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Petracca M, Carotenuto A, Scandurra C, Moccia M, Rosa L, Arena S, Ianniello A, Nozzolillo A, Turrini M, Streito LM, Abbadessa G, Cellerino M, Bucello S, Ferraro E, Mattioli M, Chiodi A, Inglese M, Bonavita S, Clerico M, Cordioli C, Moiola L, Patti F, Lavorgna L, Filippi M, Borriello G, D'Amico E, Pozzilli C, Brescia Morra V, Lanzillo R. Sexual dysfunction in multiple sclerosis: The impact of different MSISQ-19 cut-offs on prevalence and associated risk factors. Mult Scler Relat Disord 2023; 78:104907. [PMID: 37523809 DOI: 10.1016/j.msard.2023.104907] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Although multiple sclerosis (MS) Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a widely applied tool, no unique definition of sexual dysfunction (SD) based on its score exists. OBJECTIVE To explore the impact of different MSISQ-19 cut-offs on SD prevalence and associated risk factors, providing relevant information for its application in research and clinical settings. METHODS After defining SD according to two different MSISQ-19 cut-offs in 1155 people with MS (pwMS), we evaluated SD prevalence and association with sociodemographic and clinical features, mood status and disability via logistic regression. RESULTS Depending on the chosen cut-off, 45% to 54% of pwMS reported SD. SD defined as MSISQ-19 score >30 was predicted by age (OR=1.01, p=0.047), cognition (OR=0.96, p=0.004) and anxiety (OR=1.03, p=0.019). SD defined as a score >3 on any MSISQ-19 item was predicted by motor disability (OR=1.12, p=0.003) and cognition (OR= 0.96, p=0.002). CONCLUSION Applying different MSISQ-19 cut-offs influences both the estimated prevalence and the identification of risk factors for SD, a finding that should be considered during study planning and data interpretation. Preserved cognition exerts a protective effect towards SD regardless from the specific study setting, representing a key point for the implementation of preventive and therapeutic strategies.
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Affiliation(s)
- M Petracca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - A Carotenuto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - C Scandurra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - M Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Italy; MS Unit, Federico II University Hospital, Naples, Italy
| | - L Rosa
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - S Arena
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - A Ianniello
- MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - A Nozzolillo
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Turrini
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Ospedale di Montichiari, Brescia, Italy
| | - L M Streito
- San Luigi Gonzaga Academic Hospital, Orbassano, TO 10043, Italy
| | - G Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - S Bucello
- Multiple Sclerosis Centre, "E. Muscatello" Hospital - ASP8, Augusta, SR, Italy
| | - E Ferraro
- S. Filippo Neri Hospital, Rome, Italy
| | - M Mattioli
- NCL-Istituto di Neuroscienze Gruppo Neuromed, Rome, Italy
| | - A Chiodi
- Intradepartmental Program of Clinical Psychology, Federico II University Hospital, Naples, Italy
| | - M Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Clerico
- San Luigi Gonzaga Academic Hospital, Orbassano, TO 10043, Italy; Department of Clinical and Biological Sciences, University of Torino, Torino 10128, Italy
| | - C Cordioli
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Ospedale di Montichiari, Brescia, Italy
| | - L Moiola
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Patti
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - L Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Filippi
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - G Borriello
- MS Center, San Pietro Hospital Fatebenefratelli, Rome, Italy
| | - E D'Amico
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - C Pozzilli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - V Brescia Morra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - R Lanzillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy.
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Pittock S, Barnett M, Bennett J, Berthele A, de Sèze J, Levy M, Nakashima I, Oreja-Guevara C, Palace J, Paul F, Pozzilli C, Allen K, Mashhoon Y, Yountz M, Kim H. P-53 Efficacy and safety of ravulizumab in adults with anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder: Outcomes from the phase 3 CHAMPION-NMOSD trial. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.070] [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: 03/08/2023]
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3
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Abstract
Ponesimod (ACT-128800) is a directly bioavailable, rapidly reversible sphingosine-1-phosphate (S1P) receptor modulator, highly selective for the subtype 1 (S1P₁ receptor). It acts by blocking the egress of lymphocytes from the lymphoid organs, thus limiting the entry of autoreactive cells into the central nervous system. Unlike fingolimod, ponesimod does not require monitoring of the first dose, thanks to a 14-day uptitration regimen, which markedly reduces the incidence of cardiodynamic effects related to the initiation of therapy. Results from the OPTIMUM phase III trial demonstrated the superiority of ponesimod over teriflunomide on disease activity markers, without unexpected safety concerns. Furthermore, the drug is eliminated within 1 week of discontinuation, allowing for the reversibility of its effects. Ponesimod was recently approved in both the U.S. and E.U. for the treatment of relapsing forms of multiple sclerosis. This review summarizes the pharmacological characteristics of ponesimod and the main studies that led to its approval.
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Affiliation(s)
- A Ianniello
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy. .,Multiple Sclerosis Centre, Sant'Andrea Hospital, Rome, Italy
| | - C Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Multiple Sclerosis Centre, Sant'Andrea Hospital, Rome, Italy
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4
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Pontillo G, Tommasin S, Cuocolo R, Petracca M, Petsas N, Ugga L, Carotenuto A, Pozzilli C, Iodice R, Lanzillo R, Quarantelli M, Brescia Morra V, Tedeschi E, Pantano P, Cocozza S. A Combined Radiomics and Machine Learning Approach to Overcome the Clinicoradiologic Paradox in Multiple Sclerosis. AJNR Am J Neuroradiol 2021; 42:1927-1933. [PMID: 34531195 DOI: 10.3174/ajnr.a7274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 07/12/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging explains only a fraction of the clinical outcome variance in multiple sclerosis. We aimed to evaluate machine learning models for disability prediction on the basis of radiomic, volumetric, and connectivity features derived from routine brain MR images. MATERIALS AND METHODS In this retrospective cross-sectional study, 3T brain MR imaging studies of patients with multiple sclerosis, including 3D T1-weighted and T2-weighted FLAIR sequences, were selected from 2 institutions. T1-weighted images were processed to obtain volume, connectivity score (inferred from the T2 lesion location), and texture features for an atlas-based set of GM regions. The site 1 cohort was randomly split into training (n = 400) and test (n = 100) sets, while the site 2 cohort (n = 104) constituted the external test set. After feature selection of clinicodemographic and MR imaging-derived variables, different machine learning algorithms predicting disability as measured with the Expanded Disability Status Scale were trained and cross-validated on the training cohort and evaluated on the test sets. The effect of different algorithms on model performance was tested using the 1-way repeated-measures ANOVA. RESULTS The selection procedure identified the 9 most informative variables, including age and secondary-progressive course and a subset of radiomic features extracted from the prefrontal cortex, subcortical GM, and cerebellum. The machine learning models predicted disability with high accuracy (r approaching 0.80) and excellent intra- and intersite generalizability (r ≥ 0.73). The machine learning algorithm had no relevant effect on the performance. CONCLUSIONS The multidimensional analysis of brain MR images, including radiomic features and clinicodemographic data, is highly informative of the clinical status of patients with multiple sclerosis, representing a promising approach to bridge the gap between conventional imaging and disability.
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Affiliation(s)
- G Pontillo
- From the Departments of Advanced Biomedical Sciences (G.P., L.U., E.T., S.C.).,Electrical Engineering and Information Technology (G.P., M.Q.)
| | - S Tommasin
- Department of Human Neuroscience (S.T., C.P., P.P.), Sapienza University of Rome, Rome, Italy
| | - R Cuocolo
- Clinical Medicine and Surgery (R.C.) .,Laboratory of Augmented Reality for Health Monitoring (R.C.)
| | - M Petracca
- Department of Electrical Engineering and Information Technology, and Department of Neurosciences and Reproductive and Odontostomatological Sciences (M.P., A.C., R.I., R.L., V.B.M.), University of Naples "Federico II," Naples, Italy
| | - N Petsas
- Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Mediterraneo (N.P., P.P.), Pozzilli, Italy
| | - L Ugga
- From the Departments of Advanced Biomedical Sciences (G.P., L.U., E.T., S.C.)
| | - A Carotenuto
- Department of Electrical Engineering and Information Technology, and Department of Neurosciences and Reproductive and Odontostomatological Sciences (M.P., A.C., R.I., R.L., V.B.M.), University of Naples "Federico II," Naples, Italy
| | - C Pozzilli
- Department of Human Neuroscience (S.T., C.P., P.P.), Sapienza University of Rome, Rome, Italy
| | - R Iodice
- Department of Electrical Engineering and Information Technology, and Department of Neurosciences and Reproductive and Odontostomatological Sciences (M.P., A.C., R.I., R.L., V.B.M.), University of Naples "Federico II," Naples, Italy
| | - R Lanzillo
- Department of Electrical Engineering and Information Technology, and Department of Neurosciences and Reproductive and Odontostomatological Sciences (M.P., A.C., R.I., R.L., V.B.M.), University of Naples "Federico II," Naples, Italy
| | - M Quarantelli
- Electrical Engineering and Information Technology (G.P., M.Q.).,Institute of Biostructure and Bioimaging (M.Q.), National Research Council, Naples, Italy
| | - V Brescia Morra
- Department of Electrical Engineering and Information Technology, and Department of Neurosciences and Reproductive and Odontostomatological Sciences (M.P., A.C., R.I., R.L., V.B.M.), University of Naples "Federico II," Naples, Italy
| | - E Tedeschi
- From the Departments of Advanced Biomedical Sciences (G.P., L.U., E.T., S.C.)
| | - P Pantano
- Department of Human Neuroscience (S.T., C.P., P.P.), Sapienza University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Mediterraneo (N.P., P.P.), Pozzilli, Italy
| | - S Cocozza
- From the Departments of Advanced Biomedical Sciences (G.P., L.U., E.T., S.C.)
