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Hu Y, Huang J, Wang S, Sun X, Wang X, Yu H. Deciphering Autoimmune Diseases: Unveiling the Diagnostic, Therapeutic, and Prognostic Potential of Immune Repertoire Sequencing. Inflammation 2024:10.1007/s10753-024-02079-2. [PMID: 38914737 DOI: 10.1007/s10753-024-02079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/31/2024] [Accepted: 06/08/2024] [Indexed: 06/26/2024]
Abstract
Autoimmune diseases (AIDs) are immune system disorders where the body exhibits an immune response to its own antigens, causing damage to its own tissues and organs. The pathogenesis of AIDs is incompletely understood. However, recent advances in immune repertoire sequencing (IR-seq) technology have opened-up a new avenue to study the IR. These studies have revealed the prevalence in IR alterations, potentially inducing AIDs by disrupting immune tolerance and thereby contributing to our comprehension of AIDs. IR-seq harbors significant potential for the clinical diagnosis, personalized treatment, and prognosis of AIDs. This article reviews the application and progress of IR-seq in diseases, such as multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, and type 1 diabetes, to enhance our understanding of the pathogenesis of AIDs and offer valuable references for the diagnosis and treatment of AIDs.
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Affiliation(s)
- Yuelin Hu
- Department of Immunology, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Jialing Huang
- Department of Immunology, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Shuqing Wang
- Department of Immunology, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Xin Sun
- School of Basic Medical Sciences, Special Key Laboratory of Gene Detection and Therapy of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Xin Wang
- School of Basic Medical Sciences, Special Key Laboratory of Gene Detection and Therapy of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Hongsong Yu
- Department of Immunology, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, Guizhou, P.R. China.
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Braun B, Fischbach F, Richter J, Pfeffer LK, Fay H, Reinhardt S, Friese MA, Stellmann JP, Kröger NM, Heesen C, Häußler V. Benefits of aHSCT over alemtuzumab in patients with multiple sclerosis besides disability and relapses: Sustained improvement in cognition and quality of life. Mult Scler Relat Disord 2024; 82:105414. [PMID: 38176284 DOI: 10.1016/j.msard.2023.105414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplantation (aHSCT) exhibits promising results for multiple sclerosis (MS) in the short term. We investigated the long-term outcome differences in disease progression and cognitive impairment after aHSCT and alemtuzumab treatment. METHODS 20 patients receiving aHSCT and 21 patients treated with alemtuzumab between 2007 and 2020 were included in this monocentric observational cohort study. The primary objective was to compare the outcome of both groups with regards to achieving No Evidence of Disease Activity (NEDA-3), defined by the absence of relapses, EDSS progression, and MRI activity. Secondary endpoints in the study included the assessment of neurocognitive functioning, quality of life (QoL), Multiple Sclerosis Functional Composite (MSFC), and EDSS improvement. RESULTS Baseline characteristics between both groups were comparable, except for a longer disease duration in the alemtuzumab group of 11.3 years compared to 5.4 years in aHSCT-treated patients (p = 0.002) and a longer mean follow-up time in the aHSCT cohort of 9.0 (range 2.8-15.7) years compared to 5.9 years (range 0.9-9.2) in alemtuzumab patients. NEDA-3 was more frequently observed in the aHSCT group with 75.0 % and 55.0 % at five and 10 years, respectively, than in the alemtuzumab group with only 40.0 % at five years (p = 0.012). Relapse free survival was higher in the aHSCT group (p < 0.001). None of the aHSCT-treated patients showed new T2-lesions six months after therapy initiation until the end of the observational period in contrast to 35.0 % of the alemtuzumab-treated patients showing new T2-lesions (95 %CI 14.2-98.9, p = 0.002). aHSCT-treated patients showed significantly improved cognitive performance in five out of 12 cognitive tests whereas alemtuzumab treated patients deteriorated in four out of 12 tests. Quality of life remained on a constant level for up to 10 years in patients receiving aHSCT with improved scores for the subscale fatigue (p = 0.013). CONCLUSION aHSCT seems to be superior to alemtuzumab in maintaining long-term NEDA-3 status, improving cognition and stabilizing quality of life for up to 10 years.
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Affiliation(s)
- Bente Braun
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Felix Fischbach
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Johanna Richter
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Lena Kristina Pfeffer
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Heike Fay
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Stefanie Reinhardt
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Manuel A Friese
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Jan-P Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany; APHM, Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Nicolaus M Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Vivien Häußler
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Falkenried 94, Hamburg 20251, Germany; Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany.
