerly with Boston Health Economics, Inc. (G.S.), Waltham; Boston Health Economics (K.S.), Waltham; and EMD Serono, Inc. (A.L.P.), Rockland, MA
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17
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Borisow N, Hellwig K, Paul F. Neuromyelitis optica spectrum disorders and pregnancy: relapse-preventive measures and personalized treatment strategies. EPMA J 2018; 9:249-256. [PMID: 30174761 PMCID: PMC6107451 DOI: 10.1007/s13167-018-0143-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/11/2018] [Indexed: 12/19/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that predominately affect women. Some of these patients are of childbearing age at NMOSD onset. This study reviews, on the one hand, the role NMOSD play in fertility, pregnancy complications and pregnancy outcome, and on the other, the effect of pregnancy on NMOSD disease course and treatment options available during pregnancy. Animal studies show lower fertility rates in NMOSD; however, investigations into fertility in NMOSD patients are lacking. Pregnancies in NMOSD patients are associated with increased disease activity and more severe disability postpartum. Some studies found higher risks of pregnancy complications, e.g., miscarriages and preeclampsia. Acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. A decision to either stop or continue immunosuppressive therapy with azathioprine or rituximab during pregnancy should be evaluated carefully and factor in the patient's history of disease activity. To this end, involving neuroimmunological specialist centers in the treatment and care of pregnant NMOSD patients is recommended, particularly in specific situations like pregnancy.
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Affiliation(s)
- Nadja Borisow
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Kerstin Hellwig
- Clinic for Neurology, St. Josef Hospital, Ruhr Universität Bochum, Bochum, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
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18
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Houtchens MK, Bove R. A case for gender-based approach to multiple sclerosis therapeutics. Front Neuroendocrinol 2018; 50:123-134. [PMID: 30040969 DOI: 10.1016/j.yfrne.2018.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
Despite established sex differences in multiple sclerosis (MS) risk and course, sex-specific efficacy and toxicity of existing MS therapies, and possible sex-specific therapeutic approaches, remain underexplored. We systematically reviewed published sex differences from Phase III pivotal trials for FDA or EMA-approved MS disease modifying therapies (DMTs), along with additional information from pharmaceutical companies, for pre-specified or post-hoc baseline characteristics, efficacy and safety outcomes by sex, and sex-specific concerns. Then, we reviewed trials testing hormonal therapies in MS. None of the Phase III clinical trials performed baseline sex-specific analyses or were powered to evaluated DMTs in menopausal/older populations. Some recent trials performed pre-specified or post-hoc stratification of outcomes by sex. Sex-specific hormonal intervention trials were limited. Adequately powered, pre-specified analyses accounting for baseline sex and age are required to maximize safety and efficacy in specific patient populations.
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Affiliation(s)
- Maria K Houtchens
- Women's Health Program, Partners MS Center, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Riley Bove
- Weill Institute for the Neurosciences, Department of Neurology, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
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19
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Hoffmann F, Kraft A, Heigl F, Mauch E, Koehler J, Harms L, Kümpfel T, Köhler W, Ehrlich S, Bayas A, Weinmann-Menke J, Beuker C, Henn KH, Ayzenberg I, Ellrichmann G, Hellwig K, Klingel R, Fassbender CM, Fritz H, Slowinski T, Weihprecht H, Brand M, Stiegler T, Galle J, Schimrigk S. Tryptophan immunoadsorption during pregnancy and breastfeeding in patients with acute relapse of multiple sclerosis and neuromyelitis optica. Ther Adv Neurol Disord 2018; 11:1756286418774973. [PMID: 29872456 PMCID: PMC5974561 DOI: 10.1177/1756286418774973] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/20/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Up to every fourth woman with multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD) suffers a clinically relevant relapse during pregnancy. High doses of steroids bear some serious risks, especially within the first trimester of pregnancy. Immunoadsorption (IA) is an effective and more selective treatment option in disabling MS relapse than plasma exchange. Data on the use of IA during pregnancy and breastfeeding are scarce. METHODS In this retrospective multicenter study, we analyzed the safety and efficacy of IA treatment in acute relapses during pregnancy or breastfeeding. The primary outcome parameter - change of acute relapse-related disability after IA - was assessed using Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON). RESULTS A total of 24 patients were analyzed, 23 with relapsing-remitting MS, and 1 with NMOSD. Twenty patients were treated with IA during pregnancy. Four patients received IA postnatally during the breastfeeding period. Treatment was started at a mean 22.5 [standard deviation (SD) 13.9] days after onset of relapse. Patients were treated with a series of 5.8 (mean, SD 0.7) IA treatments within 7-10 days. Sixteen patients received IA because of steroid-refractory relapse, eight were treated without preceding steroid pulse therapy. EDSS improved clinically relevant from 3.5 [median, interquartile range (IQR) 2] before IA to 2.5 (median, IQR 1.1) after IA, p < 0.001. In patients with ON, VA improved in four out of five patients. Altogether, in 83% of patients, a rapid and marked improvement of relapse-related symptoms was observed after IA with either a decrease of ⩾1 EDSS grade or improvement in VA ⩾20%. No clinically relevant side effect was reported in 138 IA treatments. CONCLUSIONS Tryptophan-IA was found to be effective and well tolerated in MS/NMOSD relapses, both as an escalation option after insufficient response to steroid pulse therapy and as first-line relapse treatment during pregnancy and breastfeeding.