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5
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D'Amico E, Zanghì A, Sciandra M, Borriello G, Callari G, Gallo A, Salemi G, Cottone S, Buccafusca M, Valentino P, Bossio RB, Grimaldi LME, Pozzilli C, Tedeschi G, Zappia M, Patti F. Discontinuation of teriflunomide and dimethyl fumarate in a large Italian multicentre population: a 24-month real-world experience. J Neurol 2018; 266:411-416. [PMID: 30515629 DOI: 10.1007/s00415-018-9144-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/07/2018] [Accepted: 11/26/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Teriflunomide (TRF) and Dimethyl fumarate (DMF) are licensed drugs for relapsing-remitting Multiple Sclerosis (RRMS). OBJECTIVES We aimed to compare the rate and the time to discontinuation among persons with RRMS (pwRRMS), newly treated with TRF and DMF. MATERIALS AND METHODS A retrospective study on prospectively collected data was performed in nine tertiary MS centers, in Italy. The 24-month discontinuation rate in the two cohorts was the primary study outcome. We also assessed the time to discontinuation and reasons of therapy withdrawn. Discontinuation of TRF and DMF was defined as a gap of treatment ≥ 60 days. RESULTS A cohort of 903 pwRRMS (316 on TRF and 587 on DMF) was analyzed. During 24 months of follow-up, pwRRMS on TRF and DMF showed similar discontinuation rates. The analysis of predictors with Cox regression model showed differences between the two groups (p for log-rank test = 0.007); male gender [HR 2.21 (1.00-4.90); p = 0.01] and the number of previous switches [HR 1.47 (1.16-1.86); p = 0.01] were associated with higher hazard of discontinuation in the DMF group. CONCLUSIONS In a real-world setting, pwRRMS on TRF and DMF had similar discontinuation rates over 24 months. Male pwRRMS on DMF with a previous history of therapeutic failure are at more risk of discontinuation therapy.
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Affiliation(s)
- E D'Amico
- Department "G.F. Ingrassia", MS centre University of Catania, Catania, Italy
| | - A Zanghì
- Department "G.F. Ingrassia", MS centre University of Catania, Catania, Italy
| | - M Sciandra
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
| | - G Borriello
- University of Rome "La Sapienza"-S. Andrea Hospital, Rome, Italy
| | - G Callari
- Institute Foundation "G. Giglio", Cefalù, Italy
| | - A Gallo
- University "Federico II"-I Neurologic Clinic, Naples, Italy
| | - G Salemi
- Policlinico "P. Giaccone", Palermo, Italy
| | - S Cottone
- Villa Sofia Cervello Hospital, Palermo, Italy
| | - M Buccafusca
- Azienda Ospedaliera Universitaria "G. Martino", Messina, Italy
| | - P Valentino
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - R B Bossio
- Azienda Sanitaria Provinciale U. O. di Neurologia, Cosenza, Italy
| | | | - C Pozzilli
- University of Rome "La Sapienza"-S. Andrea Hospital, Rome, Italy
| | - G Tedeschi
- University "Federico II"-I Neurologic Clinic, Naples, Italy
| | - M Zappia
- Department "G.F. Ingrassia", MS centre University of Catania, Catania, Italy
| | - F Patti
- Department "G.F. Ingrassia", MS centre University of Catania, Catania, Italy.
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6
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Alroughani R, Singer B, Broadley S, Eichau S, Hartung H, Havrdova E, Kim H, Nakamura K, Navas C, Pozzilli C, Rovira A. Alemtuzumab Improves Clinical and MRI Disease Activity Outcomes, Including Slowing of Brain Volume Loss, in Relapsing-remitting Multiple Sclerosis Patients Over 8 Years: Care-MS Ii Follow-up (topaz Study). Mult Scler Relat Disord 2018. [DOI: 10.1016/j.msard.2018.10.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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7
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Fernández O, Delvecchio M, Edan G, Fredrikson S, Giovannoni G, Hartung HP, Havrdova E, Kappos L, Pozzilli C, Soerensen PS, Tackenberg B, Vermersch P, Comi G. Survey of diagnostic and treatment practices for multiple sclerosis (MS) in Europe. Part 2: Progressive MS, paediatric MS, pregnancy and general management. Eur J Neurol 2018; 25:739-746. [DOI: 10.1111/ene.13581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/08/2018] [Indexed: 12/01/2022]
Affiliation(s)
- O. Fernández
- Department of Neurology; Instituto de Investigación Biomédica de Malaga; Hospital Regional Universitario; Malaga University; Malaga Spain
| | - M. Delvecchio
- Public Management and Policy; SDA Bocconi Scuola di Direzione Aziendale; Milano Italy
| | - G. Edan
- Neurology; Institut des Neurosciences Cliniques de Rennes; Rennes France
| | - S. Fredrikson
- Division of Neurology; Karolinska Institute; Stockholm Sweden
| | - G. Giovannoni
- Department of Neurology; Centre for Neuroscience and Trauma; Barts and the London School of Medicine and Dentistry; Blizard Institute of Cell and Molecular Science; Queen Mary University of London; London UK
| | - H.-P. Hartung
- Neurology; Heinrich Heine University Düsseldorf; Düsseldorf Germany
| | - E. Havrdova
- Department of Neurology; Charles University; Prague Czech Republic
| | - L. Kappos
- Neurology and Department of Biomedicine; Universitatsspital Basel; Basel Switzerland
| | - C. Pozzilli
- Neurological Sciences; MS Centre; Rome Italy
| | - P. S. Soerensen
- Department of Neurology; Danish Multiple Sclerosis Research Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - B. Tackenberg
- Klinik für Neurologie; Phillipps-Universitat Marburg Fachgebiet Indologie und Tibetologie; Marburg Germany
| | | | - G. Comi
- Neuroimaging Research Unit; Osepdale San Raffaele; Milan Italy
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8
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Fernández O, Delvecchio M, Edan G, Fredrikson S, Gionvannoni G, Hartung HP, Havrdova E, Kappos L, Pozzilli C, Soerensen PS, Tackenberg B, Vermersch P, Comi G. Survey of diagnostic and treatment practices for multiple sclerosis in Europe. Eur J Neurol 2017; 24:516-522. [DOI: 10.1111/ene.13236] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- O. Fernández
- Department of Neurology; Instituto de Investigación Biomédica de Malaga; Hospital Regional Universitario; Malaga University; Malaga Spain
| | - M. Delvecchio
- Public Management and Policy; SDA Bocconi Scuola di Direzione Aziendale; Milano Italy
| | - G. Edan
- Neurology; Institut des Neurosciences Cliniques de Rennes; Rennes France
| | - S. Fredrikson
- Division of Neurology; Karolinska Institute; Stockholm Sweden
| | - G. Gionvannoni
- Centre for Neuroscience and Trauma; Department of Neurology; Blizard Institute of Cell and Molecular Science; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - H.-P. Hartung
- Neurology; Heinrich Heine University Düsseldorf; Düsseldorf Germany
| | - E. Havrdova
- Department of Neurology; Charles University; Prague Czech Republic
| | - L. Kappos
- Neurology and Department of Biomedicine; Universitatsspital Basel; Basel Switzerland
| | - C. Pozzilli
- Neurological Sciences; MS Centre; Rome Italy
| | - P. S. Soerensen
- Department of Neurology; Danish Multiple Sclerosis Research Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - B. Tackenberg
- Klinik für Neurologie; Phillipps-Universitat Marburg Fachgebiet Indologie und Tibetologie; Marburg Germany
| | | | - G. Comi
- Neuroimaging Research Unit; Osepdale San Raffaele; Milan Italy
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9
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De Giglio L, Upadhyay N, De Luca F, Prosperini L, Tona F, Petsas N, Pozzilli C, Pantano P. Corpus callosum microstructural changes associated with Kawashima Nintendo Brain Training in patients with multiple sclerosis. J Neurol Sci 2016; 370:211-213. [DOI: 10.1016/j.jns.2016.09.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 12/24/2022]
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10
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Patti F, Messina S, Solaro C, Amato MP, Bergamaschi R, Bonavita S, Bruno Bossio R, Brescia Morra V, Costantino GF, Cavalla P, Centonze D, Comi G, Cottone S, Danni M, Francia A, Gajofatto A, Gasperini C, Ghezzi A, Iudice A, Lus G, Maniscalco GT, Marrosu MG, Matta M, Mirabella M, Montanari E, Pozzilli C, Rovaris M, Sessa E, Spitaleri D, Trojano M, Valentino P, Zappia M. Efficacy and safety of cannabinoid oromucosal spray for multiple sclerosis spasticity. J Neurol Neurosurg Psychiatry 2016; 87:944-51. [PMID: 27160523 PMCID: PMC5013116 DOI: 10.1136/jnnp-2015-312591] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The approval of 9-δ-tetrahydocannabinol and cannabidiol (THC:CBD) oromucosal spray (Sativex) for the management of treatment-resistant multiple sclerosis (MS) spasticity opened a new opportunity for many patients. The aim of our study was to describe Sativex effectiveness and adverse events profile in a large population of Italian patients with MS in the daily practice setting. METHODS We collected data of all patients starting Sativex between January 2014 and February 2015 from the mandatory Italian medicines agency (AIFA) e-registry. Spasticity assessment by the 0-10 numerical rating scale (NRS) scale is available at baseline, after 1 month of treatment (trial period), and at 3 and 6 months. RESULTS A total of 1615 patients were recruited from 30 MS centres across Italy. After one treatment month (trial period), we found 70.5% of patients reaching a ≥20% improvement (initial response, IR) and 28.2% who had already reached a ≥30% improvement (clinically relevant response, CRR), with a mean NRS score reduction of 22.6% (from 7.5 to 5.8). After a multivariate analysis, we found an increased probability to reach IR at the first month among patients with primary and secondary progressive MS, (n=1169, OR 1.4 95% CI 1.04 to 1.9, p=0.025) and among patients with >8 NRS score at baseline (OR 1.8 95% CI 1.3-2.4 p<0.001). During the 6 months observation period, 631(39.5%) patients discontinued treatment. The main reasons for discontinuation were lack of effectiveness (n=375, 26.2%) and/or adverse events (n=268, 18.7%). CONCLUSIONS Sativex can be a useful and safe option for patients with MS with moderate to severe spasticity resistant to common antispastic drugs.
