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Ayzenberg I, Richter D, Henke E, Asseyer S, Paul F, Trebst C, Hümmert MW, Havla J, Kümpfel T, Ringelstein M, Aktas O, Wildemann B, Jarius S, Häußler V, Stellmann JP, Senel M, Klotz L, Pellkofer HL, Weber MS, Pawlitzki M, Rommer PS, Berthele A, Wernecke KD, Hellwig K, Gold R, Kleiter I. Pain, Depression, and Quality of Life in Neuromyelitis Optica Spectrum Disorder: A Cross-Sectional Study of 166 AQP4 Antibody-Seropositive Patients. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/3/e985. [PMID: 34108267 PMCID: PMC8058953 DOI: 10.1212/nxi.0000000000000985] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/02/2021] [Indexed: 01/05/2023]
Abstract
Objectives To evaluate prevalence, clinical characteristics, and predictors of pain,
depression, and their impact on the quality of life (QoL) in a large
neuromyelitis optica spectrum disorder (NMOSD) cohort. Methods We included 166 patients with aquaporin-4–seropositive NMOSD from 13
tertiary referral centers. Patients received questionnaires on demographic
and clinical characteristics, PainDetect, short form of Brief Pain
Inventory, Beck Depression Inventory–II, and Short Form 36 Health
Survey. Results One hundred twenty-five (75.3%) patients suffered from chronic
NMOSD-associated pain. Of these, 65.9% had neuropathic pain, 68.8% reported
spasticity-associated pain and 26.4% painful tonic spasms. Number of
previous myelitis attacks (OR = 1.27, p = 0.018)
and involved upper thoracic segments (OR = 1.31, p
= 0.018) were the only predictive factors for chronic pain. The latter
was specifically associated with spasticity-associated pain (OR = 1.36,
p = 0.002). More than a third (39.8%) suffered
from depression, which was moderate to severe in 51.5%. Pain severity (OR
= 1.81, p < 0.001) and especially neuropathic
character (OR = 3.44, p < 0.001) were associated
with depression. Pain severity and walking impairment explained 53.9% of the
physical QoL variability, while depression and walking impairment 39.7% of
the mental QoL variability. No specific medication was given to 70.6% of
patients with moderate or severe depression and 42.5% of those with
neuropathic pain. Two-thirds (64.2%) of patients with symptomatic treatment
still reported moderate to severe pain. Conclusions Myelitis episodes involving upper thoracic segments are main drivers of pain
in NMOSD. Although pain intensity was lower than in previous studies, pain
and depression remain undertreated and strongly affect QoL. Interventional
studies on targeted treatment strategies for pain are urgently needed in
NMOSD.
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Affiliation(s)
- Ilya Ayzenberg
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Daniel Richter
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Eugenia Henke
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Susanna Asseyer
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Friedemann Paul
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Corinna Trebst
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Martin W Hümmert
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Joachim Havla
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Tania Kümpfel
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Marius Ringelstein
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Orhan Aktas
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Brigitte Wildemann
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Sven Jarius
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Vivien Häußler
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Jan-Patrick Stellmann
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Makbule Senel
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Luisa Klotz
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Hannah L Pellkofer
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Martin S Weber
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Marc Pawlitzki
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Paulus S Rommer
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Achim Berthele
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Klaus-Dieter Wernecke
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Kerstin Hellwig
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Ralf Gold
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Ingo Kleiter
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany.
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