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Affiliation(s)
- Frank Hoffmann
- Department of Neurology, Martha-Maria Hospital, Halle/Saale, Academic, Hospital of University, Halle-Wittenberg, Röntgenstraße 1, D-06120 Halle (Saale), Germany
| | - Andrea Kraft
- Department of Neurology Martha-Maria Hospital, Halle/Saale, Academic Hospital of University Halle-Wittenberg, Germany
| | - Franz Heigl
- Medical Care Center Kempten-Allgäu, Kempten, Germany
| | - Erich Mauch
- Clinic for Neurology Dietenbronn, Academic Hospital of University of Ulm, Schwendi, Germany
| | - Jürgen Koehler
- Marianne-Strauss-Hospital, Multiple Sclerosis Center Kempfenhausen, Berg, Germany
| | - Lutz Harms
- Departments of Neurology Charité University Medicine Berlin, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Munich, Germany
| | - Wolfgang Köhler
- Clinic for Neurology and Neurological Intensive Care Medicine, Hubertusburg Hospital, Wermsdorf, Germany
| | - Sven Ehrlich
- Clinic for Neurology and Neurological Intensive Care Medicine, Hubertusburg Hospital, Wermsdorf, Germany
| | - Antonios Bayas
- Department of Neurology, General Hospital Augsburg, Germany
| | - Julia Weinmann-Menke
- Department of Nephrology, Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | | | | | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Gisa Ellrichmann
- Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany
| | | | | | - Harald Fritz
- Department of Anaesthesiology and Intensive Care Medicine, Martha-Maria Hospital, Halle/Saale, Germany
| | - Torsten Slowinski
- Department of Nephrology, Charité University Medicine, Berlin, Germany
| | | | - Marcus Brand
- Department of Nephrology, University of Münster, Germany
| | - Thomas Stiegler
- Clinic of Internal Medicine III, Sana Clinic, Offenbach, Germany
| | - Jan Galle
- Department of Nephrology, General Hospital Lüdenscheid, Märkische Kliniken GmbH, Germany
| | - Sebastian Schimrigk
- Department of Neurology, General Hospital Lüdenscheid, Märkische Kliniken GmbH, Germany
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Frau J, Coghe G, Casanova P, Sardu C, Lorefice L, Fenu G, Marrosu MG, Cocco E. Pregnancy planning and outcomes in patients with multiple sclerosis after mitoxantrone therapy: a monocentre assessment. Eur J Neurol 2018; 25:1063-1068. [DOI: 10.1111/ene.13650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/22/2018] [Indexed: 01/21/2023]
Affiliation(s)
- J. Frau
- Multiple Sclerosis Center Department of Medical Sciences and Public Health University of Cagliari Cagliari
| | - G. Coghe
- Multiple Sclerosis Center Department of Medical Sciences and Public Health University of Cagliari Cagliari
| | - P. Casanova
- Multiple Sclerosis Center Department of Medical Sciences and Public Health University of Cagliari Cagliari
| | - C. Sardu
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | - L. Lorefice
- Multiple Sclerosis Center Department of Medical Sciences and Public Health University of Cagliari Cagliari
| | - G. Fenu
- Multiple Sclerosis Center Department of Medical Sciences and Public Health University of Cagliari Cagliari
| | - M. G. Marrosu
- Multiple Sclerosis Center Department of Medical Sciences and Public Health University of Cagliari Cagliari
| | - E. Cocco
- Multiple Sclerosis Center Department of Medical Sciences and Public Health University of Cagliari Cagliari
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21
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Evaluation of reproductive health in female patients with multiple sclerosis in Polish population. J Clin Neurosci 2018; 53:117-121. [PMID: 29685406 DOI: 10.1016/j.jocn.2018.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/09/2018] [Indexed: 11/20/2022]
Abstract
Multiple sclerosis (MS) is a chronic disease, which affects mostly women and has an early onset. Due to progress in treatment patients maintain a high quality of life for a long period and participate in all of its fields. One of them is reproductive health with all of its aspects. The aim of the study was to evaluate the reproductive health of female MS patients with regard to various features of MS. It was a cross-sectional study. The data was collected via anonymous survey distributed among patients with MS hospitalized at the Department of Neurology, Medical University of Warsaw and online. The study group consisted of 218 women diagnosed with MS. The survey consisted of demographic questions, questions assessing features of MS, reproductive health, sexual performance and psychological comorbidities, including depression and fatigue. 