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Affiliation(s)
- F Patti
- Department of Medical, Surgical Science and Advanced Technology "GF Ingrassia", University of Catania, Catania, Italy
| | - S Messina
- Department of Medical, Surgical Science and Advanced Technology "GF Ingrassia", University of Catania, Catania, Italy
| | - C Solaro
- Neurology Unit, Department Head and Neck, ASL3 Genova, Genova, Italy
| | - M P Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
| | - R Bergamaschi
- Department of Neurology, Neurology Institute C Mondino, Pavia, Italy
| | - S Bonavita
- I Clinic Neurology, II University of Naples, Naples, Italy
| | - R Bruno Bossio
- Neurology Operating Unit, Multiple Sclerosis Center, Provincial Health Authority of Cosenza, Cosenza, Italy
| | - V Brescia Morra
- Multiple Sclerosis Centre, University Federico II, Naples, Italy
| | - G F Costantino
- Demyelinating Diseases Centre, Foggia Hospital, Foggia, Italy
| | - P Cavalla
- Multiple Sclerosis Centre, S. Giovanni Battista, Molinette Hospital, Turin, Italy
| | - D Centonze
- Department of Systems Medicine, Multiple Sclerosis Clinical and Research Center, Tor Vergata University, Rome, Italy Unit of Neurology and of Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - G Comi
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - S Cottone
- Neuroimmunology Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - M Danni
- Neurology Clinic, Ancona Hospital, Ancona, Italy
| | - A Francia
- Department Neurol Psich, Multiple Sclerosis Center, Sapienza University, Rome, Italy
| | - A Gajofatto
- Multiple Sclerosis Centre, University of Verona, Verona, Italy
| | - C Gasperini
- Neurology Division, San Camillo Hospital, Rome, Italy
| | - A Ghezzi
- Multiple Sclerosis Centre, Sant'Antonio Abate Hospital, Gallarate, Italy
| | - A Iudice
- Multiple Sclerosis Centre, University Hospital Pisa, Pisa, Italy
| | - G Lus
- Multiple Sclerosis Center, Second University of Naples, Naples, Italy
| | - G T Maniscalco
- Multiple Sclerosis Centre, Cardarelli Hospital, Naples, Italy
| | - M G Marrosu
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - M Matta
- Multiple Sclerosis Centre (CRESM), San Luigi Gonzaga Hospital, Orbassano, Italy
| | - M Mirabella
- Multiple Sclerosis Centre, Cattolica University, Rome, Italy
| | - E Montanari
- Multiple Sclerosis Centre, Vaio Hospital, Fidenza, Italy
| | - C Pozzilli
- Multiple Sclerosis Centre, S. Andrea Hospital, Rome, Italy
| | - M Rovaris
- Multiple Sclerosis Centre, IRCCS Don Gnocchi Foundation, Milan, Italy
| | - E Sessa
- Multiple Sclerosis Centre, IRCCS-Bonino Pulejo Centre, Messina, Italy
| | - D Spitaleri
- Multiple Sclerosis Centre, San G. Moscati Hospital, Avellino, Italy
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - P Valentino
- Department of Medical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - M Zappia
- Department of Medical, Surgical Science and Advanced Technology "GF Ingrassia", University of Catania, Catania, Italy
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11
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Pozzilli C, Palmisano L, Mainero C, Tomassini V, Marinelli F, Ristori G, Gasperini C, Fabiani M, Battaglia MA. Relationship between emotional distress in caregivers and health status in persons with multiple sclerosis. Mult Scler 2016; 10:442-6. [PMID: 15327043 DOI: 10.1191/1352458504ms1046oa] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 11/05/2022]
Abstract
Caregivers of persons with multiple sclerosis (MS) exhibit less satisfaction with quality of life with respect to the general population. To assess the relationship between depression in caregivers and health status profiles of MS patients, we examined data from 133 patients and their respective caregivers, as a part of a prospective randomized trial aimed to investigate the effectiveness of home-based care. Patients were evaluated at baseline and one year later with measures of physical and psychological impairment and health status (SF-36 Health Survey). Caregivers’ psychological morbidity was assessed by the Profile of Mood State (POMS) at the same time points. An improvement of patients’ health status as measured in four out of eight SF-36 dimensions was observed over the study period, while psychological morbidity of their caregivers did not change significantly. Depression in caregivers was related to physical, emotional and health status of the patients at baseline and/or at 12-month follow-up. Changes in the degree of depression of caregivers were also associated with changes in disability and health status of the patients. This study confirms and extends in a home-care setting previous findings on relationships between patients’ status and depression in caregivers. It suggests that the caregiver is an appropriate and independent target for more focused therapeutic strategies.
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Affiliation(s)
- C Pozzilli
- Department of Neurological Sciences, La Sapienza University, Rome, Italy.
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12
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Pestalozza IF, Pozzilli C, Di Legge S, Piattella MC, Pantano P, Caramia F, Pasqualetti P, Lenzi GL. Monthly brain magnetic resonance imaging scans in patients with clinically isolated syndrome. Mult Scler 2016; 11:390-4. [PMID: 16042219 DOI: 10.1191/1352458505ms1175oa] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 11/05/2022]
Abstract
We investigated if monthly gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) can assist the clinician in anticipating the diagnosis of multiple sclerosis (MS) in the very first few months following a clinically isolated syndrome (CIS). A consecutive series of CIS patients with ≥ 3 T2-weighted (T2W) hyperintense brain MRI lesions suggestive of MS were followed up for the first six consecutive months after enrollment with monthly triple-dose Gd-enhanced brain MRI scan. MRI conversion to MS was defined by the presence of either ≥ 1 new Gd-enhancing lesion or ≥ 1 new T2W lesions in the subsequent MRI scan. Sixty patients were included. Of them, 30 (50%) had at least one Gd-enhancing lesion on the baseline MRI scan. After three months, MRI conversion to MS was observed in 80% and 62% of patients based on the appearance of ≥ 1 new T2 lesion and ≥ 1 new Gd-enhancing lesions, respectively. The presence of ≥ 1 new T2W lesion was observed in 90% and 82% of patients who had, at baseline, a Gd-positive MRI scan and dissemination in space based on the new McDonald’s criteria, respectively. The rate of MRI conversion remained almost stable in the last two MRI scans. Our study suggests that the majority of CIS patients with an abnormal baseline scan showed an MRI conversion to MS after three months. The model of six months as the optimal interval for repeating MRI exam is not supported by the present data.
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Affiliation(s)
- I F Pestalozza
- Department of Neurological Science, University La Sapienza, Rome, Italy
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13
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Ghezzi A, Amato MP, Capobianco M, Gallo P, Marrosu G, Martinelli V, Milani N, Milanese C, Moiola L, Patti F, Pilato V, Pozzilli C, Trojano M, Zaffaroni M, Comi G. Disease-modifying drugs in childhood-juvenile multiple sclerosis: results of an Italian co-operative study. Mult Scler 2016; 11:420-4. [PMID: 16042224 DOI: 10.1191/1352458505ms1206oa] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [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: 11/05/2022]
Abstract
Objective: Immunomodulatory drugs (IDs) (interferon beta (IFNβ) and glatiramer acetate (GA)) reduce relapse rate and disease progression in relapsing-remitting multiple sclerosis (RRMS) but extensive data are not available on the effectiveness and tolerability of these drugs in childhood or adolescence. The aim of this study was to evaluate the impact of IFNβ and GA in MS patients treated before 16 years of age. Methods: A research group (Immunomodulatory Treatment of Early onset MS (ITEMS)) was promoted in Italy to collect a large series of patients affected by clinically definite and RRMS and treated with IDs before 16 years of age. Fifteen centres recognized subjects suitable for inclusion: 76 patients (52 females) were collected with a mean age at onset of 12.4 (SD 2.5) years, a mean disease duration of 18.6 (SD 14.7) and a relapse rate of 3.1 (SD 2.9). Results: Results were evaluated in 65 (45 females) subjects with a pretreatment and a treatment duration >3 months: 38 were treated with IFNβ-1a once weekly (Avonex), 18 with IFNβ three times weekly (16 with Rebif, 2 with Betaferon) and nine with GA (Copaxone). The mean pretreatment period was respectively 20, 18 and 9.2 months. The treatment duration lasted respectively 23.3, 40.7 and 33.3 months. The mean annualized relapse rate decreased dramatically during the treatment: from 2.4 to 0.4 in the Avonex group, from 3.2 to 0.8 in the Rebif-Betaferon group and from 2.8 to 0.25 in the GA group. The mean final EDSS scores were respectively (in brackets the initial scores): 1.3 (1.4), 1.6 (1.8) and 0.6 (1.1). In the whole group, the final score was unchanged or reduced in all subjects except eight. Clinical side effects were recorded in 41/65 subjects (mainly in subjects treated with IFNβ), abnormal laboratory findings were observed in 13/65 subjects: they were transient in most cases. IFNβ was stopped in six cases: in four because of inefficacy and in two cases because of side effects. Conclusions: Sixty-five clinically definite MS subjects were treated during childhood or adolescence with IDs. The treatment reduced the relapse rate and the progression of the disease in most cases. Side effects were common in subjects treated with IFNβ, but were well tolerated in most cases.
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Affiliation(s)
- A Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Italy.
