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Diouf I, Malpas CB, Sharmin S, Roos I, Horakova D, Kubala Havrdova E, Patti F, Shaygannejad V, Ozakbas S, Eichau S, Onofrj M, Lugaresi A, Alroughani R, Prat A, Duquette P, Terzi M, Boz C, Grand'Maison F, Sola P, Ferraro D, Grammond P, Yamout B, Altintas A, Gerlach O, Lechner-Scott J, Bergamaschi R, Karabudak R, Iuliano G, McGuigan C, Cartechini E, Hughes S, Sa MJ, Solaro C, Kappos L, Hodgkinson S, Slee M, Granella F, de Gans K, McCombe PA, Ampapa R, van der Walt A, Butzkueven H, Sánchez-Menoyo JL, Vucic S, Laureys G, Sidhom Y, Gouider R, Castillo-Trivino T, Gray O, Aguera-Morales E, Al-Asmi A, Shaw C, Al-Harbi TM, Csepany T, Sempere AP, Treviño Frenk I, Stuart EA, Kalincik T. Effectiveness of multiple disease-modifying therapies in relapsing-remitting multiple sclerosis: causal inference to emulate a multiarm randomised trial. J Neurol Neurosurg Psychiatry 2023; 94:1004-1011. [PMID: 37414534 DOI: 10.1136/jnnp-2023-331499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Simultaneous comparisons of multiple disease-modifying therapies for relapsing-remitting multiple sclerosis (RRMS) over an extended follow-up are lacking. Here we emulate a randomised trial simultaneously comparing the effectiveness of six commonly used therapies over 5 years. METHODS Data from 74 centres in 35 countries were sourced from MSBase. For each patient, the first eligible intervention was analysed, censoring at change/discontinuation of treatment. The compared interventions included natalizumab, fingolimod, dimethyl fumarate, teriflunomide, interferon beta, glatiramer acetate and no treatment. Marginal structural Cox models (MSMs) were used to estimate the average treatment effects (ATEs) and the average treatment effects among the treated (ATT), rebalancing the compared groups at 6-monthly intervals on age, sex, birth-year, pregnancy status, treatment, relapses, disease duration, disability and disease course. The outcomes analysed were incidence of relapses, 12-month confirmed disability worsening and improvement. RESULTS 23 236 eligible patients were diagnosed with RRMS or clinically isolated syndrome. Compared with glatiramer acetate (reference), several therapies showed a superior ATE in reducing relapses: natalizumab (HR=0.44, 95% CI=0.40 to 0.50), fingolimod (HR=0.60, 95% CI=0.54 to 0.66) and dimethyl fumarate (HR=0.78, 95% CI=0.66 to 0.92). Further, natalizumab (HR=0.43, 95% CI=0.32 to 0.56) showed a superior ATE in reducing disability worsening and in disability improvement (HR=1.32, 95% CI=1.08 to 1.60). The pairwise ATT comparisons also showed superior effects of natalizumab followed by fingolimod on relapses and disability. CONCLUSIONS The effectiveness of natalizumab and fingolimod in active RRMS is superior to dimethyl fumarate, teriflunomide, glatiramer acetate and interferon beta. This study demonstrates the utility of MSM in emulating trials to compare clinical effectiveness among multiple interventions simultaneously.
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Affiliation(s)
- Ibrahima Diouf
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Health and Biosecurity Unit, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - Charles B Malpas
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Izanne Roos
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dana Horakova
- Department of Neurology, Center of Clinical Neuroscience, Charles University, Praha, Czech Republic
- General University Hospital in Prague, Praha, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology, Center of Clinical Neuroscience, Charles University, Praha, Czech Republic
- General University Hospital in Prague, Praha, Czech Republic
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania 'G.F. Ingrassia', Catania, Italy
| | - Vahid Shaygannejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | | | - Sara Eichau
- Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Marco Onofrj
- Deptartment of Neuroscience, Imaging, and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait
| | - Alexandre Prat
- CHUM MS Center, Montreal, Quebec, Canada
- Universite de Montreal, Montreal, Quebec, Canada
| | - Pierre Duquette
- CHUM MS Center, Montreal, Quebec, Canada
- Universite de Montreal, Montreal, Quebec, Canada
| | - Murat Terzi
- CHUM MS Center, Montreal, Quebec, Canada
- Universite de Montreal, Montreal, Quebec, Canada
| | - Cavit Boz
- School of Medicine, Ondokuz Mayis Universitesi, Samsun, Turkey
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Ayse Altintas
- Department of Neurology, Koc Universitesi, Istanbul, Turkey
- Koc University Research Center for Translational Medicine, Istanbul, Turkey
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jeannette Lechner-Scott
- University of Newcastle Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Roberto Bergamaschi
- Foundation National Neurological Institute C Mondino Institute for Hospitalization and Care Scientific, Pavia, Italy
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | | | | | | - Maria Jose Sa
- Department of Neurology, Centro Hospitalar de São João, Porto, Portugal
| | - Claudio Solaro
- Department of Neurology, ASL3 Genovese, Genova, Italy
- Department of Rehabilitaiton, Casa di Cura Centro di Recupero e Rieducazione Funzionale Mons Luigi Novarese, Moncrivello, Italy
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine and Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Mark Slee
- Flinders University, Adelaide, South Australia, Australia
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Pamela A McCombe
- UQCCR, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Anneke van der Walt
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Steve Vucic
- Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Youssef Sidhom
- Department of Neurology, Razi University Hospital, Tunis, Tunisia
- Department of Neurology, University of Tunis El Manar, Tunis, Tunisia
| | - Riadh Gouider
- Department of Neurology, University of Tunis El Manar, Tunis, Tunisia
| | - Tamara Castillo-Trivino
- Instituto de Investigacion Sanitaria Biodonostia, Hospital Universitario de Donostia, San Sebastian, Spain
| | - Orla Gray
- South and East Belfast Health and Social Services Trust, Belfast, UK
| | | | - Abdullah Al-Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Seeb, Oman
- Sultan Qaboos University, Muscat, Oman
| | - Cameron Shaw
- University Hospital Geelong, Geelong, Victoria, Australia
| | - Talal M Al-Harbi
- Department of Neurology, King Fahad Specialist Hospital-Dammam, Khobar, Saudi Arabia
| | - Tunde Csepany
- Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Angel P Sempere
- Department of Neurology, Hospital General de Alicante, Alicante, Spain
| | - Irene Treviño Frenk
- Department of Neurology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Elizabeth A Stuart
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
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Sharmin S, Roos I, Simpson-Yap S, Malpas C, Sánchez MM, Ozakbas S, Horakova D, Havrdova EK, Patti F, Alroughani R, Izquierdo G, Eichau S, Boz C, Zakaria M, Onofrj M, Lugaresi A, Weinstock-Guttman B, Prat A, Girard M, Duquette P, Terzi M, Amato MP, Karabudak R, Grand’Maison F, Khoury SJ, Grammond P, Lechner-Scott J, Buzzard K, Skibina O, van der Walt A, Butzkueven H, Turkoglu R, Altintas A, Maimone D, Kermode A, Shalaby N, Pesch VV, Butler E, Sidhom Y, Gouider R, Mrabet S, Gerlach O, Soysal A, Barnett M, Kuhle J, Hughes S, Sa MJ, Hodgkinson S, Oreja-Guevara C, Ampapa R, Petersen T, Ramo-Tello C, Spitaleri D, McCombe P, Taylor B, Prevost J, Foschi M, Slee M, McGuigan C, Laureys G, Hijfte LV, de Gans K, Solaro C, Oh J, Macdonell R, Aguera-Morales E, Singhal B, Gray O, Garber J, Wijmeersch BV, Simu M, Castillo-Triviño T, Sanchez-Menoyo JL, Khurana D, Al-Asmi A, Al-Harbi T, Deri N, Fragoso Y, Lalive PH, Sinnige LGF, Shaw C, Shuey N, Csepany T, Sempere AP, Moore F, Decoo D, Willekens B, Gobbi C, Massey J, Hardy T, Parratt J, Kalincik T. The risk of secondary progressive multiple sclerosis is geographically determined but modifiable. Brain 2023; 146:4633-4644. [PMID: 37369086 PMCID: PMC10629760 DOI: 10.1093/brain/awad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
Geographical variations in the incidence and prevalence of multiple sclerosis have been reported globally. Latitude as a surrogate for exposure to ultraviolet radiation but also other lifestyle and environmental factors are regarded as drivers of this variation. No previous studies evaluated geographical variation in the risk of secondary progressive multiple sclerosis, an advanced form of multiple sclerosis that is characterized by steady accrual of irreversible disability. We evaluated differences in the risk of secondary progressive multiple sclerosis in relation to latitude and country of residence, modified by high-to-moderate efficacy immunotherapy in a geographically diverse cohort of patients with relapsing-remitting multiple sclerosis. The study included relapsing-remitting multiple sclerosis patients from the global MSBase registry with at least one recorded assessment of disability. Secondary progressive multiple sclerosis was identified as per clinician diagnosis. Sensitivity analyses used the operationalized definition of secondary progressive multiple sclerosis and the Swedish decision tree algorithm. A proportional hazards model was used to estimate the cumulative risk of secondary progressive multiple sclerosis by country of residence (latitude), adjusted for sex, age at disease onset, time from onset to relapsing-remitting phase, disability (Multiple Sclerosis Severity Score) and relapse activity at study inclusion, national multiple sclerosis prevalence, government health expenditure, and proportion of time treated with high-to-moderate efficacy disease-modifying therapy. Geographical variation in time from relapsing-remitting phase to secondary progressive phase of multiple sclerosis was modelled through a proportional hazards model with spatially correlated frailties. We included 51 126 patients (72% female) from 27 countries. The median survival time from relapsing-remitting phase to secondary progressive multiple sclerosis among all patients was 39 (95% confidence interval: 37 to 43) years. Higher latitude [median hazard ratio = 1.21, 95% credible interval (1.16, 1.26)], higher national multiple sclerosis prevalence [1.07 (1.03, 1.11)], male sex [1.30 (1.22, 1.39)], older age at onset [1.35 (1.30, 1.39)], higher disability [2.40 (2.34, 2.47)] and frequent relapses [1.18 (1.15, 1.21)] at inclusion were associated with increased hazard of secondary progressive multiple sclerosis. Higher proportion of time on high-to-moderate efficacy therapy substantially reduced the hazard of secondary progressive multiple sclerosis [0.76 (0.73, 0.79)] and reduced the effect of latitude [interaction: 0.95 (0.92, 0.99)]. At the country-level, patients in Oman, Tunisia, Iran and Canada had higher risks of secondary progressive multiple sclerosis relative to the other studied regions. Higher latitude of residence is associated with a higher probability of developing secondary progressive multiple sclerosis. High-to-moderate efficacy immunotherapy can mitigate some of this geographically co-determined risk.