53.01% of MS patients declared interest in maternity. Patients interested in pregnancy were significantly younger (p < .01), often nulliparous (p < .001), had lower EDSS score (p < .006) and lower motor deficit (p < .001). History of at least one labour (p < .02) had a negative impact on the frequency of gynaecologic admissions. More advanced age (p < .003), unemployment (p < .01), at least one labour (p < .043), stronger balance problems (p < .003) and more intense motor deficit (p < .002) were related to less frequent Pap smears. Reproductive health of women with MS is similar to that of background population. Therefore, the general gynaecological care in those women should not be neglected.
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22
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Borisow N, Hellwig K, Paul F. [Neuromyelitis optica spectrum disorder and pregnancy]. DER NERVENARZT 2018; 89:666-673. [PMID: 29383411 DOI: 10.1007/s00115-018-0486-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that mainly affect women. In some of these patients NMOSD occurs during fertile age. For this reason, treating physicians may be confronted with questions concerning family planning, pregnancy and birth. OBJECTIVE This study provides an overview on the influence of NMOSD on fertility, pregnancy complications and pregnancy outcome. The effect of pregnancy on NMOSD course and therapy options during pregnancy are discussed. MATERIAL AND METHODS A search of the current literature was carried out using the PubMed database. RESULTS AND CONCLUSION Animal studies have shown lower fertility rates in NMOSD; however, studies investigating fertility in NMOSD patients are lacking. Pregnancy in NMOSD patients are associated with an increase in postpartum disease activity and a higher grade of disability after pregnancy. Some studies showed higher risks of pregnancy complications e. g. spontaneous abortions and preeclampsia. With a few limitations, acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. Stopping or continuing immunosuppressive therapy with azathioprine or rituximab during pregnancy should be critically weighed considering previous and current disease activity. Therefore, a joint supervision by a specialized center is recommended, particularly in specific situations such as pregnancy.
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Affiliation(s)
- N Borisow
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - K Hellwig
- Klinik für Neurologie, St. Josef Hospital, Ruhr Universität Bochum, Bochum, Deutschland
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Koduah P, Paul F, Dörr JM. Vitamin D in the prevention, prediction and treatment of neurodegenerative and neuroinflammatory diseases. EPMA J 2017; 8:313-325. [PMID: 29209434 PMCID: PMC5700019 DOI: 10.1007/s13167-017-0120-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/18/2017] [Indexed: 12/14/2022]
Abstract
Vitamin D research has gained increased attention in recent times due to its roles beyond bone health and calcium homeostasis, such as immunomodulation. In some parts of the brain and on immune cells, vitamin D hydroxylating enzymes and its receptors are located. Epidemiological evidence demonstrates that deficiency of Vitamin D is relevant for disease risk and course in multiple sclerosis (MS) and presumably also in neuromyelitis optica spectrum disorders (NMOSD), Parkinson's disease (PD), and Alzheimer's disease (AD). Although the exact mechanism underlying vitamin D effects in these diseases remains widely unexplored, human and animal studies continue to provide some hints. While the majority of vitamin D researchers so far speculate that vitamin D may be involved in disease pathogenesis, others could not show any association although none have reported that sufficient vitamin D worsens disease progression. The studies presented in this review suggest that whether vitamin D may have beneficial effects in disease course or not, may be dependent on factors such as ethnicity, gender, diet, vitamin D receptor (VDR) polymorphisms and sunlight exposure. We here review the possible role of vitamin D in the pathogenesis and disease course of MS, NMOSD, PD, and AD and potential therapeutic effects of vitamin D supplementation which may be relevant for predictive, preventive, and personalized medicine. We suggest areas to consider in vitamin D research for future studies and recommend the need to supplement patients with low vitamin D levels below 30 ng/ml to at least reach sufficient levels.