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14
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Salvetti M, Ristori G, Fiori P, Buttinelli C, Fieschi C, Pozzilli C, Battistini L, Brosnan C. V-delta2+ gamma/delta T cells directly recognize 70-kD heat shock proteins: relevance to MS. Mult Scler 2016. [DOI: 10.1177/135245859600200513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M Salvetti
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - G Ristori
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - P Fiori
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - C Buttinelli
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - C Fieschi
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - C Pozzilli
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - L Battistini
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - C Brosnan
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
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15
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Fazekas F, Sørensen PS, Filippi M, Ropele S, Lin X, Koelmel HW, Fernandez O, Pozzilli C, O'Connor P, Enriquez MM, Hommes OR. MRI results from the European Study on Intravenous Immunoglobulin in Secondary Progressive Multiple Sclerosis (ESIMS). Mult Scler 2016; 11:433-40. [PMID: 16042226 DOI: 10.1191/1352458505ms1196oa] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 11/05/2022]
Abstract
Background: Monthly application of high-dose intravenous immunoglobulin (IVIG) to patients with secondary progressive multiple sclerosis (MS) showed no clinical benefit in the European Study on Immunoglobulin in MS (ESIMS). Magnetic resonance imaging (MRI) results may provide insights into the morphologic consequences of such treatment. Methods: A total of 318 patients (mean age 44± 7 years) were enrolled in 31 European and Canadian centres and treated monthly with 1 g/kg body weight of IVIG or equivalent amounts of albumin 0.1% for 27 months. MRI was performed at baseline and after 12 and 24 months and comprised of conventional dual-echo T2-weighted and T1-weighted scans before and after application of 0.1 mmol/kg Gd-DTPA. Results: Similar to clinical variables, MRI measures at baseline were well comparable between treatment groups except for a somewhat lower mean number of contrast-enhancing lesions and number of active scans in IVIG-treated patients. Over the trial period there was almost no change of the T2-lesion load and the ‘black hole’ volume in both treatment groups and the cumulative number of contrast-enhancing lesions were similar. There was only a trend for fewer new or enlarged T2-lesions in IVIG patients, which disappeared after correction for the imbalance in the number of contrast-enhancing lesions at baseline. Brain volume in terms of a partial cerebral fraction decreased significantly less with IVIG than placebo treatment (final visit:-0.62± 0.88% versus-0.88± 0.91%; P= 0.009). This difference remained statistically significant with correction for active lesions at baseline (P= 0.02) and was seen primarily in male patients and those with an Expanded Disability Status Scale score ≥ 6 and no relapses in the two years before the study. Conclusion: The absence of significant differences in conventional MRI measures between both treatment groups parallels the negative clinical results of ESIMS. The causes for and possible long-term clinical effects of a lower rate of brain volume loss in IVIG patients should be explored further.
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Affiliation(s)
- F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria.
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16
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Giovannelli M, Borriello G, Castri P, Prosperini L, Pozzilli C. Early physiotherapy after injection of botulinum toxin increases the beneficial effects on spasticity in patients with multiple sclerosis. Clin Rehabil 2016; 21:331-7. [PMID: 17613573 DOI: 10.1177/0269215507072772] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [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: 11/17/2022]
Abstract
Objective : To determine whether additional physiotherapy increases botulinum toxin type A effects in reducing spasticity in patients with multiple sclerosis. Design : A single-blind, randomized, controlled pilot trial with a 12-week study period. Subjects : Thirty-eight patients with progressive multiple sclerosis affected by focal spasticity and who were observed at the Multiple Sclerosis Centre operating in the S. Andrea Hospital in Rome. Interventions : For intervention all patients received botulinum toxin type A; the treatment group also received additional physiotherapy to optimize management through passive or active exercise and stretching regimens. Main measures : To measure objective and subjective level of spasticity, patients were assessed at baseline, 2, 4 and 12 weeks post treatment by Modified Ashworth Scale and visual analogue scale. Results : When compared with the control group, we found a significant decrease of spasticity by Modified Ashworth Scale (P < 0.01 by t-test) in the treatment group at week 2 (2.73 versus 3.22), week 4 (2.64 versus 3.33) and week 12 (2.68 versus 3.33). The mean (%) difference in Modified Ashworth Scale score between baseline and the end of follow-up was —0.95 (26.1) in the treatment group and —0.28 (7.7) in the control group (P < 0.01). The combined treatment proved also to be more effective by visual analogue scale (P < 0.01) at week 4 (6.95 versus 5.50) and at week 12 (7.86 versus 6.56) but not at week 2 (5.18 versus 5.50; P = 0.41). Conclusions : Our data suggest that physiotherapy in combination with botulinum toxin type A injection can improve overall response to botulinum toxin.
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Affiliation(s)
- M Giovannelli
- Multiple Sclerosis Centre, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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17
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Pozzilli C, Pugliatti M. An overview of pregnancy-related issues in patients with multiple sclerosis. Eur J Neurol 2016; 22 Suppl 2:34-9. [PMID: 26374512 DOI: 10.1111/ene.12797] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
Abstract
Although pregnancy in women with multiple sclerosis (MS) is not generally considered high risk, there are some associated therapeutic challenges. The pregnancy-associated reduction in the relapse rate, especially in the third trimester, is followed by a sharp increase in the first few months postpartum. Nevertheless, retrospective evidence for pregnant women with and without MS followed for up to 10 years indicates that pregnancy has no perceptible effect on long-term disease course or disability progression. Likewise, MS has no apparent effects on the pregnancy course or fetal outcomes. All disease-modifying therapies (DMTs) have potential adverse effects on fertility and pregnancy outcomes, but the level of risk varies amongst agents. There is some support for continued use of interferon-β and glatiramer acetate throughout pregnancy to reduce the risk of relapse. Use of DMTs during breastfeeding is best avoided if possible. Close evaluation of drug safety information is imperative when managing women with MS who are pregnant or wish to become pregnant. Decision-making should be a shared experience between patient and physician, and the approach must be individualized for each patient.
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Affiliation(s)
- C Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - M Pugliatti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Italy
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18
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Amato M, Tortorella C, Trojano M, Cocco E, Marrosu M, Lugaresi A, Annovazzi P, Ghezzi A, Gasperini C, Iudice A, Bellantonio P, Patti F, Cavalla P, Totaro R, Pozzilli C, Bosco A, Uccelli A, Lanzillo R, Brescia Morra V, Portaccio E, for T. Disease re-activation during pregnancy after natalizumab suspension in patients with multiple sclerosis. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Sbardella E, Tona F, Petsas N, Upadhyay N, Piattella MC, Filippini N, Prosperini L, Pozzilli C, Pantano P. Functional connectivity changes and their relationship with clinical disability and white matter integrity in patients with relapsing–remitting multiple sclerosis. Mult Scler 2015; 21:1681-92. [DOI: 10.1177/1352458514568826] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/22/2014] [Indexed: 11/15/2022]
Abstract
Background and objective: To define the pathological substrate underlying disability in multiple sclerosis by evaluating the relationship of resting-state functional connectivity with microstructural brain damage, as assessed by diffusion tensor imaging, and clinical impairments. Methods: Thirty relapsing–remitting patients and 24 controls underwent 3T-MRI; motor abilities were evaluated by using measures of walking speed, hand dexterity and balance capability, while information processing speed was evaluated by a paced auditory serial addiction task. Independent component analysis and tract-based spatial statistics were applied to RS-fMRI and diffusion tensor imaging data using FSL software. Group differences, after dual regression, and clinical correlations were modelled with General-Linear-Model and corrected for multiple comparisons. Results: Patients showed decreased functional connectivity in 5 of 11 resting-state-networks (cerebellar, executive-control, medial-visual, basal ganglia and sensorimotor), changes in inter-network correlations and widespread white matter microstructural damage. In multiple sclerosis, corpus callosum microstructural damage positively correlated with functional connectivity in cerebellar and auditory networks. Moreover, functional connectivity within the medial-visual network inversely correlated with information processing speed. White matter widespread microstructural damage inversely correlated with both the paced auditory serial addiction task and hand dexterity. Conclusions: Despite the within-network functional connectivity decrease and the widespread microstructural damage, the inter-network functional connectivity changes suggest a global brain functional rearrangement in multiple sclerosis. The correlation between functional connectivity alterations and callosal damage uncovers a link between functional and structural connectivity. Finally, functional connectivity abnormalities affect information processing speed rather than motor abilities.
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Affiliation(s)
- Emilia Sbardella
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - F Tona
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - N Petsas
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - N Upadhyay
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - MC Piattella
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - N Filippini
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - L Prosperini
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - C Pozzilli
- Department of Neurology and Psychiatry, University of Rome, Italy
| | - P Pantano
- Department of Neurology and Psychiatry, University of Rome, Italy
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20
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De Giglio L, Gasperini C, Tortorella C, Trojano M, Pozzilli C. Natalizumab discontinuation and disease restart in pregnancy: a case series. Acta Neurol Scand 2015; 131:336-40. [PMID: 25598313 DOI: 10.1111/ane.12364] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The humanized monoclonal alpha4-integrin antibody Natalizumab (NTZ) (Tysabri(©) , Biogen Idec, Cambridge, MA, USA) has shown to be effective in multiple sclerosis (MS) therapy; however, the interruption of the drug has been related to a disease restart. This risk has to be carefully considered in case of accidental or desired pregnancies. AIM OF THE STUDY To report the risk of disease restart in patients who interrupted NTZ because of pregnancy and discuss the implication of NTZ choice in female childbearing patients with MS. METHODS Clinical histories and MRI images of four pregnant women with MS who interrupted NTZ. RESULTS Despite pregnancy is usually related with disease stability, the cases presented here showed an abrupt increase of disability with high number of MRI lesions, some of them with a mass effect. CONCLUSIONS We recommend that female patients on childbearing age must be informed before starting NTZ treatment of the risk of a return of disease activity when the drug is discontinued. The risk occurs even during pregnancy a condition that is considered as protective for women with MS.
