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Lus G, Bassano MA, Brescia Morra V, Bonavita S, Gallo A, Maimone D, Malerba L, Maniscalco GT, Saccà F, Salemi G, Turrini R, Cottone S, Sessa E, Buccafusca M, Grimaldi LME. Unmet needs and gaps in the identification of secondary progression in multiple sclerosis: a Southern Italy healthcare professionals' perspective. Neurol Sci 2023; 44:45-58. [PMID: 36114980 PMCID: PMC9483292 DOI: 10.1007/s10072-022-06402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a chronic disease with different clinical courses and a tendency to worsening. The relapsing-remitting MS presents acute onset and relapses of neurological symptoms, followed by their remission. This form can convert to secondary progressive MS (SPMS) with irreversible neurological worsening and disability. The identification of signs, symptoms, markers of progression, and strategies to manage MS patients is mandatory to allow early identification of those at higher risk of conversion to SPMS, for prompt intervention to cope with the progression of the disease. METHODS A panel of Italian experts from Southern Italy have reviewed the current knowledge on MS and its management and identified the crucial tools for SPMS recognition. RESULTS More effective communication between patients and clinicians should be established, with the support of digital tools. Moreover, the improvement in the clinical use of biomarkers for progression (cellular structures and tissue organization, such as neurofilaments and chitinase 3-like 1, axonal and neurons density) and of instrumental analyses for recognition of whole-brain atrophy, chronic active lesions, spinal cord lesions and atrophy, and the improvement the combination of the Expanded Disability Status Scale and the evaluation of cognitive dysfunction are discussed. CONCLUSION Given the availability of a pharmacological option, adequate education both for patients, regarding the evolution of the disease and the specific treatment, and for professionals, to allow more effective and sensitive communication and the best use of diagnostic and management tools, could represent a strategy to improve patient management and their quality of life.
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Affiliation(s)
- Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, II Division of Neurology, Multiple Sclerosis Center, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Vincenzo Brescia Morra
- Department of Neurosciences Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, Università Della Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, Università Della Campania Luigi Vanvitelli, Naples, Italy
| | - Davide Maimone
- Unità Operativa Complessa Neurology, Multiple Sclerosis Center, ARNAS Garibaldi, Catania, Italy
| | | | | | - Francesco Saccà
- Department of Neurosciences Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Giuseppe Salemi
- UOC of Neurology and Multiple Sclerosis Center, DAI of Diagnostic and Interventistic Radiology and Stroke, AOIP "P. Giaccone", Palermo, Italy
| | | | - Salvatore Cottone
- Neurology and Stroke Unit, Multiple Sclerosis Center, ARNAS CIVICO, Palermo, Italy
| | - Edoardo Sessa
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Maria Buccafusca
- Neurology and Neuromuscular Unit, Multiple Sclerosis Centre, "G. Martino" University Hospital, Messina, Italy
| | - Luigi Maria Edoardo Grimaldi
- Neurology and Multiple Sclerosis Center, Unità Operativa Complessa (UOC), Foundation Institute "G. Giglio", Cefalù, PA, Italy
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NeuroTec Sitem-Insel Bern: Closing the Last Mile in Neurology. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2021. [DOI: 10.3390/ctn5020013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Neurology is focused on a model where patients receive their care through repeated visits to clinics and doctor’s offices. Diagnostic tests often require expensive and specialized equipment that are only available in clinics. However, this current model has significant drawbacks. First, diagnostic tests, such as daytime EEG and sleep studies, occur under artificial conditions in the clinic, which may mask or wrongly emphasize clinically important features. Second, early detection and high-quality management of chronic neurological disorders require repeat measurements to accurately capture the dynamics of the disease process, which is impractical to execute in the clinic for economical and logistical reasons. Third, clinic visits remain inaccessible to many patients due to geographical and economical circumstances. Fourth, global disruptions to daily life, such as the one caused by COVID-19, can seriously harm patients if access to in-person clinical visits for diagnostic and treatment purposes is throttled. Thus, translating diagnostic and treatment procedures to patients’ homes will convey multiple substantial benefits and has the potential to substantially improve clinical outcomes while reducing cost. NeuroTec was founded to accelerate the re-imagining of neurology and to promote the convergence of technological, scientific, medical and societal processes. The goal is to identify and validate new digital biomarkers that can close the last mile in neurology by enabling the translation of personalized diagnostics and therapeutic interventions from the clinic to the patient’s home.
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