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Affiliation(s)
- Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Steve Simpson-Yap
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3050, Australia
- Menzies Institute for Medical Research, University of Tasmania, Tasmania 7000, Australia
| | - Charles Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Marina M Sánchez
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
- Department of Neurology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
| | - Serkan Ozakbas
- Faculty of Medicine, Dokuz Eylul University, Konak/Izmir 35220, Turkey
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague 12808, Czech Republic
| | - Eva K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague 12808, Czech Republic
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania 95123, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq 73767, Kuwait
| | - Guillermo Izquierdo
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain
| | - Sara Eichau
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain
| | - Cavit Boz
- Faculty of Medicine, Karadeniz Technical University, Karadeniz Technical University Farabi Hospital, Trabzon 61080, Turkey
| | - Magd Zakaria
- Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio, Chieti 66013, Italy
| | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna 40139, Italy
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Multiple Sclerosis Center for Treatment and Research, University at Buffalo, Buffalo 14202, USA
| | - Alexandre Prat
- CHUM MS Center, Faculty of Medicine, Universite de Montreal, Montreal H2L 4M1, Canada
| | - Marc Girard
- CHUM MS Center, Faculty of Medicine, Universite de Montreal, Montreal H2L 4M1, Canada
| | - Pierre Duquette
- CHUM MS Center, Faculty of Medicine, Universite de Montreal, Montreal H2L 4M1, Canada
| | - Murat Terzi
- Faculty of Medicine, 19 Mayis University, Samsun 55160, Turkey
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence 50134, Italy
| | - Rana Karabudak
- Department of Neurology, Hacettepe University, Ankara 6100, Turkey
| | | | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Pierre Grammond
- Médecine spécialisée, CISSS Chaudière-Appalaches, Levis G6X 0A1, Canada
| | | | - Katherine Buzzard
- Department of Neurology, Box Hill Hospital, Melbourne 3128, Australia
| | - Olga Skibina
- Department of Neurology, Box Hill Hospital, Melbourne 3128, Australia
| | | | - Helmut Butzkueven
- Department of Neurology, The Alfred Hospital, Melbourne 3000, Australia
| | - Recai Turkoglu
- Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul 34668, Turkey
| | - Ayse Altintas
- Department of Neurology, School of Medicine, Koc University, Koc University Research Center for Translational Medicine (KUTTAM), Istanbul 34450, Turkey
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, ARNAS Garibaldi, Catania 95124, Italy
| | - Allan Kermode
- Perron Institute, University of Western Australia, Nedlands 6009, Australia
| | - Nevin Shalaby
- Department of Neurology, Kasr Al Ainy MS Research Unit (KAMSU), Cairo 11562, Egypt
| | - Vincent V Pesch
- Service de Neurologie, Cliniques Universitaires Saint-Luc, Brussels 1200 BXL, Belgium
| | | | - Youssef Sidhom
- Department of Neurology, Razi Hospital, Manouba 2010, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Manouba 2010, Tunisia
- Clinical Investigation Center Neurosciences and Mental Health, Faculty of Medicine, University of Tunis El Manar, Tunis 1068, Tunisia
| | - Saloua Mrabet
- Department of Neurology, Razi Hospital, Manouba 2010, Tunisia
- Clinical Investigation Center Neurosciences and Mental Health, Faculty of Medicine, University of Tunis El Manar, Tunis 1068, Tunisia
| | - Oliver Gerlach
- Academic MS Center Zuyderland, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen 5500, The Netherlands
- School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht 6131 BK, The Netherlands
| | - Aysun Soysal
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul 34147, Turkey
| | - Michael Barnett
- Multiple Sclerosis Clinic, Brain and Mind Centre, Sydney 2050, Australia
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel 4000, Switzerland
| | - Stella Hughes
- Department of Neurology, Royal Victoria Hospital, Belfast BT12 6BA, UK
| | - Maria J Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto 4200-319, Portugal
| | - Suzanne Hodgkinson
- Immune tolerance laboratory Ingham Institute and Department of Medicine, University of New South Wales, Sydney 2170, Australia
| | | | - Radek Ampapa
- MS centrum, Nemocnice Jihlava, Jihlava 58633, Czech Republic
| | - Thor Petersen
- Department of Neurology, Aarhus University Hospital, Arhus C 8000, Denmark
| | - Cristina Ramo-Tello
- Department of Neurology, Hospital Germans Trias i Pujol, Badalona 8916, Spain
| | - Daniele Spitaleri
- Centro Sclerosi Multipla, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino 83100, Italy
| | - Pamela McCombe
- Royal Brisbane and Women’s Hospital, University of Queensland, Brisbane 4000, Australia
| | - Bruce Taylor
- Department of Neurology, Royal Hobart Hospital, Hobart 7000, Australia
| | - Julie Prevost
- Département de neurologie, CSSS Saint-Jérôme, Saint-Jerome J7Z 5T3, Canada
| | - Matteo Foschi
- Department of Neuroscience, Neurology Unit, S. Maria delle Croci Hospital of Ravenna, Ravenna 48121, Italy
| | - Mark Slee
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Chris McGuigan
- Department of Neurology, St Vincent’s University Hospital, Dublin D04 T6F4, Ireland
| | - Guy Laureys
- Department of Neurology, Universitary Hospital Ghent, Ghent 9000, Belgium
| | - Liesbeth V Hijfte
- Department of Neurology, Universitary Hospital Ghent, Ghent 9000, Belgium
| | - Koen de Gans
- Department of Neurology, Groene Hart Hospital, Gouda 2800 BB, The Netherlands
| | - Claudio Solaro
- Department of Rehabilitation, CRRF ‘Mons. Luigi Novarese’, Moncrivello (VC) 16153, Italy
| | - Jiwon Oh
- Barlo Multiple Sclerosis Centre, St. Michael’s Hospital, Toronto M5B1W8, Canada
| | | | | | - Bhim Singhal
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai 400020, India
| | - Orla Gray
- Department of Neurology, South Eastern HSC Trust, Belfast BT16, UK
| | - Justin Garber
- Department of Neurology, Westmead Hospital, Sydney 2145, Australia
| | - Bart V Wijmeersch
- Rehabilitation and MS-Centre Overpelt, Hasselt University, Hasselt 3900, Belgium
| | - Mihaela Simu
- Clinic of Neurology II, Emergency Clinical County Hospital ‘Pius Brinzeu’, Timisoara 300723, Romania
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara 300041, Romania
| | | | | | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Abdullah Al-Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Al-Khodh 123, Oman
| | - Talal Al-Harbi
- Neurology Department, King Fahad Specialist Hospital-Dammam, Khobar 31952, Saudi Arabia
| | - Norma Deri
- Hospital Fernandez, Buenos Aires 1425, Argentina
| | - Yara Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos 11045-002, Brazil
| | - Patrice H Lalive
- Department of Clinical Neurosciences, Division of Neurology, Faculty of Medicine, Geneva University Hospital, Geneva 1211, Switzerland
| | - L G F Sinnige
- Department of Neurology, Medical Center Leeuwarden, Leeuwarden 8934 AD, The Netherlands
| | - Cameron Shaw
- Neuroscience Department, Barwon Health, University Hospital Geelong, Geelong 3220, Australia
| | - Neil Shuey
- Department of Neurology, St Vincents Hospital, Fitzroy, Melbourne 3065, Australia
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen 4032, Hungary
| | - Angel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante 3010, Spain
| | - Fraser Moore
- Department of Neurology, McGill University, Montreal H3T 1E2, Canada
| | - Danny Decoo
- Department of Neurology & Neuro-Rehabilitation, AZ Alma Ziekenhuis, Sijsele-Damme 8340, Belgium
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem 2650, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk 2650, Belgium
| | | | | | - Todd Hardy
- Concord Repatriation General Hospital, Sydney 2139, Australia
| | - John Parratt
- Royal North Shore Hospital, Sydney 2065, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne 3050, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne 3050, Australia
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Meca-Lallana J, Gómez-Ballesteros R, Pérez-Miralles F, Forero L, Sepúlveda M, Calles C, Martínez-Ginés ML, González-Suárez I, Boyero S, Romero-Pinel L, Sempere AP, Meca-Lallana V, Querol L, Costa-Frossard L, Prefasi D, Mauriño J. Impact of neuromyelitis optica spectrum disorder on quality of life: Assessing the patients' perspective. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sempere AP, Berenguer-Ruiz L, Borrego-Soriano I, Burgos-San Jose A, Concepcion-Aramendia L, Volar L, Aragones M, Palazón-Bru A. Ocrelizumab in Multiple Sclerosis: A Real-World Study From Spain. Front Neurol 2021; 11:592304. [PMID: 33519676 PMCID: PMC7844090 DOI: 10.3389/fneur.2020.592304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives: The aim of this study was to describe the tolerability, safety, and effectiveness of ocrelizumab for primary progressive multiple sclerosis (PPMS) and relapsing multiple sclerosis (RMS) in a clinical practice setting. Methods: In this retrospective observational study, we analyzed clinical and MRI data in all patients with PPMS and RMS who had received at least one infusion of ocrelizumab in two health areas in south-eastern Spain. Patients involved in any ocrelizumab trial and those patients with a follow-up shorter than 6 months were excluded. Results: The cohort included 70 patients (42 women) who had received ocrelizumab; 30% had PPMS and 70%, RMS. At baseline, patients' mean age was 47.1 years in the PPMS group and 39.2 years in the RMS group, while the median EDSS was 3.0 and 2.5, respectively. Median follow-up was 13.6 months. The median number of treatment cycles was three. Most patients remained free from clinical and MRI activity after ocrelizumab initiation. Baseline MRI showed T1 Gd-enhancing lesions in 57% of the patients; by the first MRI control at 4–6 months, all patients except one were free of T1 Gd-enhancing lesions (69/70, 98.6% P < 0.001). The proportion of patients with NEDA was 94% in the group of RMS patients who were followed for at least 1 year. Ocrelizumab was generally well-tolerated; the most common adverse events were infusion-related reactions and infections, none of which were serious. Conclusions: Our real-world study supports the tolerability, safety, and effectiveness of ocrelizumab in clinical practice.