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Affiliation(s)
- L. De Giglio
- Department of Neurology and Psychiatry; “Sapienza” Unversity of Rome; Rome Italy
| | - C. Gasperini
- Department of Neuroscience; “S. Camillo Forlanini” Hopsital; Rome Italy
| | - C. Tortorella
- Department of Department of Basic Medical Sciences; Neurosciences and Sense Organs; University of Bari; Bari Italy
| | - M. Trojano
- Department of Department of Basic Medical Sciences; Neurosciences and Sense Organs; University of Bari; Bari Italy
| | - C. Pozzilli
- Department of Neurology and Psychiatry; “Sapienza” University of Rome; Rome Italy
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21
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Masera S, Cavalla P, Prosperini L, Mattioda A, Mancinelli CR, Superti G, Chiavazza C, Vercellino M, Pinessi L, Pozzilli C. Parity is associated with a longer time to reach irreversible disability milestones in women with multiple sclerosis. Mult Scler 2014; 21:1291-7. [PMID: 25533293 DOI: 10.1177/1352458514561907] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) frequently affects women of childbearing age. While short-term effects of pregnancy on MS course are well-known, whether pregnancy may influence long-term disability progression is debated. METHODS A two-centre retrospective study to investigate long-term effect of pregnancy on disability was performed in a population of MS women. Survival analyses and multivariate Cox proportional regression models (including early predictors of MS severity and exposure to disease-modifying treatments) were performed to compare time to reach well-established disability milestones in nulliparous women and in those with pregnancies after MS onset ('parous'). Women with pregnancies before MS onset were excluded from analyses as they represent a heterogeneous group. RESULTS Data about 445 women (261 nulliparous, 184 'parous') were analysed. A longer time to reach Expanded Disability Status Scale (EDSS) 4.0 and 6.0 was observed in parous women; Cox regression models revealed a lower risk for 'parous' than nulliparous women in reaching EDSS 4.0 and 6.0 (HR = 0.552, p = 0.008 and HR = 0.422, p = 0.012 respectively). CONCLUSION Our findings suggest that pregnancy after MS onset is associated with a slower long-term disability progression. Whether this represents a biological/immunological effect, or reflects a higher propensity toward childbearing in women with milder disease, it remains uncertain deserving further investigations.
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Affiliation(s)
- S Masera
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - P Cavalla
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - L Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - A Mattioda
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - C R Mancinelli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - G Superti
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - C Chiavazza
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - M Vercellino
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - L Pinessi
- MS Centre, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Italy
| | - C Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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22
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Amato MP, Goretti B, Ghezzi A, Hakiki B, Niccolai C, Lori S, Moiola L, Falautano M, Viterbo RG, Patti F, Cilia S, Pozzilli C, Bianchi V, Roscio M, Martinelli V, Comi G, Portaccio E, Trojano M. Neuropsychological features in childhood and juvenile multiple sclerosis: Five-year follow-up. Neurology 2014; 83:1432-8. [DOI: 10.1212/wnl.0000000000000885] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Bianchi V, De Giglio L, Prosperini L, Mancinelli C, De Angelis F, Barletta V, Pozzilli C. Mood and coping in clinically isolated syndrome and multiple sclerosis. Acta Neurol Scand 2014; 129:374-81. [PMID: 24172013 DOI: 10.1111/ane.12194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Few studies have examined behavioural changes in the early phase of multiple sclerosis (MS). The aim of the study is to investigate mood alterations and to explore coping strategies regarding patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS). MATERIALS AND METHODS The communication of diagnosis was made by one neurologist using a standardized approach. Depression, anxiety and coping questionnaires were filled in within 1 month from the diagnosis and at 3, 6, 12, 18 and 24 months subsequently. RESULTS Thirty-nine patients were examined (11 CIS, 28 RRMS), also 39 healthy controls. At entry, patients showed a lower degree of hostile behaviour and a higher level of depression than the controls. At follow-up, a reduction in depression, anxiety and a better coping adjustment was observed. A higher reliance on 'Accepting responsibilities' coping score was seen in patients with higher levels of depression and anxiety. No significant differences were revealed by group comparisons between CIS and RRMS. CONCLUSIONS This study highlights transient mood alterations and an improving of adaptive coping over a period of time in patients with CIS and RRMS. Similar emotional reactions and coping in clinical subgroups suggest that these factors are independent from the type of information provided during the communication of the diagnosis.
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Affiliation(s)
- V. Bianchi
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
| | - L. De Giglio
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
- Department of Psychology; Sapienza University; Rome Italy
| | - L. Prosperini
- Department of Neurology and Psychiatry; Sapienza University; Rome Italy
| | - C. Mancinelli
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
| | - F. De Angelis
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
| | - V. Barletta
- MS Centre; S. Andrea Hospital; Neurological Sciences; La Sapienza University; Rome Italy
| | - C. Pozzilli
- Department of Neurology and Psychiatry; Sapienza University; Rome Italy
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24
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Carlesimo M, Mari E, Abruzzese C, Cortesi G, Del Giglio L, Pozzilli C, Bozzao C, Chessa L. What is Erythema Annulare Centrifugum? A Familial Case. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M. Carlesimo
- NESMOS, U.O.C. Dermatology, Sant'Andrea Hospital of Rome, II Unit University of Rome “Sapienza”, Rome Italy
| | - E. Mari
- NESMOS, U.O.C. Dermatology, Sant'Andrea Hospital of Rome, II Unit University of Rome “Sapienza”, Rome Italy
| | - C. Abruzzese
- NESMOS, U.O.C. Dermatology, Sant'Andrea Hospital of Rome, II Unit University of Rome “Sapienza”, Rome Italy
| | - G. Cortesi
- NESMOS, U.O.C. Dermatology, Sant'Andrea Hospital of Rome, II Unit University of Rome “Sapienza”, Rome Italy
| | - L. Del Giglio
- Neurology, Sant'Andrea Hospital, University of Rome “Sapienza”, Rome, Italy
| | - C. Pozzilli
- Neurology, Sant'Andrea Hospital, University of Rome “Sapienza”, Rome, Italy
| | - C. Bozzao
- Medical Genetics, Sant'Andrea Hospital, University of Rome “Sapienza”, Rome Italy
| | - L. Chessa
- Medical Genetics, Sant'Andrea Hospital, University of Rome “Sapienza”, Rome Italy
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Ghezzi A, Pozzilli C, Grimaldi LME, Moiola L, Brescia-Morra V, Lugaresi A, Lus G, Rinaldi F, Rocca MA, Trojano M, Bianchi A, Comi G, Filippi M. Natalizumab in pediatric multiple sclerosis: results of a cohort of 55 cases. Mult Scler 2013; 19:1106-12. [PMID: 23401129 DOI: 10.1177/1352458512471878] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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
BACKGROUND Limited information is available on the use of natalizumab (NA) in pediatric multiple sclerosis (ped-MS) patients. OBJECTIVE The purpose of this study was to describe the long-term effects of NA in a large cohort of active ped-MS patients. METHODS Patients with definite ped-MS were treated with NA if in the previous year they had experienced at least two relapses or a severe relapse with incomplete recovery while on immunomodulating treatment, or at least two relapses and new magnetic resonance imaging (MRI) lesions regardless of any prior treatment. RESULTS The study included 55 patients (mean age: 14.4 years, mean number of relapses: 4.4, pre-treatment mean disease duration: 25.5 months). They received a median number of 26 infusions. Three relapses occurred during the follow-up, one female patient continued to deteriorate in cognitive functioning. Mean Expanded Disability Status Scale (EDSS) scores decreased from 2.7 to 1.9 at the last visit (p<0.001). During the follow-up the majority of patients remained free from MRI activity. Transient and mild clinical adverse events occurred in 20 patients. Mild hematological abnormalities occurred in seven patients. Anti-JCV antibodies were detected in 20/51 tested patients. CONCLUSIONS NA was well tolerated in all patients. A strong suppression of disease activity was observed in the majority of patients during the follow-up.
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Affiliation(s)
- A Ghezzi
- Multiple Sclerosis Study Center, Hospital of Gallarate, Italy.
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26
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Truini A, Barbanti P, Pozzilli C, Cruccu G. A mechanism-based classification of pain in multiple sclerosis. J Neurol 2013; 260:351-67. [PMID: 22760942 PMCID: PMC3566383 DOI: 10.1007/s00415-012-6579-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [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] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 05/31/2012] [Accepted: 06/03/2012] [Indexed: 12/30/2022]
Abstract
Pharmacological treatment of pain in multiple sclerosis (MS) is challenging due to the many underlying pathophysiological mechanisms. Few controlled trials show adequate pain control in this population. Emerging evidence suggests that pain might be more effectively classified and treated according to symptoms and underlying mechanisms. The new mechanism-based classification we propose here distinguishes nine types of MS-related pain: trigeminal neuralgia and Lhermitte's phenomenon (paroxysmal neuropathic pain due to ectopic impulse generation along primary afferents), ongoing extremity pain (deafferentation pain secondary to lesion in the spino-thalamo-cortical pathways), painful tonic spasms and spasticity pain (mixed pains secondary to lesions in the central motor pathways but mediated by muscle nociceptors), pain associated with optic neuritis (nerve trunk pain originating from nervi nervorum), musculoskeletal pains (nociceptive pain arising from postural abnormalities secondary to motor disorders), migraine (nociceptive pain favored by predisposing factors or secondary to midbrain lesions), and treatment-induced pains. Identification of various types of MS-related pain will allow appropriate targeted pharmacological treatment and improve clinical practice.
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Affiliation(s)
- A. Truini
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185 Rome, Italy
- Don Gnocchi Foundation, Milan, Italy
| | | | - C. Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185 Rome, Italy
- MS Center, S. Andrea Hospital, Rome, Italy
| | - G. Cruccu
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185 Rome, Italy
- San Raffaele IRCCS, Rome, Italy
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27
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Tinelli E, Francia A, Quartuccio EM, Morreale M, Contessa GM, Pascucci S, Sbardella E, Pozzilli C, Pantano P. Structural brain MR imaging changes associated with obsessive-compulsive disorder in patients with multiple sclerosis. AJNR Am J Neuroradiol 2012; 34:305-9. [PMID: 22821917 DOI: 10.3174/ajnr.a3210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Psychiatric symptoms occur in approximately 30% of patients with MS. Such symptoms include OCD, which may interfere heavily with the patient's daily life. We hypothesized that the widespread involvement of both GM and WM, which characterizes MS, may be responsible for the occurrence of OCD when specific brain structures are affected. The aim of this study was to evaluate the relationship between GM and WM tissue damage and OCD in patients with MS. MATERIALS AND METHODS We evaluated 16 patients with relapsing-remitting MS who had been diagnosed with OCD on the basis of the Diagnostic and Statistical Manual of Mental Disorders (4th edition) and 15 age- and sex-matched patients with relapsing-remitting MS with no psychiatric disorders as a CG. The MR study (1.5T) included 3D T1-weighted fast-field echo sequences, DTI (32 directions), and conventional MRI. Images were processed using SPM5, FSL, and Jim 5.0 software to evaluate VBM, TBSS, and global and regional LV, respectively. RESULTS The VBM analysis revealed a set of clusters of reduced GM volume in the OCD group, compared with the CG, located in the right inferior and middle temporal gyri and in the inferior frontal gyrus. TBSS did not detect any differences in the FA values between the 2 groups; global and regional LV values also did not differ significantly between the 2 groups. CONCLUSIONS Our study suggests that OCD in MS may be caused by damage in the right frontotemporal cortex.