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Affiliation(s)
- Priscilla Koduah
- Charité – Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt- Universitäts zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany
| | - Friedemann Paul
- Charité – Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan-Markus Dörr
- Charité – Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt- Universitäts zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, and Multiple Sclerosis Center Hennigsdorf, Oberhavel Clinics, Berlin, Germany
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24
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Ferraro D, Simone AM, Adani G, Vitetta F, Mauri C, Strumia S, Senesi C, Curti E, Baldi E, Santangelo M, Montepietra S, Immovilli P, Guareschi A, Neri W, Granella F, Caniatti L, Tola MR, Motti L, Pesci I, Montanari E, Sola P. Definitive childlessness in women with multiple sclerosis: a multicenter study. Neurol Sci 2017; 38:1453-1459. [DOI: 10.1007/s10072-017-2999-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/12/2017] [Indexed: 11/29/2022]
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25
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Fong A, Chau CT, Quant C, Duffy J, Pan D, Ogunyemi DA. Multiple sclerosis in pregnancy: prevalence, sociodemographic features, and obstetrical outcomes. J Matern Fetal Neonatal Med 2017; 31:382-387. [PMID: 28139946 DOI: 10.1080/14767058.2017.1286314] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We sought to describe the prevalence, sociodemographic features, and antenatal/peripartum outcomes of multiple sclerosis (MS) in pregnancy. STUDY DESIGN A retrospective cohort study was performed using deliveries in California from 2001 to 2009. Cases of MS as well as other morbidities were identified via ICD-9-CM code. Logistic regression was performed to adjust for potential confounders. RESULTS About 1185 out of 4,424,049 deliveries were complicated by MS. MS prevalence increased with maternal age, with Caucasians comprising a higher proportion of MS subjects. MS subjects were older and more likely to have private insurance. Women with MS were more likely to have preexisting medical conditions such as asthma, chronic hypertension, thyroid disease, or cardiac disease. However, no significant antepartum and peripartum morbidities were found to be increased in patients with MS. Urinary tract infection, cesarean delivery, and induction of labor were slightly increased in MS patients. CONCLUSIONS MS is a rare condition which is more likely to affect older Caucasian women of higher socioeconomic status and is associated with several preexisting medical conditions. MS, however, does not appear to pose significant increases in adverse pregnancy outcome. This suggests that pregnant patients with MS may likely experience an uneventful pregnancy.
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Affiliation(s)
- Alex Fong
- a Department of Obstetrics and Gynecology , Memorial Care Center for Women at Miller Children's Hospital Long Beach , Long Beach , CA , USA
| | - Cindy T Chau
- b Department of Obstetrics and Gynecology , University of California , Irvine, Orange , CA, USA
| | - Cara Quant
- c Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Jennifer Duffy
- b Department of Obstetrics and Gynecology , University of California , Irvine, Orange , CA, USA
| | - Deyu Pan
- d Charles Drew University of Medicine and Science, Center for Health Services Research , Los Angeles , CA , USA
| | - Dotun A Ogunyemi
- e Oakland University, William Beaumont School of Medicine , Rochester , MI , USA
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26
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Veauthier C, Hasselmann H, Gold SM, Paul F. The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue. EPMA J 2016; 7:25. [PMID: 27904656 PMCID: PMC5121967 DOI: 10.1186/s13167-016-0073-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/21/2016] [Indexed: 12/11/2022]
Abstract
More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.
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Affiliation(s)
- Christian Veauthier
- Interdisciplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Helge Hasselmann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany ; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany ; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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27
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Abstract
Following the introduction of interferon beta 1b as the first immunomodulatory therapy for multiple sclerosis (MS) in 1993, there are currently nine substances or substance classes approved for the treatment of MS (i.e. alemtuzumab, azathioprine, dimethyl fumarate, fingolimod, glatiramer acetate, interferon beta, mitoxantrone, natalizumab and teriflunomide). Major developments during the last 5 years include the approval of orally administered medications (i.e. fingolimod, teriflunomide and dimethyl fumarate), a monoclonal antibody (alemtuzumab), as well as glatiramer acetate with an administration frequency three times a week and a pegylated formulation of interferon beta 1a. The broadened therapeutic options enable a more differentiated and individualized therapy of MS; however, evidence-based data for therapeutic decision-making relevant in clinical practice are not always available. Rare but potentially severe and even life-threatening side effects of immunotherapies for MS require continuous pharmacovigilance and adherence to risk management plans.