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Affiliation(s)
- Angel P Sempere
- Neurology Service, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.,Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | | | - Ines Borrego-Soriano
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - Amparo Burgos-San Jose
- Pharmacy Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | - Lucian Volar
- Department of Radiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Miguel Aragones
- Neurology Service, Hospital Marina Baixa, Villajoyosa, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
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Fernandez-Diaz E, Perez-Vicente JA, Villaverde-Gonzalez R, Berenguer-Ruiz L, Candeliere Merlicco A, Martinez-Navarro ML, Gracia Gil J, Romero-Sanchez CM, Alfaro-Saez A, Diaz I, Gimenez-Martinez J, Mendez-Miralles MA, Millan-Pascual J, Jimenez-Pancho J, Mola S, Sempere AP. Real-world experience of ocrelizumab in multiple sclerosis in a Spanish population. Ann Clin Transl Neurol 2020; 8:385-394. [PMID: 33369288 PMCID: PMC7886031 DOI: 10.1002/acn3.51282] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022] Open
Abstract
Objective Pivotal trial have shown that patients with multiple sclerosis (MS) receiving ocrelizumab had better outcomes. However, data on ocrelizumab in clinical practice are limited. The aim of this study was to evaluate the preliminary safety profile and effectiveness of ocrelizumab treatment for multiple sclerosis (MS) in a real‐world clinical setting. Methods We conducted a retrospective study including consecutive patients from nine public hospitals in south‐eastern Spain who received ocrelizumab after it was approved. Results A total of 228 MS patients were included (144 with relapsing–remitting MS [RRMS], 25 secondary progressive MS [SPMS], and 59 primary progressive MS [PPMS]). Median follow‐up period was 12 months (range, 1‐32). No evidence of disease activity (NEDA) status at year 1 was achieved in 91.2% of the relapsing MS (RMS) population, while disability progression was detected in 37.5% of the PPMS patients (median follow‐up period, 19 months). The most common adverse events reported were infusion‐related reactions and infections, with the most common infections being urinary tract infections followed by upper respiratory infections and COVID‐19. Interpretation The preliminary results in our real‐world setting show that ocrelizumab presented excellent results in suppressing disease activity with a favorable and consistent safety profile.
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Affiliation(s)
- Eva Fernandez-Diaz
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | | | | | - Julia Gracia Gil
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Arantxa Alfaro-Saez
- Section of Neurology, Hospital Vega Baja, Orihuela, Spain.,Center for Biomedical Research in the Network in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Elche, Spain
| | - Inmaculada Diaz
- Neurology Department, Hospital Universitario Santa Lucía, Cartagena, Spain
| | | | - Maria Angeles Mendez-Miralles
- Section of Neurology, Hospital Universitario Los Arcos del Mar Menor, Murcia, Spain.,Universidad Católica de Murcia (UCAM), Murcia, Spain
| | | | | | - Santiago Mola
- Section of Neurology, Hospital Vega Baja, Orihuela, Spain
| | - Angel P Sempere
- Hospital General Universitario de Alicante, Alicante, Spain.,Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain.,ISABIAL, Alicante, Spain
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Abstract
INTRODUCTION Multiple sclerosis is a chronic autoimmune, inflammatory and neurodegenerative disease of the central nervous system and the most common non-traumatic disabling neurological disease in young adults. In the latest decades, multiple sclerosis is increasing worldwide, especially in women. The latitudinal distribution has been progressively attenuated. AIM To review the epidemiological studies of multiple sclerosis in Spain to verify if this worldwide trend also occurs in Spain. DEVELOPMENT We searched PubMed and Teseo databases using the search terms «epidemiology», «prevalence», «incidence», «multiple sclerosis» and «Spain». We selected articles published in Spanish and English between 1968 and 2018. CONCLUSIONS Recent epidemiological studies confirm that Spain is a medium-high risk area for MS. The prevalence of MS has increased significantly throughout Spain in the latest years, especially in women, and recent studies show prevalence as high as 80-180 cases per 100,000.
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Affiliation(s)
| | - E Fernandez-Jover
- Universidad Miguel Hernandez. Instituto de Bioingenieria, 03202 Elche, Espana
| | - A P Sempere
- Hospital General Universitario de Alicante, Alicante, Espana
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Saposnik G, Maurino J, Sempere AP, Terzaghi MA, Ruff CC, Mamdani M, Tobler PN, Montalban X. Overcoming Therapeutic Inertia in Multiple Sclerosis Care: A Pilot Randomized Trial Applying the Traffic Light System in Medical Education. Front Neurol 2017; 8:430. [PMID: 28871238 PMCID: PMC5567059 DOI: 10.3389/fneur.2017.00430] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background Physicians often do not initiate or intensify treatments when clearly warranted, a phenomenon known as therapeutic inertia (TI). Limited information is available on educational interventions to ameliorate knowledge-to-action gaps in TI. Objectives To evaluate the feasibility and efficacy of an educational intervention compared to usual care among practicing neurologists caring for patients with multiple sclerosis (MS). Methods We conducted a pilot double-blind, parallel-group, randomized clinical trial. Inclusion criteria included neurologists who are actively involved in managing MS patients. Participants were exposed to 20 simulated case-scenarios (10 cases at baseline, and 10 cases post-randomization to usual care vs. educational intervention) of relapsing–remitting MS with moderate or high risk of disease progression. The educational intervention employed a traffic light system (TLS) to facilitate decisions, allowing participants to easily recognize high-risk scenarios requiring treatment escalation. We also measured differences between blocks to invoke decision fatigue. The control group responded as they would do in their usual clinical practice not exposed to the educational intervention. The primary feasibility outcome was the proportion of participants who completed the study and the proportion of participants who correctly identified a high-risk case-scenario with the “red traffic light.” Secondary outcomes included decision fatigue (defined as an increment of TI in the second block of case-scenarios compared to the first block) and the efficacy of the educational intervention measured as a reduction in TI for MS treatment. Results Of 30 neurologists invited to be part of the study, the participation rate was 83.3% (n = 25). Of the 25 participants, 14 were randomly assigned to the control group and 11 to the intervention group. TI was present in 72.0% of participants in at least one case scenario. For the primary feasibility outcome, the completion rate of the study was 100% (25/25 participants). Overall, 77.4% of participants correctly identified the “red traffic light” for clinical-scenarios with high risk of disease progression. Similarly, 86.4% of participants correctly identified the “yellow traffic light” for cases that would require a reassessment within 6–12 months. For the secondary fatigue outcome, within-group analysis showed a significant increased prevalence of TI in the second block of case-scenarios (decision fatigue) among participants randomized to the control group (TI pre-intervention 57.1% vs. TI post-intervention 71.4%; p = 0.015), but not in the active group (TI pre-intervention 54.6% vs. TI post-intervention 63.6%; p = 0.14). For the efficacy outcome, we found a non-significant reduction in TI for the targeted intervention compared to controls (22.6 vs. 33.9% post-intervention; OR 0.57; 95% CI 0.26–1.22). Conclusion An educational intervention applying the TLS is feasible and shows some promising results in the identification of high-risk scenarios to reduce decision fatigue and TI. Larger studies are needed to determine the efficacy of the proposed educational intervention. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT03134794.
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Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.,Outcomes Research and Decision Neuroscience Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jorge Maurino
- Neuroscience Area, Medical Department, Roche Farma, Madrid, Spain
| | - Angel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Maria A Terzaghi
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Outcomes Research and Decision Neuroscience Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Christian C Ruff
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Muhammad Mamdani
- Healthcare Analytics Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Philippe N Tobler
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Xavier Montalban
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Neurology-Neuroimmunology Department, Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
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8
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Arroyo R, Sempere AP, Ruiz-Beato E, Prefasi D, Carreño A, Roset M, Maurino J. Conjoint analysis to understand preferences of patients with multiple sclerosis for disease-modifying therapy attributes in Spain: a cross-sectional observational study. BMJ Open 2017; 7:e014433. [PMID: 28274968 PMCID: PMC5353311 DOI: 10.1136/bmjopen-2016-014433] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess patients' preferences for a range of disease-modifying therapy (DMT) attributes in multiple sclerosis (MS). DESIGN A cross-sectional observational study. SETTING The data reported were from 17 MS units throughout Spain. PARTICIPANTS Adult patients with relapsing-remitting MS. MAIN OUTCOME A conjoint analysis was applied to assess preferences. A total of 221 patients completed a survey with 10 hypothetical DMT profiles developed using an orthogonal design and rating preferences from 1 (most acceptable) to 10 (least acceptable). Medication attributes included preventing relapse, preventing disease progression, side effect risk, route and frequency of administration. RESULTS Patients placed the greatest relative importance on the side effect risk domain (32.9%), followed by route of administration (26.1%), frequency of administration (22.7%), prevention of disease progression (10.0%) and prevention of relapse (8.3%). These results were independent of the Expanded Disability Status Scale score. The importance assigned to side effect risk was highest for patients with a recent diagnosis. Patients who had previously received more than one DMT gave a higher importance to relapse rate reduction than patients receiving their first DMT. CONCLUSIONS Patient DMT preferences were mainly driven by risk minimisation, route of administration and treatment schedule. The risk-benefit spectrum of available DMT for MS is becoming increasingly complicated. Understanding which treatment characteristics are meaningful to patients may help to tailor information for them and facilitate shared decision-making in clinical practice.