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Affiliation(s)
- E Tinelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Universitá 30, 00185 Rome, Italy.
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28
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Martinelli V, Cocco E, Capra R, Salemi G, Gallo P, Capobianco M, Pesci I, Ghezzi A, Pozzilli C, Lugaresi A, Bellantonio P, Amato MP, Grimaldi LM, Trojano M, Mancardi GL, Bergamaschi R, Gasperini C, Rodegher M, Straffi L, Ponzio M, Comi G. Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone. Neurology 2011; 77:1887-95. [DOI: 10.1212/wnl.0b013e318238ee00] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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29
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Borriello G, Prosperini L, Mancinelli C, Giannì C, Fubelli F, Pozzilli C. Pulse monthly steroids during an elective interruption of natalizumab: a post-marketing study. Eur J Neurol 2011; 19:783-7. [DOI: 10.1111/j.1468-1331.2011.03577.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Goretti B, Portaccio E, Ghezzi A, Lori S, Moiola L, Falautano M, Viterbo R, Patti F, Vecchio R, Pozzilli C, Bianchi V, Cappiello S, Comi G, Trojano M, Amato MP. Fatigue and its relationships with cognitive functioning and depression in paediatric multiple sclerosis. Mult Scler 2011; 18:329-34. [PMID: 21844064 DOI: 10.1177/1352458511420846] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is limited information on fatigue and its clinical and psychosocial correlates in children and adolescents with multiple sclerosis (MS). OBJECTIVE To assess the relationships between fatigue, cognitive functioning and depression in paediatric MS. METHODS The study cohort consisted of patients with MS recruited for an Italian collaborative study on cognitive and psychosocial functioning in paediatric MS. The present assessment included evaluation of fatigue on the Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale, cognitive functioning on an extensive neuropsychological battery and depression on the Children's Depression Inventory (CDI). A psychiatric interview through the Kiddie-SADS-Present and Lifetime Version was also administered. RESULTS In total, 57 patients with relapsing-remitting MS were compared with 70 healthy controls. Percentages of fatigued patients ranged from 9% to 14% according to self-reports, and from 23% to 39% according to parent reports. Fatigue was significantly related with higher scores on the CDI (p < 0.03). Higher levels of self-reported cognitive fatigue were associated with impaired performance on a problem-solving test, whereas higher levels of parent-reported cognitive fatigue were associated with impairment on tests of verbal learning, processing speed, complex attention and verbal comprehension. CONCLUSIONS Our data show that fatigue can affect a sizeable proportion of paediatric MS patients, and confirm the association between fatigue and depressive symptoms in MS. They also highlight the difficulties of fatigue assessment in the paediatric population and provide a few clues to further research in the field.
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Affiliation(s)
- B Goretti
- Department of Neurology, University of Florence, Florence, Italy
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31
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Portaccio E, Ghezzi A, Hakiki B, Martinelli V, Moiola L, Patti F, La Mantia L, Mancardi GL, Solaro C, Tola MR, Pozzilli C, De Giglio L, Totaro R, Lugaresi A, De Luca G, Paolicelli D, Marrosu MG, Comi G, Trojano M, Amato MP. Breastfeeding is not related to postpartum relapses in multiple sclerosis. Neurology 2011; 77:145-50. [PMID: 21734184 DOI: 10.1212/wnl.0b013e318224afc9] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the relationship between breastfeeding and risk of puerperal relapses in a large cohort of patients with multiple sclerosis (MS). METHODS We prospectively followed-up pregnancies occurring between 2002 and 2008 in women with MS, recruited from 21 Italian MS centers, and gathered data on breastfeeding through a standardized interview. The risk of relapses after delivery was assessed using the Cox regression analysis. RESULTS A total of 302 out of 423 pregnancies in 298 women resulted in full-term deliveries. Patients were followed up for at least 1 year after delivery. The time-dependent profile of the relapse rate before, during, and after pregnancy did not differ between patients who breastfed and patients who did not. In the multivariate analysis, adjusting for age at onset, age at pregnancy, disease duration, disability level, and relapses in the year prior to pregnancy and during pregnancy, treatment with disease-modifying drugs (DMDs), and exposure to toxics, the only significant predictors of postpartum relapses were relapses in the year before pregnancy (hazard ratio [HR] = 1.5; 95%confidence interval [CI] 1.3-1.9; p < 0.001) and during pregnancy (HR = 2.2; 95% CI 1.5-3.3; p < 0.001). CONCLUSIONS In our sample, postpartum relapses were predicted only by relapses before and during pregnancy. Therefore, the reported association between breastfeeding and a lower risk of postpartum relapses may simply reflect different patient behavior, biased by the disease activity. Our results can assist neurologists facing the breastfeeding issue in mother counseling and shared decision-making. Especially, among patients with high risk of postpartum relapses, breastfeeding may not be feasible and early postpartum treatment should be an option.
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Affiliation(s)
- E Portaccio
- Department of Neurology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
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32
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Sbardella E, Tomassini V, Stromillo ML, Filippini N, Battaglini M, Ruggieri S, Ausili Cefaro L, Raz E, Gasperini C, Sormani MP, Pantano P, Pozzilli C, De Stefano N. Pronounced focal and diffuse brain damage predicts short-term disease evolution in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2011; 17:1432-40. [DOI: 10.1177/1352458511414602] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In clinically isolated syndrome (CIS), the role of quantitative magnetic resonance imaging (MRI) in detecting prognostic markers is still debated. Objective: To evaluate measures of diffuse brain damage (such as brain atrophy and the ratio of N-acetylaspartate to creatine (NAA/Cr)) in patients with CIS, in addition to focal lesions, as predictors of 1-year disease evolution. Methods: 49 patients with CIS underwent MRI scans to quantify T2-lesions (T2-L) and gadolinium-enhanced lesion (GEL) number at baseline and after 1 year. Along with 25 healthy volunteers, they also underwent combined MRI/magnetic resonance spectroscopy examination to measure normalized brain volumes (NBVs) and NAA/Cr. Occurrence of relapses and new T2-L was recorded over 1 year to assess disease evolution. Results: Occurrence of relapses and/or new T2-L over 1 year divided patients with CIS into ‘active’ and ‘stable’ groups. Active patients had lower baseline NAA/Cr and NBV. Baseline T2-L number, GEL, NAA/Cr and NBV predicted subsequent disease activity. Multivariable logistic regression models showed that both ‘focal damage’ (based on T2-L number and GEL) and ‘diffuse damage’ (based on NBV and NAA/Cr) models predicted disease activity at 1 year with great sensitivity, specificity and accuracy. This was best when the four MRI measures were combined (80% sensitivity, 89% specificity, 83% accuracy). Conclusions: Quantitative MRI measures of diffuse tissue damage such as brain atrophy and NAA/Cr, in addition to measures of focal demyelinating lesions, may predict short-term disease evolution in patients with CIS, particularly when used in combination. If confirmed in larger studies, these findings may have important clinical and therapeutic implications.
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Affiliation(s)
- E Sbardella
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
- Department of Psychology, “Sapienza” University of Rome, Italy
| | - V Tomassini
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
- Oxford University Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford, UK
| | - ML Stromillo
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - N Filippini
- Oxford University Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford, UK
- Department of Psychiatry, University of Oxford, UK
- Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M Battaglini
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - S Ruggieri
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | | | - E Raz
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | | | - MP Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - P Pantano
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | - C Pozzilli
- S. Andrea Hospital, “Sapienza” University of Rome, Italy
| | - N De Stefano
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
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Ristori G, Brescianini S, Pino A, Visconti A, Vittori D, Coarelli G, Cotichini R, Bocca B, Forte G, Pozzilli C, Pestalozza I, Stazi MA, Alimonti A, Salvetti M. Serum elements and oxidative status in clinically isolated syndromes: imbalance and predictivity. Neurology 2011; 76:549-55. [PMID: 21300970 DOI: 10.1212/wnl.0b013e31820af7de] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Metals are suspected of being involved in the pathogenesis of various neurologic diseases. We previously found a complex imbalance in serum chemical elements and oxidative status in patients with clinically definite multiple sclerosis (CDMS). OBJECTIVE To understand whether this imbalance affects people with clinically isolated syndrome (CIS) and, if so, whether it predicts conversion to CDMS. METHODS We studied 22 chemical elements and the oxidative status in 49 patients with CIS, 49 patients with CDMS, and 49 healthy donors (HD). Univariate and multivariate approaches were used to identify profiles for each group. A logistic regression analysis was used to identify the predictive potential of baseline data (elements, oxidative status, and MRI findings) for conversion to CDMS over 36 months. RESULTS Several elements and oxidative status values differed significantly among the 3 groups. Discriminant analysis revealed a major contribution of Ca, Fe, Sn, Zn, serum antioxidant capacity, and serum oxidative status, which resulted in distinct profiles (the prediction of group membership was 96% [cross-validated 92%] for HD, 92% [cross-validated 92%] for CDMS, and 90% [cross-validated 86%] for CIS). A weighted combination of element concentrations and oxidative status values, adjusting for all other predictors, would predict a reduction in the risk of conversion to CDMS within 3 years (odds ratio 0.37; 95% confidence interval 0.18-0.76; p = 0.007), thereby proving more effective than MRI at baseline. CONCLUSIONS The peculiar imbalance in serum elements and oxidative status that characterizes patients with CIS and may predict conversion to CDMS warrants studies on larger sample sizes.