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28
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Bove R, McHenry A, Hellwig K, Houtchens M, Razaz N, Smyth P, Tremlett H, Sadovnick AD, Rintell D. Multiple sclerosis in men: management considerations. J Neurol 2016; 263:1263-73. [DOI: 10.1007/s00415-015-8005-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 01/28/2023]
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29
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Altintas A, Najar B, Gozubatik-Celik G, Menku SF. Pregnancy Data in a Turkish Multiple Sclerosis Population. Eur Neurol 2015; 74:296-302. [PMID: 26656283 DOI: 10.1159/000441450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND To conduct the first retrospective clinical study investigating pregnancy in Turkish multiple sclerosis (MS) patients. SUMMARY We evaluated 558 pregnancies in 199 MS patients and results were compared with general Turkish population's data. The fertility rate in the MS group was found to be lower than that in the general population, even before MS diagnosis was established. Our study suggests that the higher number of pregnancies may have a favorable effect on transition from relapsing-remitting MS to secondary progressive MS, although no effect has been shown regarding the possibility to reach EDSS 6.0 as a milestone. KEY MESSAGES Our data support the conclusion that MS does not have a negative effect on the MS course and disability.
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Affiliation(s)
- Ayse Altintas
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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30
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Sinnecker T, Kuchling J, Dusek P, Dörr J, Niendorf T, Paul F, Wuerfel J. Ultrahigh field MRI in clinical neuroimmunology: a potential contribution to improved diagnostics and personalised disease management. EPMA J 2015; 6:16. [PMID: 26312125 PMCID: PMC4549950 DOI: 10.1186/s13167-015-0038-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/20/2015] [Indexed: 12/29/2022]
Abstract
Conventional magnetic resonance imaging (MRI) at 1.5 Tesla (T) is limited by modest spatial resolution and signal-to-noise ratio (SNR), impeding the identification and classification of inflammatory central nervous system changes in current clinical practice. Gaining from enhanced susceptibility effects and improved SNR, ultrahigh field MRI at 7 T depicts inflammatory brain lesions in great detail. This review summarises recent reports on 7 T MRI in neuroinflammatory diseases and addresses the question as to whether ultrahigh field MRI may eventually improve clinical decision-making and personalised disease management.
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Affiliation(s)
- Tim Sinnecker
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Department of Neurology, Asklepios Fachklinikum Teupitz, Buchholzer Str. 21, 15755 Teupitz, Germany
| | - Joseph Kuchling
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Petr Dusek
- Institute of Neuroradiology, Universitaetsmedizin Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany.,Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Kateřinská 30, 128 21 Praha 2, Czech Republic
| | - Jan Dörr
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine, Robert-Roessle-Strasse 10, 13125 Berlin, Germany.,Experimental and Clinical Research Center, Charité - Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Robert-Roessle-Strasse 10, 13125 Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Experimental and Clinical Research Center, Charité - Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Robert-Roessle-Strasse 10, 13125 Berlin, Germany.,Department of Neurology, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Institute of Neuroradiology, Universitaetsmedizin Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany.,Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine, Robert-Roessle-Strasse 10, 13125 Berlin, Germany.,Medical Image Analysis Center, Mittlere Strasse 83, CH-4031 Basel, Switzerland
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31
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D’Amico E, Leone C, Caserta C, Patti F. Oral drugs in multiple sclerosis therapy: an overview and a critical appraisal. Expert Rev Neurother 2015; 15:803-24. [DOI: 10.1586/14737175.2015.1058162] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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32
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Golubnitschaja O, Costigliola V. EPMA summit 2014 under the auspices of the presidency of Italy in the EU: professional statements. EPMA J 2015; 6:4. [PMID: 25878761 PMCID: PMC4397737 DOI: 10.1186/s13167-015-0026-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/04/2015] [Indexed: 01/02/2023]
Abstract
Over the next 10-20 years, a pessimistic prognosis considers pandemic scenario for type 2 diabetes mellitus, neurodegenerative disorders and some types of cancer followed by the economic disaster of healthcare systems in a global scale. Well-recognised deficits of currently provided medical services result from the delayed 'disease care'. Herewith EPMA releases the long-term strategies for the effective promotion of predictive, preventive and personalised medicine (PPPM) considered as the medicine of the future. Under the EPMA-umbrella, an international forum of currently 45 countries is actively contributing to the development and implementation of the innovative PPPM concepts. EPMA is open for collaboration with other leading European and global professional networks relevant for the effective promotion of PPPM in sciences and practical implementation.