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Affiliation(s)
- Rafael Arroyo
- Department of Neurology, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Angel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Elena Ruiz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma SA, Madrid, Spain
| | | | - Agata Carreño
- Health Economics and Outcomes Research, IMS Health, Barcelona, Spain
| | - Montse Roset
- Health Economics and Outcomes Research, IMS Health, Barcelona, Spain
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9
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Saposnik G, Sempere AP, Prefasi D, Selchen D, Ruff CC, Maurino J, Tobler PN. Decision-making in Multiple Sclerosis: The Role of Aversion to Ambiguity for Therapeutic Inertia among Neurologists (DIScUTIR MS). Front Neurol 2017; 8:65. [PMID: 28298899 PMCID: PMC5331032 DOI: 10.3389/fneur.2017.00065] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/13/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives Limited information is available on physician-related factors influencing therapeutic inertia (TI) in multiple sclerosis (MS). Our aim was to evaluate whether physicians’ risk preferences are associated with TI in MS care, by applying concepts from behavioral economics. Design In this cross-sectional study, participants answered questions regarding the management of 20 MS case scenarios, completed 3 surveys, and 4 experimental paradigms based on behavioral economics. Surveys and experiments included standardized measures of aversion ambiguity in financial and health domains, physicians’ reactions to uncertainty in patient care, and questions related to risk preferences in different domains. The primary outcome was TI when physicians faced a need for escalating therapy based on clinical (new relapse) and magnetic resonance imaging activity while patients were on a disease-modifying agent. Results Of 161 neurologists who were invited to participate in the project, 136 cooperated with the study (cooperation rate 84.5%) and 96 completed the survey (response rate: 60%). TI was present in 68.8% of participants. Similar results were observed for definitions of TI based on modified Rio or clinical progression. Aversion to ambiguity was associated with higher prevalence of TI (86.4% with high aversion to ambiguity vs. 63.5% with lower or no aversion to ambiguity; p = 0.042). In multivariate analyses, high aversion to ambiguity was the strongest predictor of TI (OR 7.39; 95%CI 1.40–38.9), followed by low tolerance to uncertainty (OR 3.47; 95%CI 1.18–10.2). Conclusion TI is a common phenomenon affecting nearly 7 out of 10 physicians caring for MS patients. Higher prevalence of TI was associated with physician’s strong aversion to ambiguity and low tolerance of uncertainty.
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Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, Stroke Outcomes and Decision Neuroscience Research Unit, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Angel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante , Alicante , Spain
| | - Daniel Prefasi
- Neuroscience Area, Medical Department, Roche Farma , Madrid , Spain
| | - Daniel Selchen
- Division of Neurology, Stroke Outcomes and Decision Neuroscience Research Unit, Department of Medicine, St. Michael's Hospital, University of Toronto , Toronto, ON , Canada
| | - Christian C Ruff
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich , Zurich , Switzerland
| | - Jorge Maurino
- Neuroscience Area, Medical Department, Roche Farma , Madrid , Spain
| | - Philippe N Tobler
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich , Zurich , Switzerland
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Saposnik G, Maurino J, Sempere AP, Ruff CC, Tobler PN. Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS. Patient Prefer Adherence 2017; 11:175-180. [PMID: 28203061 PMCID: PMC5293495 DOI: 10.2147/ppa.s124192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Herding is a phenomenon by which individuals follow the behavior of others rather than deciding independently on the basis of their own private information. A herding-like phenomenon can occur in multiple sclerosis (MS) when a neurologist follows a therapeutic recommendation by a colleague even though it is not supported by best practice clinical guidelines. Limited information is currently available on the role of herding in medical care. The objective of this study was to determine the prevalence (and its associated factors) of herding in the management of MS. METHODS We conducted a study among neurologists with expertise in MS care throughout Spain. Participants answered questions regarding the management of 20 case scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms based on behavioral economics. The herding experiment consisted of a case scenario of a 40-year-old woman who has been stable for 3 years on subcutaneous interferon and developed a self-limited neurological event. There were no new magnetic resonance imaging (MRI) lesions. Her neurological examination and disability scores were unchanged. She was advised by an MS neurologist to switch from interferon to fingolimod against best practice guidelines. Multivariable logistic regression analysis was conducted to evaluate factors associated with herding. RESULTS Out of 161 neurologists who were invited to participate, 96 completed the study (response rate: 60%). Herding was present in 75 (78.1%), having a similar prevalence in MS experts and general neurologists (68.8% vs 82.8%; P=0.12). In multivariate analyses, the number of MS patients seen per week was positively associated with herding (odds ratio [OR] 1.08, 95% CI 1.01-1.14). Conversely, physician's age, gender, years of practice, setting of practice, or risk preferences were not associated with herding. CONCLUSION Herding was a common phenomenon affecting nearly 8 out of 10 neurologists caring for MS patients. Herding may affect medical decisions and lead to poorer outcomes in the management of MS.
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Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Jorge Maurino
- Neuroscience Area, Medical Department, Roche Farma, Madrid
| | - Angel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Christian C Ruff
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Philippe N Tobler
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
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Mallada J, Perez-Carmona N, Berenguer-Ruiz L, Sanchez-Perez R, Martin-Gonzalez R, Sola-Martinez D, Mola S, Lopez-Arlandis JM, Vela-Yebra R, Gabaldon-Torres L, Freire-Alvarez E, Garcia-Escriva A, Sempere AP. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in the province of Alicante]. Rev Neurol 2016; 63:S27-S34. [PMID: 27658433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Post-authorisation studies are important to confirm whether the outcomes of clinical trials are reproduced in usual clinical practice. AIMS To evaluate the effectiveness and safety of fingolimod in clinical practice in the province of Alicante. PATIENTS AND METHODS A retrospective multi-centre study was conducted with remitting multiple sclerosis patients treated with fingolimod. Demographic, clinical and pharmacological data were collected. We report on the effectiveness of the drug -annualised relapse rate (ARR) and percentage of patients free from attacks- at one and at two years after treatment in relation to the previous year, and data concerning side effects are also provided. RESULTS The sample consisted of 89 patients. Previous treatment was with immunomodulators (interferon beta or glatiramer acetate) in 54 patients and natalizumab in 32. Fifty patients changed due to failure with the immunomodulator and 31 owing to positive serology for JC virus (JCV+). Overall ARR decreased by 67.3% the first year (p < 0.0001) and by 84.1% the second (p = 0.0078). It diminished in patients with immunomodulator failure (85.6% the first year, p < 0.0001; 88.9% the second year, p = 0.0039) and increased in a non-significant manner in JCV+ patients in the first year. The percentage of patients free from relapses in the overall population increased from 32.6% to 68.1% in the first year (p < 0.0019) and to 82.6% in the second (p = 0.0215). This increase was not observed in JCV+ patients. Side effects were reported by 13 patients, which led to the drug being withdrawn in two of them. CONCLUSION In clinical practice in the province of Alicante, levels of effectiveness and safety of fingolimod proved to be slightly higher than those found in clinical trials.
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Affiliation(s)
- J Mallada
- Hospital General de Elda, 03600 Elda, Espana
| | | | | | - R Sanchez-Perez
- Hospital General Universitario de Alicante, Alicante, Espana
| | | | - D Sola-Martinez
- Hospital General Universitario de Elche, 03203 Elche, Espana
| | - S Mola
- Hospital Vega Baja, 03314 Orihuela, Espana
| | | | | | | | | | | | - A P Sempere
- Hospital General Universitario de Alicante, Alicante, Espana
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Duarte J, Ruiz MD, Mataix AL, Sempere AP, García FM, Coria F, Jose MAS, Clavería LE. Efficacy of Intranasal Apomorphine in Parkinson's Disease. J Pharm Technol 2016. [DOI: 10.1177/875512259501100512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To suggest that intranasal delivery may offer an effective alternative to subcutaneous injection of apomorphine. Methods: Four patients (3 men, 1 woman) with idiopathic Parkinson's disease, with disabling “on-off” fluctuations in motor performance, despite optimal adjustment in the levodopa regimen and use of dopamine agonists, were included in this study. Their mean age was 61.5 years (range 58–65) and the mean duration of the disease was 13.5 years (range 5–18). The mean duration of levodopa treatment was 12.2 years (range 5–16). Disabling fluctuations had been present in these patients for more than 1 year. The Hoehn and Yahr stage was III-IV during the off periods. All four patients had dyskinesia when receiving the peak dose. Levodopa and dopamine agonist medications were unchanged for 1 month before the study. All four patients had already received intermittent subcutaneous apomorphine injections for a mean of 12.25 months (range 7–16). Apomorphine solution 10 mg/mL was administered with the use of a metered-dose nebulizer that delivered 1 mg of solution with each puff. Results: All patients showed a clear clinical response, with a mean reduction in daily off period of 94.5% with respect to the basal off period. No loss of therapeutic effect or increase in dyskinesia was observed compared with subcutaneous apomorphine. The speed, quality, and duration of response were comparable with that found with injection of apomorphine. One patient showed a slight vestibulitis, but it did not interfere with the efficacy of apomorphine. Conclusions: Intranasal apomorphine is a comfortable and easy alternative to subcutaneous apomorphine in the treatment of off phases in patients with Parkinson's disease and severe refractory motor fluctuations.
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Affiliation(s)
- V Medrano
- Department of Neurology, Hospital General de Elda, Elda, Spain.
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Sempere AP, Porta-Etessam J, Medrano V, Garcia-Morales I, Concepción L, Ramos A, Florencio I, Bermejo F, Botella C. Neuroimaging in the Evaluation of Patients with Non-Acute Headache. Cephalalgia 2016; 25:30-5. [PMID: 15606567 DOI: 10.1111/j.1468-2982.2004.00798.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Available studies offer only limited guidance on neuroimaging of non-acute headache patients. The aim of this study was to estimate the frequency of significant intracranial lesions in patients with headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. All patients aged ≥l 15 years attending the Neurology Clinic with non-acute headache were included in the study and followed prospectively. Every patient was investigated by neuroimaging studies, either computed tomography or magnetic resonance imaging. Neuroimaging results were classified as ‘significant abnormalities’, ‘nonsignificant abnormalities’ or ‘normal’. Significant abnormalities included neoplastic disease, hydrocephalus, vascular malformations, Chiari malformation, large arachnoid cysts, intracranial haemorrhage, and acute cerebral infarcts. Consecutive patients ( n = 1876; 1243 women and 633 men) were included. Their mean age was 38 years (range 15-95 years). Neuroimaging studies detected significant lesions in 22 patients [1.2%, 95% confidence interval (CI) 0.7, 1.8]. The rate of significant intracranial abnormalities in patients with headache and normal neurological examination was 0.9% (95% CI 0.5, 1.4). The only clinical variable associated with a higher probability of intracranial abnormalities was neurological examination. The proportion of patients with headache and intracranial lesions is relatively small, but neither neurological examination nor the features in the clinical history permit us to rule out such abnormalities.