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Gakis G, Angelopoulos I, Panagoulias I, Mouzaki A. Current knowledge on multiple sclerosis pathophysiology, disability progression assessment and treatment options, and the role of autologous hematopoietic stem cell transplantation. Autoimmun Rev 2024; 23:103480. [PMID: 38008300 DOI: 10.1016/j.autrev.2023.103480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) that affects nearly 2.8 million people each year. MS distinguishes three main types: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS). RRMS is the most common type, with the majority of patients eventually progressing to SPMS, in which neurological development is constant, whereas PPMS is characterized by a progressive course from disease onset. New or additional insights into the role of effector and regulatory cells of the immune and CNS systems, Epstein-Barr virus (EBV) infection, and the microbiome in the pathophysiology of MS have emerged, which may lead to the development of more targeted therapies that can halt or reverse neurodegeneration. Depending on the type and severity of the disease, various disease-modifying therapies (DMTs) are currently used for RRMS/SPMS and PPMS. As a last resort, and especially in highly active RRMS that does not respond to DMTs, autologous hematopoietic stem cell transplantation (AHSCT) is performed and has shown good results in reducing neuroinflammation. Nevertheless, the question of its potential role in preventing disability progression remains open. The aim of this review is to provide a comprehensive update on MS pathophysiology, assessment of MS disability progression and current treatments, and to examine the potential role of AHSCT in preventing disability progression.
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Affiliation(s)
- Georgios Gakis
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Ioannis Angelopoulos
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Ioannis Panagoulias
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Athanasia Mouzaki
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece.
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Bayas A, Berthele A, Blank N, Dreger P, Faissner S, Friese MA, Gerdes LA, Grauer OM, Häussler V, Heesen C, Janson D, Korporal-Kuhnke M, Kowarik M, Kröger N, Lünemann JD, Martin R, Meier U, Meuth S, Muraro P, Platten M, Schirmer L, Stürner KH, Stellmann JP, Scheid C, Bergh FT, Warnke C, Wildemann B, Ziemssen T. Autologous haematopoietic stem cell transplantation for multiple sclerosis: a position paper and registry outline. Ther Adv Neurol Disord 2023; 16:17562864231180730. [PMID: 37780055 PMCID: PMC10540601 DOI: 10.1177/17562864231180730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background While substantial progress has been made in the development of disease-modifying medications for multiple sclerosis (MS), a high percentage of treated patients still show progression and persistent inflammatory activity. Autologous haematopoietic stem cell transplantation (AHSCT) aims at eliminating a pathogenic immune repertoire through intense short-term immunosuppression that enables subsequent regeneration of a new and healthy immune system to re-establish immune tolerance for a long period of time. A number of mostly open-label, uncontrolled studies conducted over the past 20 years collected about 4000 cases. They uniformly reported high efficacy of AHSCT in controlling MS inflammatory disease activity, more markedly beneficial in relapsing-remitting MS. Immunological studies provided evidence for qualitative immune resetting following AHSCT. These data and improved safety profiles of transplantation procedures spurred interest in using AHSCT as a treatment option for MS. Objective To develop expert consensus recommendations on AHSCT in Germany and outline a registry study project. Methods An open call among MS neurologists as well as among experts in stem cell transplantation in Germany started in December 2021 to join a series of virtual meetings. Results We provide a consensus-based opinion paper authored by 25 experts on the up-to-date optimal use of AHSCT in managing MS based on the Swiss criteria. Current data indicate that patients who are most likely to benefit from AHSCT have relapsing-remitting MS and are young, ambulatory and have high disease activity. Treatment data with AHSCT will be collected within the German REgistry Cohort of autologous haematopoietic stem CeLl trAnsplantation In MS (RECLAIM). Conclusion Further clinical trials, including registry-based analyses, are urgently needed to better define the patient characteristics, efficacy and safety profile of AHSCT compared with other high-efficacy therapies and to optimally position it as a treatment option in different MS disease stages.
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Affiliation(s)
- Antonios Bayas
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, University of Augsburg, Augsburg
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University of Munich, Munich
| | - Norbert Blank
- Rheumatology Section, Interdisciplinary Centre for Chronic Inflammatory Diseases, Heidelberg University Hospital, Heidelberg
| | - Peter Dreger
- Spokesman German Working Group for Haematopoietic Stem Cell Transplantation and Cellular Therapy e.V., Heidelberg University Hospital, Heidelberg
| | - Simon Faissner
- Department of Neurology, University Hospital of Ruhr-University Bochum, St. Josef-Hospital, Bochum
| | - Manuel A. Friese
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS) and Department of Neurology, University Medical Center Hamburg-Eppendorf
| | - Lisa-Ann Gerdes
- Institut für Klinische Neuroimmunologie am Klinikum der Ludwig-Maximilians-Universität München, München
| | - Oliver Martin Grauer
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster
| | - Vivien Häussler
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS) and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS) and Department of Neurology University Medical Center Hamburg-Eppendorf
- Clinical and Rehabilitative MS Research, Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, D-20246 Hamburg, Germany
| | - Dietlinde Janson
- Clinic for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg
| | | | - Markus Kowarik
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Kröger
| | - Nikolaus Kröger
- Clinic for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Jan D. Lünemann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster
| | - Roland Martin
- Institute of Experimental Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Uwe Meier