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Affiliation(s)
- Olga Golubnitschaja
- Department of Radiology, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany ; The European Association for Predictive, Preventive and Personalised Medicine, 1150 Brussels, Belgium
| | - Vincenzo Costigliola
- The European Association for Predictive, Preventive and Personalised Medicine, 1150 Brussels, Belgium
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Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstet Gynecol 2015; 124:1157-1168. [PMID: 25415167 DOI: 10.1097/aog.0000000000000541] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine the evidence guiding management of multiple sclerosis (MS) in reproductive-aged women. DATA SOURCES We conducted an electronic literature search using PubMed, ClinicalTrials.gov, and other available resources. The following keywords were used: "multiple sclerosis" and "pregnancy." We manually searched the reference lists of identified studies. METHODS OF STUDY SELECTION Two reviewers categorized all studies identified in the search by management topic, including effect of pregnancy on MS course, fetal risks associated with disease-modifying treatments during pregnancy, and management of patients off disease-modifying treatment. We categorized studies by strength of evidence and included prior meta-analyses and systematic studies. These studies were then summarized and discussed by an expert multidisciplinary team. TABULATION, INTEGRATION, AND RESULTS The risk of MS relapses is decreased during pregnancy and increased postpartum. Data are lacking regarding the risks of disease-modifying treatments during pregnancy. There may be an increased risk of MS relapses after use of assisted reproductive techniques. There does not appear to be a major increase in adverse outcomes in newborns of mothers with MS. CONCLUSION Although there are many unmet research needs, the reviewed data support the conclusion that in the majority of cases, women with MS can safely choose to become pregnant, give birth, and breastfeed children. Clinical management should be individualized to optimize both the mother's reproductive outcomes and MS course.
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Borisow N, Paul F, Dörr J. Optimal management of multiple sclerosis during pregnancy: current perspectives. Degener Neurol Neuromuscul Dis 2014; 4:111-120. [PMID: 32669905 PMCID: PMC7337198 DOI: 10.2147/dnnd.s48618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/06/2014] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a common inflammatory demyelinating disorder of the central nervous system. It frequently affects females in their reproductive phase of life. Therefore, family planning, pregnancy, and breastfeeding are important issues in the management of MS, particularly with respect to counseling and drug treatment. This paper reviews currently available data on the outcome of pregnancies in MS patients and the influence of pregnancy on the course of the disease. We give an update on the use of various disease-modifying MS drugs during pregnancy and breastfeeding. In addition to established therapies such as interferon-β, glatiramer acetate, natalizumab, and fingolimod, we also discuss the state of knowledge about new agents such as dimethyl fumarate, teriflunomide, and alemtuzumab in the context of pregnancy and breastfeeding.
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Affiliation(s)
- Nadja Borisow
- NeuroCure Clinical Research Center and Clinical and Experimental Research Center for Multiple Sclerosis, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Research Center for Multiple Sclerosis, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Dörr
- NeuroCure Clinical Research Center and Clinical and Experimental Research Center for Multiple Sclerosis, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Borisow N, Paul F, Ohlraun S, Pach D, Fischer F, Dörr J. Pregnancy in multiple sclerosis: a questionnaire study. PLoS One 2014; 9:e99106. [PMID: 24901447 PMCID: PMC4047092 DOI: 10.1371/journal.pone.0099106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/10/2014] [Indexed: 11/30/2022] Open
Abstract
Background Multiple sclerosis (MS) preferentially affects females at childbearing age. For this reason patients and treating physicians were frequently confronted with questions concerning family planning, pregnancy and birth. Objective The aim of this study was to evaluate the expertise about pregnancy related topics in multiple sclerosis of neurologists in private practice. Methods We developed a survey with 16 multiple choice questions about pregnancy related topics and sent it to neurologists in private practice in Berlin, Germany. Results 56 completed questionnaires were sent back. 54% of all questions were answered correctly, 21% of the questions were answered with “I don’t know”. Correct answers were more often given by physicians who treat more than 400 MS patients per year (p = 0.001). Further positive associations were found for assumed relevance of the topic (p = 0.002) and the degree of counseling (p<0.001). Conclusion To provide a comprehensive counseling, MS patients with desire for children should be counseled by physicians with a lot of experience in MS treatment.