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Affiliation(s)
- A P Sempere
- Department of Neurology, Hospital Vega Baja, Orihuela, Spain.
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Sempere AP, Gimenez-Martinez J. Safety considerations when choosing the appropriate treatment for patients with multiple sclerosis. Expert Opin Drug Saf 2014; 13:1287-9. [DOI: 10.1517/14740338.2014.955012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Sempere AP, Feliu-Rey E, Sanchez-Perez R, Nieto-Navarro J. Neurological picture. Rituximab for tumefactive demyelination refractory to corticosteroids and plasma exchange. J Neurol Neurosurg Psychiatry 2013; 84:1338-9. [PMID: 23804236 DOI: 10.1136/jnnp-2013-305456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Angel P Sempere
- Neurology Department, Hospital General Universitario de Alicante, , Alicante, Spain
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Aleixandre-Benavent R, Alonso-Arroyo A, Gonzalez de Dios J, Sempere AP, Castello-Cogollos L, Bolanos-Pizarro M, Valderrama-Zurian JC. [Co-authorship and collaboration networks in Spanish research into multiple sclerosis (1996-2010)]. Rev Neurol 2013; 57:157-166. [PMID: 23884870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION. Scientific collaboration is vital for to the advance of knowledge and is especially important in health sciences. The aim of this study is to identify scientific collaboration indicators and co-authorship networks of researchers and Spanish institutions that publish on multiple sclerosis (MS) during the period 1996-2010. MATERIALS AND METHODS. The analyzed papers were obtained from Web of Science and Scopus international databases, and IBECS and IME national databases, applying specific search profiles in each one of them. In order to identify collaboration networks all signed papers were quantified and co-authored measures were obtained, as the different indexes, degree, intermediation and closeness. RESULTS. 1,613 articles were published in the period 1996-2010, 92% of them in collaboration. With 10 or more works signed in collaboration, 20 Spanish research groups in MS were identified. 64.23% of the papers were published in collaboration between Spanish institutions, and 33.85% were in collaboration with foreign institutions. The institutional participation analysis has identified a large network of institutional partnerships that integrates 27 institutions, with the Hospital Vall d'Hebron in a central position. International collaboration is headed by the U.S. and European countries, most notably the UK and Italy. CONCLUSION. The most collaborative authors, institutions, and work groups in Spanish research in MS have been identified. Despite these indicators that characterize the collaboration in this area, it is necessary to enhance cooperation between them, since this collaboration is positively related to the quality and impact of research and publications.
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Affiliation(s)
- R Aleixandre-Benavent
- Consejo Superior de Investigaciones Cientificas. Instituto de Historia de la Ciencia, Valencia, Espana.
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Sepúlveda M, Blanco Y, Rovira A, Rio J, Mendibe M, Llufriu S, Gabilondo I, Villoslada P, Castilló J, Corral J, Ayuso T, Iñiguez C, Santos S, Guijarro C, Ramió-Torrentà L, Sempere AP, Olascoaga J, Graus F, Montalban X, Saiz A. Analysis of prognostic factors associated with longitudinally extensive transverse myelitis. Mult Scler 2012; 19:742-8. [PMID: 23037550 DOI: 10.1177/1352458512461968] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to report the clinical profile and outcome of longitudinally extensive transverse myelitis (LETM). METHODS We prospectively studied adult patients who presented with LETM from January 2008 to December 2011. Information on demographic, clinical course, magnetic resonance imaging (MRI) and outcome was collected. HLA-DRB1 genotype was compared with those of 225 normal controls and patients with MS (228) and neuromyelitis optica (NMO) (22). RESULTS In total, 23 patients (16 female) with a median age of 44.5 years (range: 20-77 years) were included. Most (74%) had moderate-severe disability at nadir (48% non-ambulatory), normal/non-multiple sclerosis (MS) brain MRI (96%) and a median MRI cord lesion of 5 vertebral segments (range: 3-19). Laboratory analysis showed cerebrospinal fluid pleocytosis (45%), NMO-IgG (9%), antinuclear antibodies (70%), and genotype HLA-DRB1*13 (57%). The frequency of DRB1*13 genotype was higher compared with controls (p=0.002), MS (p=0.001) and NMO (p=0.003) patients. After a median follow-up of 32 months, one patient converted to MS, two had relapsing LETM with NMO-IgG, and 20 remained as idiopathic with recurrences in four (20%). Twelve (52%) patients recovered with minimal disability (Expanded Disability Status Scale (EDSS) ≤2.5) and three (13%) remained wheelchair dependent. Disability at nadir was associated with the final outcome and extension of the spinal cord lesion with risk of recurrence. Recurrence was not associated with worse outcome. CONCLUSIONS Inflammatory LETM is mostly idiopathic with a good outcome. It includes a relatively homogenous group of patients with an overrepresentation of the HLA-DRB1*13 genotype. EDSS at nadir is a predictor of the final outcome and extension of the myelitis of the recurrence risk.
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Affiliation(s)
- María Sepúlveda
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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Sempere AP, Mola S, Martin-Medina P, Bernabeu A, Khabbaz E, Lopez-Celada S. Response to Immunotherapy in CLIPPERS: Clinical, MRI, and MRS Follow-Up. J Neuroimaging 2011; 23:254-5. [DOI: 10.1111/j.1552-6569.2011.00631.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abarca-Olivas J, Feliu-Rey E, Sempere AP, Sanchez-Payá J, Baño-Ruiz E, Caminero-Canas MA, Nieto-Navarro J, Botella-Asunción C. [Volumetric measurement of the posterior fossa and its components using magnetic resonance imaging in idiopathic trigeminal neuralgia]. Rev Neurol 2010; 51:520-524. [PMID: 20979031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The neurovascular conflict is now considered an unquestionable dogma in the pathophysiology of idiopathic trigeminal neuralgia (ITN). However, there are more and more papers that provide information about other factors that promote such conflict or neuralgia itself. AIMS. To measure the volume of the substructures of the posterior fossa in patients with ITN and controls and to investigate the association between a reduced volume of these structures and the incidence of ITN. SUBJECTS AND METHODS In 20 patients with unilateral ITN and 20 healthy participants, high resolution 1.5 T magnetic resonance imaging scans including axial and coronal sequences T2-weighted with a slice thickness of 1 mm were performed with the aim of a volumetric study of pontomesencephalic cistern, Meckel's cave and trigeminal nerve. RESULTS Measuring the pontomesencephalic cistern on each side of the midline, the volume of the affected side cistern was significantly lower than the healthy side one in patients with ITN (p = 0.004) and also when compared with controls hemicisterns. No significant differences in the Meckel's cave nor the trigeminal nerve were found. The incidence of neurovascular conflict was also studied resulting in 10% of patients with ITN where the conflict was not identified. CONCLUSIONS Our data support the theory that a small volume of the posterior fossa cisterns containing the trigeminal nerve may increase the incidence of ITN.
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Affiliation(s)
- Javier Abarca-Olivas
- Secretaría de Neurocirugía, Hospital General Universitario de Alicante, Pintor Baeza s/n, Alicante, Spain.
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Giner-Bernabeu JC, Sempere AP, Hernández-Rubio L, López-Celada S, Montoya-Gutiérrez J. [Cortical infarction mimicking paralysis of the median nerve]. Rev Neurol 2010; 50:61. [PMID: 20073027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abarca-Olivas J, Sempere AP, Cortés-Vela JJ, Baño-Ruiz E, Nieto-Navarro J, Botella-Asunción C. [The role of platybasia in trigeminal neuralgia]. Rev Neurol 2009; 49:630-632. [PMID: 20013714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The vascular compression of a nerve is known to be the most important cause of idiopathic trigeminal neuralgia (ITN) by most authors. However, several cases of skull base deformities in patients with ITN have been reported in our bibliographic review. AIM. To compare the existence of platybasia between a group of patients with ITN and a randomized control group. SUBJECTS AND METHODS Twenty-five patients with ITN and twenty-five control subjects were X-rayed and their basal angles were measured and compared. RESULTS The basal angle measured to investigate the existence of platybasia is significantly greater in the ITN group than in the control group. Platybasia was found in 10 patients with ITN. However, only two cases of platybasia were reported in the control group. Therefore in our study we have found that the incidence of platybasia in patients with ITN is significantly increased. CONCLUSION Our data demonstrated that platybasia has an important role in the pathogenesis of the ITN by altering the normal anatomy of the nerves and vessels within the posterior fossa.
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Affiliation(s)
- J Abarca-Olivas
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, E-03010 Alicante, Espana.
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Sempere AP, López-Celada S, Berenguer-Ruiz L, Giner-Bernabeu JC, Hernández-Rubio L. [Radiologically isolated syndrome]. Rev Neurol 2009; 49:599-600. [PMID: 19921626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- A P Sempere
- Servicio de Neurología, Hospital General Universitario de Alicante, 03010 Alicante, Espana.
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Giner-Bernabeu JC, Hernández-Rubio L, Sempere AP, Bosacoma-Ros N, Berenguer-Ruiz L, Lezcano-Rodas M, Martínez-Lazcano T, Mira-Berenguer F, Baño E, Abarca-Olivas J, Duart M, Asensio-Asensio M. [The use of intravenous levetiracetam in a general hospital]. Rev Neurol 2009; 49:517-519. [PMID: 19859874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION AND AIMS Although antiepileptic drugs are usually administered orally, sometimes they must be given intravenously. Levetiracetam is the only one of the new antiepileptic drugs that can be administered intravenously. In this study we report on the use of intravenous levetiracetam in a general hospital, while also evaluating its effectiveness and safety. PATIENTS AND METHODS A retrospective analysis was conducted of the medical records of all hospital admissions that were treated with intravenous levetiracetam between July 2007 and May 2008. RESULTS A total of 53 patients were treated with intravenous levetiracetam. Approximately half the patients (47%) had been admitted to neurology, followed by neurosurgery (21%) and oncology (9%). The mean age was 52.2 years (range: 9-87 years) and 40% were females. Seizures were symptomatic in 81% of cases and the most common aetiologies were strokes (40%) and brain tumours (33%). The most frequent presenting symptoms were repeated epileptic seizures (47.2%) and epileptic status (26.4%). Overall, control of seizures was achieved in 87% of patients. No severe side-effects that could be attributed to levetiracetam therapy were detected. CONCLUSIONS Intravenous levetiracetam seems to be an effective, safe antiepileptic drug in hospitalised patients, and especially so in those who present an associated comorbidity and/or who are on multiple drug therapy.