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Affiliation(s)
- G Ristori
- Center for Experimental Neurological Therapies, S. Andrea Hospital, II Faculty of Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
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Novotna A, Mares J, Ratcliffe S, Novakova I, Vachova M, Zapletalova O, Gasperini C, Pozzilli C, Cefaro L, Comi G, Rossi P, Ambler Z, Stelmasiak Z, Erdmann A, Montalban X, Klimek A, Davies P. A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®) ), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. Eur J Neurol 2011; 18:1122-31. [PMID: 21362108 DOI: 10.1111/j.1468-1331.2010.03328.x] [Citation(s) in RCA: 283] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spasticity is a disabling complication of multiple sclerosis, affecting many patients with the condition. We report the first Phase 3 placebo-controlled study of an oral antispasticity agent to use an enriched study design. METHODS A 19-week follow-up, multicentre, double-blind, randomized, placebo-controlled, parallel-group study in subjects with multiple sclerosis spasticity not fully relieved with current antispasticity therapy. Subjects were treated with nabiximols, as add-on therapy, in a single-blind manner for 4weeks, after which those achieving an improvement in spasticity of ≥20% progressed to a 12-week randomized, placebo-controlled phase. RESULTS Of the 572 subjects enrolled, 272 achieved a ≥20% improvement after 4weeks of single-blind treatment, and 241 were randomized. The primary end-point was the difference between treatments in the mean spasticity Numeric Rating Scale (NRS) in the randomized, controlled phase of the study. Intention-to-treat (ITT) analysis showed a highly significant difference in favour of nabiximols (P=0.0002). Secondary end-points of responder analysis, Spasm Frequency Score, Sleep Disturbance NRS Patient, Carer and Clinician Global Impression of Change were all significant in favour of nabiximols. CONCLUSIONS The enriched study design provides a method of determining the efficacy and safety of nabiximols in a way that more closely reflects proposed clinical practice, by limiting exposure to those patients who are likely to benefit from it. Hence, the difference between active and placebo should be a reflection of efficacy and safety in the population intended for treatment.
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Affiliation(s)
- A Novotna
- Krajska nemocnice Pardubice, Neurologicke odd, Paradubice, Czech Republic.
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35
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Fieschi C, Gasperini C, Ristori G, Bastianello S, Girmenia F, Leuzzi V, Buttinelli C, Pozzilli C, Rasura M. Diagnostic problems in “clinically definite” multiple sclerosis patients with normal CSF and multiple MRI abnormalities. Eur J Neurol 2011; 1:127-33. [DOI: 10.1111/j.1468-1331.1994.tb00060.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Amato MP, Portaccio E, Ghezzi A, Hakiki B, Zipoli V, Martinelli V, Moiola L, Patti F, La Mantia L, Mancardi GL, Solaro C, Tola MR, Pozzilli C, De Giglio L, Totaro R, Lugaresi A, Di Tommaso V, Paolicelli D, Marrosu MG, Comi G, Pellegrini F, Trojano M. Pregnancy and fetal outcomes after interferon-β exposure in multiple sclerosis. Neurology 2010; 75:1794-802. [PMID: 21079181 DOI: 10.1212/wnl.0b013e3181fd62bb] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess pregnancy and fetal outcomes after in utero exposure to interferon-β (IFNβ) in all pregnancies occurring in women with multiple sclerosis (MS) during the study period, with a specific focus on the risk of spontaneous abortion. METHODS In this cohort study, data were gathered through a standardized, semi-structured interview. Patients who discontinued IFNβ less than 4 weeks from conception (exposed) were compared with those who had discontinued the drug at least 4 weeks from conception or who were never treated (not exposed). Possible confounders were handled through multivariate analyses adjusted for propensity score (PS). RESULTS We collected data on 396 pregnancies in 388 women, 88 classified as exposed (mean exposure 4.6 ± 5.8 weeks). IFNβ exposure was not associated with an increased risk of spontaneous abortion (PS-adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 0.4 to 2.9, p = 0.88), although it was associated with both lower baby weight (PS-adjusted β -113.8, p < 0.0001) and length (PS-adjusted β -1.102, p < 0.0001). Proportion of spontaneous abortion in exposed patients fell within the range expected for the Italian population in the same period. IFNβ exposure (PS-adjusted OR 2.11, 95% CI 1.18 to 3.78, p = 0.012) and cesarean delivery were the only predictors of preterm delivery. In the exposed group, we did not observe any significant fetal complications, malformations, or developmental abnormalities over a median follow-up of 2.1 years. CONCLUSIONS Our findings point to the relative safety of IFNβ exposure times of up to 4 weeks and can assist neurologists facing therapeutic decisions in women with MS with a pregnancy plan.
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Affiliation(s)
- M P Amato
- Department of Neurology, University of Florence, Florence, Italy.
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37
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Amato MP, Goretti B, Ghezzi A, Lori S, Zipoli V, Moiola L, Falautano M, De Caro MF, Viterbo R, Patti F, Vecchio R, Pozzilli C, Bianchi V, Roscio M, Martinelli V, Comi G, Portaccio E, Trojano M. Cognitive and psychosocial features in childhood and juvenile MS: Two-year follow-up. Neurology 2010; 75:1134-40. [DOI: 10.1212/wnl.0b013e3181f4d821] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ghezzi A, Pozzilli C, Grimaldi LME, Brescia Morra V, Bortolon F, Capra R, Filippi M, Moiola L, Rocca MA, Rottoli M, Sarchielli P, Zaffaroni M, Comi G. Safety and efficacy of natalizumab in children with multiple sclerosis. Neurology 2010; 75:912-7. [DOI: 10.1212/wnl.0b013e3181f11daf] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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39
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Mancardi GL, Tedeschi G, Amato MP, D’Alessandro R, Drago F, Milanese C, Popoli P, Rossi P, Savettieri G, Tola MR, Comi G, Pozzilli C, Bertolotto A, Marrosu MG, Grimaldi LME, Laroni A, Vanacore N, Covezzoli A, De Rosa M, Piccinni C, Montanaro N, Periotto L, Iommelli R, Tomino C, Provinciali L. Three years of experience: the Italian registry and safety data update. Neurol Sci 2010; 31 Suppl 3:295-7. [DOI: 10.1007/s10072-010-0356-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Trojano M, Pellegrini F, Paolicelli D, Fuiani A, Zimatore GB, Tortorella C, Simone IL, Patti F, Ghezzi A, Zipoli V, Rossi P, Pozzilli C, Salemi G, Lugaresi A, Bergamaschi R, Millefiorini E, Clerico M, Lus G, Vianello M, Avolio C, Cavalla P, Lepore V, Livrea P, Comi G, Amato MP. Real-life impact of early interferon beta therapy in relapsing multiple sclerosis. Ann Neurol 2009; 66:513-20. [PMID: 19847899 DOI: 10.1002/ana.21757] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent findings support greater efficacy of early vs. delayed interferon beta (IFNbeta) treatment in patients with a first clinical event suggestive of multiple sclerosis (MS). We aimed to evaluate the effectiveness of early IFNbeta treatment in definite relapsing-remitting MS (RRMS) and to assess the optimal time to initiate IFNbeta treatment with regard to the greatest benefits on disability progression. METHODS A cohort of 2,570 IFNbeta-treated RRMS patients was prospectively followed for up to 7 years in 15 Italian MS Centers. A Cox proportional hazards regression model adjusted for propensity score (PS) quintiles was used to assess differences between groups of patients with early vs. delayed IFNbeta treatment on risk of reaching a 1-point progression in the Expanded Disability Status Scale (EDSS) score, and the EDSS 4.0 and 6.0 milestones. A set of PS-adjusted Cox hazards regression models were calculated according to different times of treatment initiation (within 1 year up to within 5 years from disease onset). A sensitivity analysis was performed to assess the robustness of findings. RESULTS The lowest hazard ratios (HRs) for the three PS quintiles-adjusted models were obtained by a cutoff of treatment initiation within 1 year from disease onset. Early treatment significantly reduced the risk of reaching a 1-point progression in EDSS score (HR = 0.63; 95% CI = 0.48-0.85; p < 0.002), and the EDSS 4.0 milestone (HR = 0.56; 95% CI = 0.36-0.90; p = 0.015). Sensitivity analysis showed the bound of significance for unmeasured confounders. INTERPRETATION Greater benefits on disability progression may be obtained by an early IFNbeta treatment in RRMS.
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Affiliation(s)
- M Trojano
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy.
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Trojano M, Pellegrini F, Paolicelli D, Fuiani A, Zimatore G, Tortorella C, Simone I, Patti F, Ghezzi A, Portaccio E, Rossi P, Pozzilli C, Salemi G, Lugaresi A, Bergamaschi R, Millefiorini E, Clerico M, Lus G, Vianello M, Avolio C, Cavalla P, Iaffaldano P, Direnzo V, D'Onghia M, Lepore V, Livrea P, Comi G, Amato M. Post-marketing of disease modifying drugs in multiple sclerosis: An exploratory analysis of gender effect in interferon beta treatment. J Neurol Sci 2009; 286:109-13. [DOI: 10.1016/j.jns.2009.06.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 05/23/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
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Martinelli V, Capra R, Gasperini C, Cocco E, Bellantonio P, Pesci I, Bertolotto A, Gallo P, Amato M, Ghezzi A, Grimaldi L, Lugaresi A, Mancardi G, Bergamaschi R, Ponzio M, Pozzilli C, Salemi G, Trojano M, Rodegher M, Straffi L, Comi G. FP39-WE-05 High incidence of acute leukaemia in multiple sclerosis patients treated with mitoxantrone: a retrospective multicentre Italian study. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70476-9] [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: 10/20/2022]
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Abstract
BACKGROUND AND PURPOSE To define the predictive value of clinical and magnetic resonance imaging (MRI) characteristics in identifying relapsing-remitting multiple sclerosis (RR-MS) patients with sustained disability progression during interferon beta (IFNB) treatment. METHODS All patients receiving treatment with one of the available IFNB formulations for at least 1 year were included in this single-centre, prospective and post-marketing study. Demographic, clinical and MRI data were collected at IFNB start and at 1 year of therapy; patients were followed-up at least yearly. Poor clinical response was defined as the occurrence of a sustained disability progression of > or =1 point in the Expanded Disability Status Scale (EDSS) during the follow-up period. RESULTS Out of 454 RR-MS patients starting IFNB therapy, data coming from 394 patients with a mean follow-up of 4.8 (2.4) years were analysed. Sixty patients were excluded because of too short follow-up. Less than 1/3 (30.4%) of the patients satisfied the criterion of 'poor responders'. Patients presenting new lesions on T2-weighted MRI scan after 1 year of therapy (compared with baseline) had a higher risk of being poor responder to treatment with IFNB during the follow-up period (HR 16.8, 95% CI 7.6-37.1, P < 0.001). An augmented risk increasing the number of lesions was observed, with a 10-fold increase for each new lesion. CONCLUSIONS Developing new T2-hyperintense lesions during IFNB treatment was the best predictor of long-term poor response to therapy. MRI scans performed after 1 year of IFNB treatment may be useful in contributing to early identification of poor responders.