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Affiliation(s)
- Nadja Borisow
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Ohlraun
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Pach
- Institute for Social Medicine, Epidemiology and Health Economics Charité, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Fischer
- Institute for Social Medicine, Epidemiology and Health Economics Charité, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychosomatic Medicine, Clinic for Internal Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Dörr
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Behrens J, Pfüller C, Mansow-Model S, Otte K, Paul F, Brandt AU. Using perceptive computing in multiple sclerosis - the Short Maximum Speed Walk test. J Neuroeng Rehabil 2014; 11:89. [PMID: 24886525 PMCID: PMC4041903 DOI: 10.1186/1743-0003-11-89] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 05/22/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We investigated the applicability and feasibility of perceptive computing assisted gait analysis in multiple sclerosis (MS) patients using Microsoft Kinect™. To detect the maximum walking speed and the degree of spatial sway, we established a computerized and observer-independent measure, which we named Short Maximum Speed Walk (SMSW), and compared it to established clinical measures of gait disability in MS, namely the Expanded Disability Status Scale (EDSS) and the Timed 25-Foot Walk (T25FW). METHODS Cross-sectional study of 22 MS patients (age mean ± SD 43 ± 9 years, 13 female) and 22 age and gender matched healthy control subjects (HC) (age 37 ± 11 years, 13 female). The disability level of each MS patient was graded using the EDSS (median 3.0, range 0.0-6.0). All subjects then performed the SMSW and the Timed 25-Foot Walk (T25FW). The SMSW comprised five gait parameters, which together assessed average walking speed and gait stability in different dimensions (left/right, up/down and 3D deviation). RESULTS SMSW average walking speed was slower in MS patients (1.6 ± 0.3 m/sec) than in HC (1.8 ± 0.4 m/sec) (p = 0.005) and correlated well with EDSS (Spearman's Rho 0.676, p < 0.001). Furthermore, SMSW revealed higher left/right deviation in MS patients compared to HC. SMSW showed high recognition quality and retest-reliability (covariance 0.13 m/sec, ICC 0.965, p < 0.001). There was a significant correlation between SMSW average walking speed and T25FW (Pearson's R = -0.447, p = 0.042). CONCLUSION Our data suggest that ambulation tests using Microsoft Kinect™ are feasible, well tolerated and can detect clinical gait disturbances in patients with MS. The retest-reliability was on par with the T25FW.
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Affiliation(s)
| | | | | | | | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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Ghezzi A, Annovazzi P, Portaccio E, Cesari E, Amato MP. Current recommendations for multiple sclerosis treatment in pregnancy and puerperium. Expert Rev Clin Immunol 2014; 9:683-91; quiz 692. [PMID: 23899239 DOI: 10.1586/1744666x.2013.811046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
As multiple sclerosis (MS) typically starts at about 30 years of age, and is twice more frequent in females than in males, women with MS frequently face issues related to pregnancy and to the effects of medications commonly used in MS treatment. In this review, the authors provide and summarize literature data addressing the effect of MS and its treatments on pregnancy, delivery, postpartum and conception. There is a strong evidence that relapses are fewer during pregnancy but more frequent during postpartum, and that IFN-β and glatiramer acetate do not expose patients and their babies to relevant adverse events; nevertheless, these drugs should be discontinued during pregnancy and before conception. However, if their preventive withdrawal exposes patients to a high risk of disease activity, these medications could be continued until proven conception. Little information is available on the effect of natalizumab and fingolimod.
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Affiliation(s)
- Angelo Ghezzi
- UO Neurologia 2 - Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013 Gallarate, Italy.
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Veauthier C, Paul F. Sleep disorders in multiple sclerosis and their relationship to fatigue. Sleep Med 2014; 15:5-14. [DOI: 10.1016/j.sleep.2013.08.791] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/14/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
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Lu E, Wang BW, Guimond C, Synnes A, Sadovnick AD, Dahlgren L, Traboulsee A, Tremlett H. Safety of disease-modifying drugs for multiple sclerosis in pregnancy: current challenges and future considerations for effective pharmacovigilance. Expert Rev Neurother 2013; 13:251-60; quiz 261. [PMID: 23448215 DOI: 10.1586/ern.13.12] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
When contemplating a pregnancy, women treated for multiple sclerosis (MS) with a disease-modifying drug must decide to discontinue their medication before conception or risk exposing their unborn child to potential drug toxicity. Few studies exist as reference for patients and physicians, and of those available, the majority are less than ideal due to real-world constraints, ethical issues and methodological shortcomings. The authors provide a brief summary of existing animal and human data with current recommendations regarding the safety of IFN-β, glatiramer acetate, natalizumab, mitoxantrone, fingolimod and teriflunomide during pregnancy and lactation in women with MS. We also assess the quality, strengths and limitations of the existing studies including challenges with study design. The investigation of outcomes such as spontaneous abortion and congenital anomalies are highlighted with potential methodological improvements for future studies on drug safety in pregnancy suggested. The authors explore the pharmacokinetics and pharmacodynamics of the MS disease-modifying drugs for their possible mechanistic role in fetal harm and discuss the potential role of clinical trials. Future pharmacovigilance studies should continue to pursue multicenter collaboration with an emphasis on appropriate study design.