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Affiliation(s)
- J C Giner-Bernabeu
- Servicio de Neurología, Hospital General Universitario de Alicante, Alicante, España
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Pascual AM, Téllez N, Boscá I, Mallada J, Belenguer A, Abellán I, Sempere AP, Fernández P, Magraner MJ, Coret F, Sanz MA, Montalbán X, Casanova B. Revision of the risk of secondary leukaemia after mitoxantrone in multiple sclerosis populations is required. Mult Scler 2009; 15:1303-10. [PMID: 19825889 DOI: 10.1177/1352458509107015] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective in this paper is to compare the cumulative incidence and incidence density of therapy-related acute myeloid leukaemia in two cohorts of patients with multiple sclerosis treated with mitoxantrone, and with previously reported data in the literature. Six new cases of acute myeloid leukaemia were observed by prospectively following two Spanish series of 142 and 88 patients with worsening relapsing multiple sclerosis and secondary-progressive disease treated with mitoxantrone. A literature review shows 32 further cases of acute myeloid leukaemia reported, 65.6% of which are therapy-related acute promyelocytic leukaemia. Five cases in the cohorts fulfilled the diagnostic criteria for acute promyelocytic leukaemia, and one patient was diagnosed with pre-B-acute lymphoblastic leukaemia. Acute myeloid leukaemia latency after mitoxantrone discontinuation was 1 to 45 months. The accumulated incidence and incidence density was 2.82% and 0.62%, respectively, in the Valencian cohort, and 2.27% and 0.44% in the Catalonian cohort. In the only seven previously reported series, the accumulated incidence varied from 0.15% to 0.80%. The real incidence of acute myeloid leukaemia after mitoxantrone therapy in the multiple sclerosis population could be higher as evidenced by the growing number of cases reported. Haematological monitoring should continue for at least 5 years after the last dose of mitoxantrone. These data stress the necessity of re-evaluating this risk.
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Affiliation(s)
- Ana M Pascual
- Department of Neurology, Hospital Universitario La Fe, Valencia, Spain. med004201saludalia.com
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Gonzalez de Dios J, Valderrama-Zurian JC, Gonzalez-Alcaide G, Sempere AP, Bolanos-Pizarro M, Aleixandre-Benavent R. [Approximation to the impact of biomedical journals in neurological sciences: study of bibliometric indicators in the Journal Citation Reports-Science Citation Index 2006]. Rev Neurol 2009; 48:117-128. [PMID: 19206058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Neurological sciences form a multidisciplinary field that produces a wide range of scientific journals. The aim of this study was to perform a scientometric analysis of neurological science journals in the 2006 Journal Citation Reports-Science Citation Index (JCR-SCI) edition. MATERIALS AND METHODS We study the three areas dedicated to neurological sciences (Neurosciences, Clinical Neurology and Neuroimaging) in the 2006 JCR-SCI edition. Bibliometric indicators used are: journals, articles, citations, impact factor (IF), immediacy index, half life and journals with the greatest IF in each specialty. We also perform a special analysis of Spanish neurological journals in JCR-SCI. RESULTS In the area of Neurosciences we find a total of 200 journals, 27.157 articles, 1.109.784 citations and an average IF of 2,446, the greatest IF belonging to Annu Rev Neurosci (28,533) and Nat Rev Neurosci (23,054); Spanish journals: Neurocirugia and Acta Esp Psiquiatr. The area of Clinical Neurology contains 147 journals, 18.114 articles, 540.364 citations and an average IF of 1,848, the greatest IF belonging to Lancet Neurol (9,479) and Ann Neurol (8,051); Spanish journals: Neurologia and Rev Neurol. The area of Neuroimaging contains 13 journals, 1.747 articles, 49.210 citations and an average IF of 1,298, the greatest IF belonging to Neuroimage (5,559) and Hum Brain Mapp (4,888). CONCLUSIONS We found out a broad representation of neurological journals from the 6,166 journals included in the 2006 JCR-SCI edition. Bibliometric characteristics differ in accordance to the clinical (Clinical Neurology) or experimental (Neurosciences) nature of the area. Even though bibliometric indicators for the four Spanish neurological journals have gradually improve over the previous 5 years, they are still proportionally ranked low in JCR-SCI. Due to significant limitations observed in the IF, we suggest conducting its analysis from a multidimensional bibliometric perspective, and always within its contextual research area.
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Affiliation(s)
- J Gonzalez de Dios
- Servicio de Pediatría, Hospital de Torrevieja, Profesor Manuel Sala 6, Torrevieja, Spain.
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Sempere AP, Giner-Bernabeu JC, Berenguer-Ruiz L, Selles-Galiana MF, Hernandez-Rubio L, Lezcano-Rodas M. [Sleep disorders associated with treatment with rimonabant]. Rev Neurol 2008; 47:446. [PMID: 18937208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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González-Alcaide G, Alonso-Arroyo A, González de Dios J, Sempere AP, Valderrama-Zurián JC, Aleixandre-Benavent R. [Coauthorship networks and institutional collaboration in Revista de Neurología]. Rev Neurol 2008; 46:642-651. [PMID: 18509820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Scientific cooperation is essential for the advance of science. Bibliometrics and social network analysis offer evaluation indicators to analyse collaboration in scientific papers. The aim of this study is to characterize scientific collaboration patterns in Revista de Neurología between 2002 and 2006. MATERIALS AND METHODS Coauthorships and institutional relationships of papers published in Revista de Neurología have been identified. Collaboration Index, the most productive authors' and institutional collaboration patterns and the types of institutional collaborations have been quantified. Also, it has been constructed the coauthorship networks and the institutional collaboration network. Networks have been identified and represented using Access and Pajek software tools. RESULTS The Collaboration Index was 4.01. 56.54% of papers involved institutional collaboration. The collaboration between institutions of the same country prevails (52.7%), followed by collaborations between departments, services or units of the same institution (40.47%) and international collaboration (6.83%). 45 coauthorship networks involving 149 investigators with a high intensity of collaboration and a large institutional network involved 80 centres were observed. CONCLUSIONS Revista de Neurología covers scientific production of a high number of research groups. It has been observed a positive evolution in the collaboration patterns over the time. Nevertheless, it is essential to encourage inter-regional and international collaboration.
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Affiliation(s)
- G González-Alcaide
- Instituto de Historia de la Ciencia, Universitat de València-CSIC, Valencia, Espana
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Sempere AP, Berenguer-Ruiz L, Lezcano-Rodas M, Mira-Berenguer F, Waez M. [Lumbar puncture: its indications, contraindications, complications and technique]. Rev Neurol 2007; 45:433-436. [PMID: 17918111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Although first described over 100 years ago, lumbar puncture is still an important tool in the diagnosis of neurological diseases. In this article we review its indications, contraindications, the technique for carrying it out, the analysis of the cerebrospinal fluid and possible complications. DEVELOPMENT The lumbar puncture has diagnostic and therapeutic indications. The chief diagnostic indications include infectious, inflammatory and neoplastic diseases affecting the central nervous system. Complications are infrequent, except for headaches and low back pain, but can be severe. Analysis of the cerebrospinal fluid must include a cell count and determination of the glucose and protein concentrations. The other analytical studies of cerebrospinal fluid must be conducted according to the diagnostic suspicion. CONCLUSION The lumbar puncture in expert hands is a safe test. The health professional should be suitably familiar with its contraindications, the regional anatomy and the technique used to perform it.
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Affiliation(s)
- A P Sempere
- Servicio de Neurología, Hospital General Universitario de Alicante, Spain.
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Aleixandre-Benavent R, Alonso-Arroyo A, González-Alcaide G, González de Dios J, Sempere AP, Valderrama-Zurián JC. [Gender analysis of papers published in Revista de Neurología (2002-2006)]. Rev Neurol 2007; 45:137-43. [PMID: 17661271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION There is an ongoing interest in the society in promoting gender equality and in women integration in research activities. The purpose of this work is to identify from a gender perspective the bibliometric characteristics of articles published in Revista de Neurología journal during the 2002-2006 period. MATERIALS AND METHODS Records were obtained from Science Citation Index database of ISI-Thomson platform. The following indicators were determined, disaggregated by gender: year of publication, type of document, number and order of signatures, number of collaborators, signature/papers index and in the institutional and geographical level. RESULTS 4527 authors were identified, 2614 (57.74%) men and 1913 (42.,26%) women. The highest women's participation took place in original articles (39.01% of signatures). 44.5% of authors with one published article were women, while 'big women producers' (those with more than 9 articles) only were 16.67%. A greater productivity in men and a greater rate of collaboration in women has been detected. CONCLUSIONS Scientific activity studies disaggregated by gender give an essential information in order to establish the basis of a scientific policy for promoting the woman as researcher. The evolution in the number of female authors in Revista de Neurología journal does not present an aiming growth to reach the parity in the next years. A low presence of women in positions of high productivity has been detected, whose causes should be identified.
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Affiliation(s)
- R Aleixandre-Benavent
- Instituto de Historia de la Ciencia y Documentación López Piñero, Universitat de València-CSIC Valencia.
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Bermejo-Pareja F, Sempere AP. [A poliedric journal]. Rev Neurol 2007; 45:1. [PMID: 17620257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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González de Dios J, Sempere AP, Aleixandre-Benavent R. [Biomedical publications in Spain on debate (II): the on-going 'revolutions' and their application to neurological journals]. Rev Neurol 2007; 44:101-12. [PMID: 17236150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
AIM AND DEVELOPMENT To debate about the application of on-going 'revolutions' in medical knowledge to Spanish neurological journals in the 21st century. This article reviews the current status of five revolutions in the field of health sciences, in general, and in neurological sciences, in particular: 1) the knowledge revolution: to translate the scientific investigation to the patient, with knowledge needs-driven research agenda with founder commissioning research to answer questions posed by clinicians, managers and patients, and systematic and critical appraisal reviews as the creator of quality improved knowledge; 2) the evidence based medicine revolution: the pyramid information of '4S', with systems (guidelines and computerized decision support systems), synopses (secondary journals), syntheses (systematic reviews and meta-analysis) and studies (original studies published in journals); 3) the web revolution: the possibility of dissemination of biomedical documentation by means of the Internet network are producing changes in the traditional way of conceiving scientific publication; the Internet represents a great advantage for investigation and also for clinical practice, since it permits free, universal access to databases and the interchange of texts, images and videos; 4) the open access revolution: to take full control over all operations related to the process of publish (to create, publish, communicate, distribute, reproduce and transform) with no need of any intermediaries, and to transform fundamental aspects concerning the circulation of knowledge, its use and availability; and 5) the librarian revolution: the project of a Virtual Health Library in Spain as a tool to access and disseminate scientific and technical knowledge on health through the Internet.