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Affiliation(s)
- L Prosperini
- Multiple Sclerosis Centre, Department of Neurological Sciences, S. Andrea Hospital, La Sapienza University, Rome, Italy
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Hussain H, Usman A, Raza Q, Amato M, Goretti B, Ghezzi A, Lori S, Zipoli V, Portaccio E, Moiola L, Falautano M, De Caro M, Lopez M, Patti F, Vecchio R, Pozzilli C, Bianchi V, Roscio M, Comi G, Trojano M. COGNITIVE AND PSYCHOSOCIAL FEATURES OF CHILDHOOD AND JUVENILE MS. Neurology 2009; 72:1189; author reply1189-90. [DOI: 10.1212/01.wnl.0000346320.61178.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Conte A, Lenzi D, Frasca V, Gilio F, Giacomelli E, Gabriele M, Marini Bettolo C, Iacovelli E, Pantano P, Pozzilli C, Inghilleri M. Intracortical excitability in patients with relapsing–remitting and secondary progressive multiple sclerosis. J Neurol 2009; 256:933-8. [DOI: 10.1007/s00415-009-5047-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 01/15/2009] [Accepted: 01/20/2009] [Indexed: 11/30/2022]
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Bonaccorso S, Ricciardi A, Matrisciano F, Nicoletti F, Scaccianoce S, Ruberto A, Girardi P, Tatarelli R, Pompei F, Manciocchi R, Pozzilli C, Verkerk R, Scharpe S, Wang L, Shelton R. Activation of Serotonin Metabolism and BDNF Changes in Depressed Patients with Multiple Sclerosis During Interferon-Beta Therapy. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background:Indoleamine-2, 3-dioxygenase is responsible for tryptophan catabolism; IFN-β is a treatment for multiple sclerosis (MS) and it has been associated with depression. IDO activation might play a role in IFN-β induction of depressive symptoms. Depressive symptoms associated with MS illness and IFN-β treatment have been treated with pharmacological and non-pharmacological intervention.Aims:Evaluation of the kynurenine pathway, IDO activation and neurotoxic agents, serum BDNF in MS patients during IFN-β intervention.Methods:14 study subjects, aged 18-64 years with major depressive disorder and MS treated with IFN-β, before and after pharmacologic and non-pharmacologic intervention, and 34 age matched healthy controls were enrolled at the University of Rome "La Sapienza" and at the at the University of Antwerp. Depressed participants were randomized to sertraline-treatment or interpersonal psychodynamic psychotherapy.Results:There were significant improvements in both depression and anxiety symptoms with medication and psychotherapy groups, although the effect with sertraline was more robust. Sertraline treatment was associated with a decline in serotonin. In the psychotherapy group, a significant increase in 3-hydroxyanthranilic acid (HAA) was observed after 4 months treatment (p= .04) with a significant decrease in tryptophan levels at 6 weeks (p= .02) and a trend towards a significant decrease in BDNF after 6 wks (p=0.06), neither of which were seen in the medication condition.Discussion:The increase in HAA among the psychotherapy-treated patients raises the possibility of a neurodegenerative challenge for patients with multiple sclerosis during treatment with IFN-β which appeared to be prevented with pharmacological treatment.
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Altmann DR, Jasperse B, Barkhof F, Beckmann K, Filippi M, Kappos LD, Molyneux P, Polman CH, Pozzilli C, Thompson AJ, Wagner K, Yousry TA, Miller DH. Sample sizes for brain atrophy outcomes in trials for secondary progressive multiple sclerosis. Neurology 2008; 72:595-601. [PMID: 19005170 DOI: 10.1212/01.wnl.0000335765.55346.fc] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Progressive brain atrophy in multiple sclerosis (MS) may reflect neuroaxonal and myelin loss and MRI measures of brain tissue loss are used as outcome measures in MS treatment trials. This study investigated sample sizes required to demonstrate reduction of brain atrophy using three outcome measures in a parallel group, placebo-controlled trial for secondary progressive MS (SPMS). METHODS Data were taken from a cohort of 43 patients with SPMS who had been followed up with 6-monthly T1-weighted MRI for up to 3 years within the placebo arm of a therapeutic trial. Central cerebral volumes (CCVs) were measured using a semiautomated segmentation approach, and brain volume normalized for skull size (NBV) was measured using automated segmentation (SIENAX). Change in CCV and NBV was measured by subtraction of baseline from serial CCV and SIENAX images; in addition, percentage brain volume change relative to baseline was measured directly using a registration-based method (SIENA). Sample sizes for given treatment effects and power were calculated for standard analyses using parameters estimated from the sample. RESULTS For a 2-year trial duration, minimum sample sizes per arm required to detect a 50% treatment effect at 80% power were 32 for SIENA, 69 for CCV, and 273 for SIENAX. Two-year minimum sample sizes were smaller than 1-year by 71% for SIENAX, 55% for CCV, and 44% for SIENA. CONCLUSION SIENA and central cerebral volume are feasible outcome measures for inclusion in placebo-controlled trials in secondary progressive multiple sclerosis.
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Affiliation(s)
- D R Altmann
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK.
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Bodini B, Mandarelli G, Tomassini V, Tarsitani L, Pestalozza I, Gasperini C, Lenzi GL, Pancheri P, Pozzilli C. Alexithymia in multiple sclerosis: relationship with fatigue and depression. Acta Neurol Scand 2008; 118:18-23. [PMID: 18162056 DOI: 10.1111/j.1600-0404.2007.00969.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [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: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of alexithymia in a sample of patients with multiple sclerosis (MS) and to further evaluate the association between alexithymia and the occurrence of common disabling MS-related symptoms such as fatigue and depression. METHODS Fifty-eight relapsing-remitting MS patients treated with interferon (IFN)-beta-1a underwent a complete neurological evaluation, including Expanded Disability Status Scale score assessment. Alexithymia, depressive symptoms and fatigue were assessed using the 20-item Toronto Alexithymia Scale, Beck Depression Inventory and Fatigue Severity Scale. RESULTS Prevalence of alexithymia was 13.8%, with 27.6% of patients presenting borderline alexithymia. Sixty-seven per cent of the patients complained of fatigue while 29.3% of them were depressed. Higher levels of fatigue and depression were found in alexithymic patients when compared with non-alexithymic patients. Results from logistic regressions showed that alexithymia significantly contributes to the severity of fatigue and depression. CONCLUSIONS Alexithymia was associated with increased severity of fatigue and depression.
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Affiliation(s)
- B Bodini
- Department of Neurological Sciences, Sapienza University of Rome, Italy
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Amato MP, Goretti B, Ghezzi A, Lori S, Zipoli V, Portaccio E, Moiola L, Falautano M, De Caro MF, Lopez M, Patti F, Vecchio R, Pozzilli C, Bianchi V, Roscio M, Comi G, Trojano M. Cognitive and psychosocial features of childhood and juvenile MS. Neurology 2008; 70:1891-7. [PMID: 18474844 DOI: 10.1212/01.wnl.0000312276.23177.fa] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M P Amato
- Department of Neurology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
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Buttinelli C, Clemenzi A, Borriello G, Denaro F, Pozzilli C, Fieschi C. Mitoxantrone treatment in multiple sclerosis: a 5-year clinical and MRI follow-up. Eur J Neurol 2007; 14:1281-7. [PMID: 17956449 DOI: 10.1111/j.1468-1331.2007.01969.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mitoxantrone (MTX) is an antineoplastic agent approved for treatment of secondary progressive and rapidly worsening relapsing-remitting multiple sclerosis (MS). We designed a longitudinal open-label prospective study to evaluate the efficacy and toxicity of MTX over a 2-year treatment period with a further 3-year follow-up. Fifty consecutive MS patients were included and received MTX intravenously (8 mg/m(2) every 2 months for a total of 12 infusions). Efficacy was assessed clinically and by brain MRI performed before MTX therapy, at the end of treatment and at the end of each year of follow-up. Forty-nine patients completed the 5-year study, 44 (89.8%) completed the MTX course, five (10.2%) interrupted the treatment because of side effects. Fifteen (30.6%) patients showed Expanded Disability Status Scale (EDSS) progression on treatment and nine (18.4%) during follow-up. Seventeen (34.7%) patients had enhancing lesions at baseline, nine (18.4%) at the end of treatment, but none at the end of follow-up. In conclusion, we observed EDSS progression in about 1/3 of the patients during the treatment period and in 1/5 during the further 3-year follow-up period. This evidence suggests a delayed beneficial effect after MTX treatment is completed with only a minority of patients showing disability progression once the drug was suspended.
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Affiliation(s)
- C Buttinelli
- Department of Neurological Science, Neurological Unit, S. Andrea Hospital, University La Sapienza, Rome, Italy
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