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Affiliation(s)
- Ellen Lu
- Department of Medicine, Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Mähler A, Mandel S, Lorenz M, Ruegg U, Wanker EE, Boschmann M, Paul F. Epigallocatechin-3-gallate: a useful, effective and safe clinical approach for targeted prevention and individualised treatment of neurological diseases? EPMA J 2013; 4:5. [PMID: 23418936 PMCID: PMC3585739 DOI: 10.1186/1878-5085-4-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/25/2013] [Indexed: 12/12/2022]
Abstract
Neurodegenerative disorders show an increasing prevalence in a number of highly developed countries. Often, these diseases require life-long treatment mostly with drugs which are costly and mostly accompanied by more or less serious side-effects. Their heterogeneous manifestation, severity and outcome pose the need for individualised treatment options. There is an intensive search for new strategies not only for treating but also for preventing these diseases. Green tea and green tea extracts seem to be such a promising and safe alternative. However, data regarding the beneficial effects and possible underlying mechanism, specifically in clinical trials, are rare and rather controversial or non-conclusive. This review outlines the existing evidence from preclinical studies (cell and tissue cultures and animal models) and clinical trials regarding preventive and therapeutic effects of epigallcatechin-3-gallate in neurodegenerative diseases and considers antioxidative vs. pro-oxidative properties of the tea catechin important for dosage recommendations.
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Affiliation(s)
- Anja Mähler
- Experimental and Clinical Research Center, a joint cooperation between the Charité University Medicine Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, D-13125, Germany.
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Dörr J, Döring A, Paul F. Can we prevent or treat multiple sclerosis by individualised vitamin D supply? EPMA J 2013; 4:4. [PMID: 23356351 PMCID: PMC3564873 DOI: 10.1186/1878-5085-4-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/09/2013] [Indexed: 12/31/2022]
Abstract
Apart from its principal role in bone metabolism and calcium homeostasis, vitamin D has been attributed additional effects including an immunomodulatory, anti-inflammatory, and possibly even neuroprotective capacity which implicates a possible role of vitamin D in autoimmune diseases like multiple sclerosis (MS). Indeed, several lines of evidence including epidemiologic, preclinical, and clinical data suggest that reduced vitamin D levels and/or dysregulation of vitamin D homeostasis is a risk factor for the development of multiple sclerosis on the one hand, and that vitamin D serum levels are inversely associated with disease activity and progression on the other hand. However, these data are not undisputable, and many questions regarding the preventive and therapeutic capacity of vitamin D in multiple sclerosis remain to be answered. In particular, available clinical data derived from interventional trials using vitamin D supplementation as a therapeutic approach in MS are inconclusive and partly contradictory. In this review, we summarise and critically evaluate the existing data on the possible link between vitamin D and multiple sclerosis in light of the crucial question whether optimization of vitamin D status may impact the risk and/or the course of multiple sclerosis.
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Affiliation(s)
- Jan Dörr
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
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Pharmacogenomic update on multiple sclerosis: a focus on actual and new therapeutic strategies. THE PHARMACOGENOMICS JOURNAL 2012; 12:453-61. [PMID: 23044601 DOI: 10.1038/tpj.2012.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Multiple sclerosis (MS) is an inflammatory and demyelinating disease of central nervous system comprising several subtypes. Pharmacological treatment involves only few drugs. Among these, interferon beta (IFN-β) and glatiramer acetate were the most used. Although evidence supports the efficacy of these agents in treating MS symptoms, actual studies allowed to introduce new innovative drugs in clinical practice. Applying pharmacogenetic approach to MS, IFN-β and several other immune pathways were abundantly investigated. Numerous reports identified some promising therapy markers but only few markers have emerged as clinically useful. This may be partially due to differences in clinical and methodological criteria in the studies. Indeed, responder and non-responder definitions lack standardized clinical definition. The goal of this review is to treat advances in research on the pharmacogenetic markers of MS drugs and to highlight possible correlations between type of responses and genetic profile, with regard to clinical and methodological discrepancies in the studies.
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