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González de Dios J, Sempere AP, Aleixandre-Benavent R. [Biomedical publications in Spain on debate (I): state of neurological journals]. Rev Neurol 2007; 44:32-42. [PMID: 17199227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Bibliometric studies belong to the so-called 'social studies of science', and science policy constitutes one of its main applied fields, providing objective and useful tools for evaluating the results of scientific activity. Neurological sciences are very important in the bibliometric map of Spain about biomedicine and health sciences, from a quantitative (second thematic area in productivity, only after biology-biochemical) and a qualitative (high health costs and morbimortality) point of view. DEVELOPMENT In Spain we can found about 360 biomedical journals, 18 of them related to the area of neurological sciences. In 2005, only 17 biomedical Spanish journals were in the Science Citation Index database, three of them in the field of neurosciences: Neurologia (impact factor = 0.57), Revista de Neurologia (0.39) and Neurocirugia (0.23), and these journals have also very good Latindex criteria about formal aspects. But it is important to mention that the impact factor specifically measures visibility and diffusion of the works published by these journals rather than their scientific quality. We search the answer to some questions about the present and future of biomedical journals in general and neurological journals in particular: paper or electronic publication?, free access or open access?, scientific journal or scientific article?, English or Spanish publication? CONCLUSIONS The Acuerdo de Buenos Aires is an initiative to promote scientific neurological papers of high quality in Spanish. The current status of neurological journals in the bibliometric context of our country is good and open to the advantages of electronic and free access.
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Affiliation(s)
- J González de Dios
- Departamento de Pediatría, Hospital Universitario San Juan, 03550 San Juan, Espana.
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Sempere AP, Berenguer-Ruiz L, Almazán F. [Chronic cluster headache: Response to psilocybin]. Rev Neurol 2006; 43:571-2. [PMID: 17072817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Medrano V, Sempere AP, Morera-Guitart J, Fernandez-Izquierdo S, Espinosa-Martinez J. [Preventive treatment with topiramate enhances the quality of life of patients with migraine]. Rev Neurol 2006; 43:259-63. [PMID: 16941422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Topiramate has recently proved to be safe and effective in the prevention of migraine and is currently the only neuromodulatory drug indicated for the prevention of migraine in Spain. AIM To evaluate the adherence, effectiveness and safety of preventive treatment with topiramate in patients diagnosed with migraine. PATIENTS AND METHODS A prospective, observational, multi-centre study was conducted in general neurology departments. Patients eligible for the study were those with migraine, above 14 years of age, who needed preventive treatment and in whom other preventive treatments had failed or for whom topiramate was believed to be the most suitable therapy as regards its profile of side effects. The effectiveness of the treatment, patient satisfaction, side effects and loss of body weight were all evaluated. Effectiveness of the treatment was evaluated by means of the reduction in the frequency of migraines and the score obtained on the Headache Impact Test (HIT-6). RESULTS A total of 79 patients were evaluated. The dosage of topiramate ranged between 25 and 200 mg/day, with an average of 100 mg/day. 19% of the patients dropped out of the study due to side effects. Paresthesias were the most frequent reason for dropping out. No serious side effects were observed. 14% of the patients lost more than 5% of the base weight. The percentage of patients who responded was 58%. The degree of satisfaction of the patients who completed the follow-up was: good (80%), regular (11%) and poor (9%). CONCLUSIONS Preventive treatment with topiramate significantly reduces the impact of migraine and the disability that results from it. Treatment is satisfactory and improves the quality of life in a large percentage of patients.
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Affiliation(s)
- V Medrano
- Servico de Neurología. Hospital General de Elda, Elda, Alicante.
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González de Dios J, Ochoa-Sangrador C, Sempere AP. [Generic drugs in the treatment of epilepsy]. Rev Neurol 2005; 41:676-83. [PMID: 16317637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
AIM We discuss some controversial aspects with prescription of generic drugs (GD) and the problems concerning bioequivalence, mainly in the case of drugs with non-linear pharmacokinetics and/or narrow therapeutic rank, like the antiepileptic drugs (AED). DEVELOPMENT There is considerable debate about GD in the treatment of epilepsy, with clearly advantages (cost saving) and disadvantages (loss of seizure control or drug toxicity) in prescribing generics anticonvulsants. We make a systematic review of the literature in primary (PubMed) and secondary (Tripdatabase and Cochrane Library) bibliographic databases in relation to GD and AED. The main information is about classical AED (phenytoin, carbamazepine, valproic acid and primidone) and we don't found studies in this area about the new AED. The level of evidence is, generally, weak, based on case-series and expert opinion without explicit critical appraisal (except in phenytoin with level of evidence moderate, based on some analytical studies). In Spain, at this moment, there are only two generic AED, one-classical (carbamazepine) and one-new (gabapentin). CONCLUSION The American Academy of Neurology and Epilepsy Foundation maintains that the individual and physician should be notified and give their consent before a switch in antiepileptic medications is made, whether it involves generic substitution for brand name products, or generic to generic substitutions.
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Affiliation(s)
- J González de Dios
- Departamento de Pediatría, Hospital Universitario San Juan, Universidad Miguel Hernández, San Juan, Alicante, Spain.
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Medrano V, Royo-Villanova C, Flores-Ruiz JJ, Sempere AP, Mola-Caballero de Roda S. [Parainfectious opsoclonus-myoclonus syndrome secondary to varicella-zoster virus infection]. Rev Neurol 2005; 41:507-8. [PMID: 16224740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Sempere AP. [Richard Smith and the British Medical Journal: a role model]. Rev Neurol 2005; 40:65. [PMID: 15712155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Sempere AP, Callejo-Domínguez JM, García-Clemente C, Ruipérez-Bastida MC, Mola-Caballero de Roda S, García-Barragán N, Vela-Yebra R, Flores-Ruiz JJ. [Cost effectiveness of the diagnostic study of dementia in an extra-hospital Neurology service]. Rev Neurol 2004; 39:807-10. [PMID: 15543493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM The purpose of this study was to analyse the cost effectiveness of the complementary tests in the diagnosis of reversible causes of dementia in an extra-hospital Neurology service. PATIENTS AND METHODS Patients referred to the Neurology service from Primary Care with a diagnosis of dementia according to DSM-III-R criteria. The following routine complementary tests were performed: 1. Analyses, including blood count, biochemical study, vitamin B12 and folic levels, thyroid hormones, and syphilis serodiagnosis; 2. Neuroimaging study, consisting in computerised axial tomography or cranial magnetic resonance. RESULTS A total of 269 consecutive patients diagnosed as suffering from dementia were included in the study. The mean age of the patients was 74.5 years (49-94 years) and 61% were females. The most frequent cause of dementia was Alzheimer's disease (79.9%). In all, 31 patients presented potentially reversible conditions (11.5%), but if we exclude depression, the dementia was only reversible in one patient (0.4%). CONCLUSIONS The percentage of patients with reversible causes of dementia in the field of extra-hospital neurology is low. The diagnostic study must be individualised according to the clinical suspicion.
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Affiliation(s)
- A P Sempere
- Sección de Neurología, Hospital Vega Baja, Orihuela, Alicante, Spain.
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40
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López-García F, Amorós-Martínez F, Sempere AP. [A reversible posterior leukoencephalopathy syndrome]. Rev Neurol 2004; 38:261-6. [PMID: 14963856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
INTRODUCTION AND METHOD The reversible posterior leukoencephalopathy (RPLS) was initially described by Hinchey et al in patients hospitalized due to different acute process that cause hypertension and renal disease that were being treated with immunosuppressive agents. Clinically it produces an acute or subacute encephalopathy that usually agrees with a fast increase of blood pressure. Neuroimaging technique demonstrated abnormalities involving the white matter, especially bilateral edema in the posterior portions of the cerebral hemispheres, although it can also affect to any other cerebral area, trunk or cerebellum. The production mechanism is not well know. In case of hypertensive encephalopathy and eclampsia of pregnancy it is believed to be caused by vascular and endothelial autoregulation alterations, and when it's related to immunosuppressors the edema seems to have a cytotoxical origin. The particularity that defines the RPLS is that, in most cases, neurological symptoms and white matter lesions disappear after anti hypertensive treatment or when immunosuppressive agents is ceased. CONCLUSION The RPLS is an uncommon neurological complication, however each time more news cases appear in the medical literature. The excellent evolution and treatment response that these patients show and the full clinical and radiological recuperation suggest the need of its early identification to avoid unnecessary diagnostic studies or wrong treatments.
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Affiliation(s)
- F López-García
- Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, España.
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Sempere AP, Pérez-Tur J, García-Barragán N, Sellés J, Medrano V, Mola S. [Clinical and neuroimaging findings in a family with CADASIL associated to C475T mutation]. Rev Neurol 2004; 38:37-41. [PMID: 14730489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
INTRODUCTION The term CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) refers to an autosomal dominant hereditary arteriopathy of the brain that is characterised by headache, recurring strokes and progressive cognitive deterioration. We report the case of another family with CADASIL and emphasise the importance of a genetic study in its diagnosis. CASE REPORT A 62-year-old female patient with repeating lacunar strokes, subcortical dementia and a family history of dementia and strokes. Neuroimaging studies conducted on the patient and her siblings showed signs of leukoencephalopathy and lacunar infarctions. The ultrastructural study of the biopsy performed on a sample of the patient's skin, which included five dermal vessels, did not show any electron-dense deposits. The genetic study revealed the presence of mutation C475T in exon 4 of NOTCH3. CONCLUSIONS The possible presence of CADASIL must be suspected in patients with symptoms of cerebrovascular disease or dementia who present characteristic alterations in the magnetic resonance brain scan, especially when there is a compatible family history. The first choice diagnostic procedure must be a genetic study.