- Chairman of the Professional Association of German Neurologists, Neurocentrum Grevenbroich, Grevenbroich
| | - Sven Meuth
- Medical Faculty, Department of Neurology, University Hospital Düsseldorf, Düsseldorf
| | - Paolo Muraro
- Department of Brain Sciences, Imperial College London, London, UK
| | - Michael Platten
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Heidelberg
| | - Lucas Schirmer
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Heidelberg
| | | | - Jan Patrick Stellmann
- Centre de Résonance Magnétique Biologique et Médicale, Aix-Marseille Université, Marseille
| | - Christof Scheid
- Clinic I for Internal Medicine, University Hospital Cologne, Cologne
| | | | - Clemens Warnke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic and Polyclinic of Neurology, Cologne
| | - Brigitte Wildemann
- AG Neuroimmunology, Neurological Clinic, Heidelberg University Hospital, Heidelberg
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus Dresden, Technische Universität Dresden
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Sánchez-Bonilla D, Robles-Nasta M, Gallardo-Pérez MM, Hernández-Flores EJ, Montes-Robles M, Pastelín-Martínez MDL, Garcés-Eisele SJ, Olivares-Gazca JC, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Long-term results of autografting persons with multiple sclerosis are better in those not exposed to prior disease-modifying therapies. Mult Scler Relat Disord 2023; 75:104744. [PMID: 37178580 DOI: 10.1016/j.msard.2023.104744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a disabling disease that affects young adults. Treatments for MS have increased exponentially in number, efficacy and risk. Autologous hematopoietic stem cell transplantation (aHSCT) can change the natural history of the disease. To analyze if aHSCT should be done early in the course of the disease or after failing of other therapies, we have studied the long-term results of aHSCT in a cohort of persons with MS who were given, or not, immunosuppressive drugs before the transplant. MATERIALS AND METHODS Patients with MS referred to our center for aHSCT between June 2015 and January 2023 were prospectively entered in the study. All phenotypes of MS were included (relapsing remitting, primary progressive and secondary progressive). The follow up was assessed with the patient reported EDSS score in an online form; only patients followed by three or more years were included in the analysis. Patients were divided into two groups: Given or not disease modifying treatments (DMT) before the aHSCT. RESULTS 1132 subjects were prospectively enrolled. 74 patients were followed for more than 36 months, and the subsequent analysis was done in this cohort. The response rate (RR = improvement + stabilization) at 12, 24 and 36 mo was 84%, 84% and 58% respectively for patients not receiving prior DMT and 72%, 90% and 67% for patients receiving DMT. In the whole group, the EDSS score dropped from a mean of 5.5 to 4.5 at 12 mo, to 5.0 at 24 mo and to 5.5 at 36 mo, after the aHSCT. The EDSS score was on average worsening in patients before the aHSCT, but the transplant stabilized the EDSS score at 3 years in patients with prior exposure to DMT, whereas in persons not given DMT, the transplant resulted in a significant decrease (p = .01) of the EDSS score. This indicates a positive response in all patients given aHSCT, but significantly better in those not exposed to DMT before the graft. CONCLUSION The response to aHSCT was better for persons not exposed to immunosuppressive DMT before the transplant, thus suggesting that aHSCT should be done early in the course of the disease and probably before the treatment with DMT. Additional studies are needed to further analyze the impact of the use of DMT therapies before the aHSCT in MS, as well as the timing of the procedure.
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Affiliation(s)
- Daniela Sánchez-Bonilla
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Max Robles-Nasta
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Moisés Manuel Gallardo-Pérez
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Edgar J Hernández-Flores
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Merittzel Montes-Robles
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Anáhuac Puebla. Puebla, México
| | | | - Solón Javier Garcés-Eisele
- Universidad Popular Autónoma del Estado de Puebla. Puebla, México; Laboratorios Ruiz. Laboratorios SYNLAB Puebla, México
| | - Juan Carlos Olivares-Gazca
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México.
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Bellinvia A, Portaccio E, Amato MP. Current advances in the pharmacological prevention and management of cognitive dysfunction in multiple sclerosis. Expert Opin Pharmacother 2023; 24:435-451. [PMID: 36542754 DOI: 10.1080/14656566.2022.2161882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cognitive impairment (CI) is a core feature of Multiple Sclerosis (MS), being detectable in up to 65% of subjects. Treatment of CI can be considered of paramount importance. However, no standardized strategies are available to date to define the best treatment approach, especially for the pharmacological management. AREAS COVERED In this narrative review, the authors outline the latest advances in pharmacological management of CI in MS, including Disease Modifying Treatments (DMTs) which indirectly may or may not influence CI and symptomatic drugs. Selected publications were restricted to those written in English, reporting on an adult relapsing-remitting MS or progressive MS sample, assessing the effects of (at least) 1 DMT or treatment in a longitudinal design, reporting data on (at least) one standardized cognitive test performed at baseline and follow-up, and published between January 2018 and May 2022. EXPERT OPINION Recent data can be considered encouraging and inspiring for future studies. Overall, there is preliminary evidence of a beneficial effect of DMTs on cognition, particularly for high-efficacy DMTs. As for symptomatic treatments, dalfampridine appears to be the only medication with robust evidence of a positive effect on cognition. However, the definition of clinically meaningful change/improvement in cognitive functions remains an unmet need. Future studies should assess the role of other patient-related factors that can be associated with a better cognitive response to treatments and investigate the possible positive effect of multimodal interventions on cognition.
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Affiliation(s)
| | | | - Maria Pia Amato
- NEUROFARBA Department, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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