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Affiliation(s)
- A P Sempere
- Servicio de Neurología, Hospital Vega Baja, Orihuela, Alicante, España.
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Abstract
Stroke is a disease with well-defined modifiable risk factors such as arterial hypertension, smoking, diabetes, hyperlipidemia and atrial fibrillation. The need of new risk factors is based on the fact that only half the cardiovascular disease risk is explained by conventional risk factors. Inflammatory markers, infection, homocysteine and sleep-disordered breathing rank as the four most important new risk factors in cerebral atherosclerosis. C-reactive protein is the inflammatory marker that has been most thoroughly studied. Elevated concentrations of C-reactive protein increase the risk of heart disease and thromboembolic stroke in men and women. The role of Chlamydia pneumoniae is still controversial. Influenza vaccination is a simple and effective preventive measure against stroke. Despite the potential relationship between homocysteine and stroke, we should wait to the results of the ongoing trials to know if the reduction of homocysteine levels with vitamin therapy is of clinical benefit. Sleep-disordered breathing is a potential new risk factor with an effective therapy. Neurologists should not forget to look for sleep disorders in their stroke patients and probably manage them with breathing therapy from the acute phase.
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Affiliation(s)
- Jaime Diaz
- S Neurología, Hospital 12 de Octubre, Madrid, Spain
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Medrano V, Sempere AP, González E. [Paraneoplastic ataxia associated to anti CV2 antibodies]. Rev Neurol 2003; 36:131-3. [PMID: 12589599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Anti CV2 antibodies are a type of paraneoplastic antibodies that interact with the cytoplasmatic antigens of a subpopulation of oligodendrocytes. They are usually associated with the presence of a small cell carcinoma. We report the case of a patient with an epidermoid carcinoma of the lung and paraneoplastic cerebellous ataxia associated with anti CV2 antibodies. CASE REPORT Male aged 73, ex smoker for 10 years, with a 45 packet/year habit. He presented a 5 month old constitutional syndrome. Altered gait with a sensation of instability. During the course of the exploration, we detected an increase in the support base, the impossibility to walk in tandem, non exhaustible horizontal nystagmus in bilateral extreme look, and vertical when looking down, with abolition of Achilles reflexes. Brain MR revealed supratentorial demyelinating lesions of a probable ischemic origin. Anti CV 2 antibodies in serum positive (anti HU negative). Biopsy performed using bronchial brushing in the left upper lobe detected the presence of malign epithelial strain, not microcytic, cells, which are compatible with epidermoid carcinoma. DISCUSSION Anti CV2 antibodies have only been found in patients who have developed a neurological syndrome within the context of a neoplasia. The detection of these antibodies in serum is related with the presence of a concealed neoplasia
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Affiliation(s)
- V Medrano
- Unidad de Neurología, Hospital General de Elda, Elda (Alicante), España.
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Sempere AP, Mola S, Medrano V, Esguevillas T, Costa C, Salazar V, Flores-Ruiz JJ, Custardoy J. [Descriptive epidemiology of ambulatory neurological care in the Vega Baja (Alicante) area]. Rev Neurol 2002; 35:822-6. [PMID: 12436379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
AIMS The aim of our work is to analyse ambulatory neurological care in the area of Vega Baja, which is located in the province of Alicante (Spain), in order to find out: a) the demographic characteristics of the population that visits the neurologist; b) the motives that led to the visit; c) the diagnoses carried out. PATIENTS AND METHODS A prospective two year study of patients over the age of 14 sent to the Neurology department. The reasons for the visit were classified into 15 categories and the diagnoses were given a code according to the criteria set out in the International Classification of Diseases 9th edition. RESULTS A total of 2,227 patients were included in the study. The annual incidence of first visits was 10.6 per 1,000 people. 60% of the patients were women. The average age was 51.6 years old. Headache was the most frequent reason for the visiting the doctor. One out of every three patients visited because of headache and/or facial pain. The five most frequent diagnoses in the under 65 group were, in descending order of frequency: migraine, tension type headache, epilepsy, syncope and anxiety. The five most common diagnoses in the over 65 group were, in descending order of frequency: Alzheimer, Parkinson, transitory cerebral ischemia, cerebral thrombosis and epilepsy. CONCLUSIONS The type of ambulatory neurological pathology depends on the age of the patients, and thus we find that headache is prevalent in the younger patients whereas neurodegenerative and vascular pathological conditions are more common in those over the age of 65.
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Affiliation(s)
- A P Sempere
- Servicio de Neurología, Hospital Vega Baja, Orihuela, España.
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Medrano-Martínez V, Sempere AP, Mola S, Flores-Ruiz JJ, Vázquez-Suárez JC. [Amaurosis fugax as the sole manifestation of a dural arteriovenous fistula]. Rev Neurol 2002; 35:325-7. [PMID: 12235561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Ophthalmologic disorders caused by arteriovenous malformations (AVM) are generally related with alterations in the cavernous sinus or papilloedema. However, the appearance of amaurosis fugax (AF) as the sole clinical manifestation of an AVM has very rarely been reported in the literature. CASE REPORT We present the case of a 64 year old male patient who displayed recurring episodes of temporary monocular blindness (AF) as a consequence of the haemodynamic disorders triggered off in the course of a dural AVM. DISCUSSION The arteriovenous fistula, located in the anterior fossa, gives rise to theft phenomena in the region of the arteries that nourish the retina and trigger episodes of AF of an essentially haemodynamic nature.
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Sempere AP, Díaz Guzmán J. [Declaration of conflicts of interests]. Neurologia 2002; 17:175-6; author reply 176. [PMID: 11927112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Sempere AP, Millán JM, Royo-Vilanova C, Medrano V. [Type 8 spinocerebellar ataxia. A report of a family]. Rev Neurol 2001; 33:150-2. [PMID: 11562876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Over the past decade, from the genetic point of view, several of the entities included in the group of hereditary ataxias have been identified. We report a Spanish family with type 8 spinocerebellar ataxia (SCA8), one of the most recent hereditary ataxias to be described from the clinical and genetic points of view. CLINICAL CASE A 59 year old woman consulted us complaining of progressive dysarthria and unsteady gait. The only abnormal findings on neurological examination were those of cerebellar involvement. The patient s mother had a similar condition, characterized by difficulty in speaking which started when she was 62 years old and progressed to anarthria. Cranial magnetic resonance showed the presence of cerebellar atrophy with no signs of atrophy of the brainstem. On electromyographic studies there were no signs of neuropathy. Visual, auditory and sensory evoked potentials were normal. Genetic studies showed expansion of trinucleotide CTG (112 repetitions in the expanded allele and 28 repetitions in the normal allele) on the gene responsible for SCA8. CONCLUSION SCA8 should be included in the differential diagnosis of progressive cerebellar syndromes, especially when changes in speech predominate with regard to other cerebellar signs.
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Affiliation(s)
- A P Sempere
- Servicio de Neurología; Hospital Vega Baja, Orihuela, 03314, España.
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Carnero C, Maestre J, Marta J, Mola S, Olivares J, Sempere AP. [Validation of a model for the prediction of verbal semantic fluency]. Rev Neurol 2000; 30:1012-5. [PMID: 10904944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The diagnosis of dementia requires documentation of cognitive loss with respect to the patient's previous level. It would therefore be very useful to have models available which would predict the result expected in the tests normally used in the diagnosis of dementia. OBJECTIVE To validate a model for prediction of the results of a test of semantic verbal fluency in persons with no dementia. PATIENTS AND METHODS A model for the prediction of semantic verbal fluency deduced from a sample of 138 persons was applied to two other independent samples: the first of 86 persons from the same environment as the original sample and a second multicentric sample of 92 persons. The validity of the model was evaluated by residual analysis. RESULTS No sex differences were seen between the samples, but there were differences regarding the other variables, including the observed and predicted verbal fluency. The residuals of the samples did not differ from each other nor vary from zero, but were normally distributed. CONCLUSION The model proposed based on sociodemographic and clinical variables is valid and satisfactorily predicts the verbal fluency to be expected in each case.
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Affiliation(s)
- C Carnero
- Sección de Neurología, Hospital Torrecárdenas, Almería, España.
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Sempere AP, Bailén L, Martínez-Guillén J, Mola S. [Rabdomyolysis due to influenza A]. Rev Neurol 2000; 30:899. [PMID: 10870209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- A P Sempere
- Servicio de Neurología, Hospital Vega Baja, Orihuela, Alicante, España.
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Sempere AP, Ferrero M, Tahoces ML, Duarte J, Tabernero C, Cabezas C, Guerrero P, Clavería LE. [Side effects of antithrombotic treatment in the secondary prevention of cerebrovascular disease]. Rev Neurol 2000; 30:5-7. [PMID: 10742988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To determine the incidence of adverse effects of antithrombotic drugs (platelet anti-aggregants and anticoagulants) in patients with transient ischemic attacks (TIA) and mild ischemic strokes (IL). PATIENTS AND METHODS Clinical follow-up data on the patients with TIA and IL included in a community-based observational study undertaken in the province of Segovia. Adverse effects which led to suspension of treatment or were a potential danger for the patient's life were recorded. RESULTS The groups studied included 235 patients and the average initial age was 70.8 years. The average follow-up time was 3.6 years. The treatment initially given included: aspirin (75.7%), ticlopidine (12.8%) and acenocumarol (9.4%). Adverse effects led to suspension of treatment in 6% (5% with aspirin and acenocumarol, 17% with ticlopidine). The adverse effects of ticlopidine were mild and patients did not need admission to hospital (cutaneous exanthema, diarrhoea and reversible leucopenia). Aspirin was associated with digestive tract bleeding (2.8%) and cerebral hemorrhage (1.7%) which required hospital admission in most cases. One patient treated with acenocumarol presented with a retroperitoneal hematoma. CONCLUSIONS In general antithrombotic drugs are well-tolerated by patients with TIA and LI. Hemorrhagic complications, particularly of the digestive tract, associated with aspirin limit tolerance to it.
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Affiliation(s)
- A P Sempere
- Servicio de Neurología, Hospital General de Segovia, España.
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