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Auroux M, Laurent B, Coste B, Massy E, Mercier A, Confavreux C, Coury F. Réponse sérologique après vaccination contre le coronavirus chez les patients atteints de rhumatisme inflammatoire chronique traités par DMARDs : une étude de cohorte et revue systématique avec méta-analyse. Rev Rhum Ed Fr 2022. [PMCID: PMC9758725 DOI: 10.1016/j.rhum.2022.10.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction La vaccination contre le coronavirus constitue l’une des pierres angulaires dans la gestion de la crise sanitaire liée au COVID-19. Alors que la vaccination confère une protection efficace chez les sujets immunocompétents, son immunogénicité dans la population atteinte de rhumatisme inflammatoire chronique (RIC) n’est pas clairement établie. Patients et méthodes Nous avons conduit une étude monocentrique rétrospective évaluant la réponse sérologique après deux doses de vaccination contre le coronavirus chez des patients adultes atteints de RIC et traités par traitements ciblés ou biologiques (n = 123). Les titres d’anticorps IgG dirigés contre la protéine spike du coronavirus (SARS-CoV-2) ont été mesurés après la seconde dose de vaccin. De plus, nous avons conduit une recherche systématique jusqu’au 31 septembre 2021 dans les bases de données PUBMED, preprint et littérature grise non encore publiée des études observationnelles des taux sérologiques après vaccination chez des patients atteints de RIC traités par médicaments ciblés ou biologiques (numéro d’enregistrement PROSPERO : CRD42021259410). Les études rapportant la taille d’échantillon, la date, le pays d’origine, le taux de séroconversion ont été incluses. Nous avons ensuite conduit une méta-analyse afin d’identifier des facteurs associés à la séroconversion. Résultats Sur nos 123 patients (âge médian 66 ans écart interquartile [EI] 57–75), 69,9 % ont séroconverti après 2 doses de vaccination. Les patients ayant eu une séroconversion étaient plus âgés que ceux qui n’en ont pas eu. Les patients traités par rituximab sont ceux qui ont le moins répondu à la vaccination. Nous avons identifié 20 études de séroprévalence en plus de notre cohorte, représentant un total de 4423 patients dans 11 pays. La méta-analyse a confirmé un impact négatif sur le taux de séroconversion du rituximab et dans une moindre mesure de l’abatacept, du léflunomide et du méthotrexate. Conclusion Le rituximab diminue la réponse sérologique à la vaccination contre le SARS-CoV-2 chez les patients atteints de RIC. Ce travail suggère également un impact négatif de l’abatacept, du méthotrexate ou du léflunomide particulièrement en cas d’association à un médicament biologique.
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Affiliation(s)
- M. Auroux
- Rhumatologie, hôpital Édouard-Herriot, HCL, Lyon, France,Auteur correspondant
| | - B. Laurent
- Rhumatologie, hôpital Lyon Sud, HCL, Pierre-Bénite, France
| | - B. Coste
- Rhumatologie, CH rhumatologique d’Uriage, Saint-Martin-d’Uriage, France
| | - E. Massy
- Rhumatologie, hôpital Sainte-Marguerite, Marseille, France
| | - A. Mercier
- Pavillon F, rhumatologie, hôpital Édouard-Herriot, HCL, Lyon, France
| | - C. Confavreux
- Rhumatologie, Inserm UMR1033, université de Lyon, hospices civils de Lyon, Lyon, France
| | - F. Coury
- Rhumatolgie, centre hospitalier Lyon-Sud, Pierre-Bénite, France
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Brown JE, Wood SL, Confavreux C, Abe M, Weilbaecher K, Hadji P, Johnson RW, Rhoades JA, Edwards CM, Croucher PI, Juarez P, El Badri S, Ariaspinilla G, D'Oronzo S, Guise TA, Van Poznak C. Management of bone metastasis and cancer treatment-induced bone loss during the COVID-19 pandemic: An international perspective and recommendations. J Bone Oncol 2021; 29:100375. [PMID: 34131559 PMCID: PMC8192265 DOI: 10.1016/j.jbo.2021.100375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 02/02/2023] Open
Abstract
Optimum management of patients with cancer during the COVID-19 pandemic has proved extremely challenging. Patients, clinicians and hospital authorities have had to balance the risks to patients of attending hospital, many of whom are especially vulnerable, with the risks of delaying or modifying cancer treatment. Those whose care has been significantly impacted include patients suffering from the effects of cancer on bone, where delivering the usual standard of care for bone support has often not been possible and clinicians have been forced to seek alternative options for adequate management. At a virtual meeting of the Cancer and Bone Society in July 2020, an expert group shared experiences and solutions to this challenge, following which a questionnaire was sent internationally to the symposium's participants, to explore the issues faced and solutions offered. 70 respondents, from 9 countries (majority USA, 39%, followed by UK, 19%) included 50 clinicians, spread across a diverse range of specialties (but with a high proportion, 64%, of medical oncologists) and 20 who classified themselves as non-clinical (solely lab-based). Spread of clinician specialty across tumour types was breast (65%), prostate (27%), followed by renal, myeloma and melanoma. Analysis showed that management of metastatic bone disease in all solid tumour types and myeloma, adjuvant bisphosphonate breast cancer therapy and cancer treatment induced bone loss, was substantially impacted. Respondents reported delays to routine CT scans (58%), standard bone scans (48%) and MRI scans (46%), though emergency scans were less affected. Delays in palliative radiotherapy for bone pain were reported by 31% of respondents with treatments often involving only a single dose without fractionation. Delays to, or cancellation of, prophylactic surgery for bone pain were reported by 35% of respondents. Access to treatments with intravenous bisphosphonates and subcutaneous denosumab was a major problem, mitigated by provision of drug administration at home or in a local clinic, reduced frequency of administration or switching to oral bisphosphonates taken at home. The questionnaire also revealed damaging delays or complete stopping of both clinical and laboratory research. In addition to an analysis of the questionnaire, this paper presents a rationale and recommendations for adaptation of the normal guidelines for protection of bone health during the pandemic.
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Affiliation(s)
- J E Brown
- Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.,Directorate of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S L Wood
- Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - C Confavreux
- Department of Rheumatology South of Hospices Civils de Lyon and INSERM UMR1033, University of Lyon, Lyon, France
| | - M Abe
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School, Japan
| | - K Weilbaecher
- Division of Oncology, Washington University, St. Louis, USA
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Krankenhaus Nordwest, Frankfurt, Germany
| | - R W Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - J A Rhoades
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.,Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, USA
| | - C M Edwards
- Nuffield Department of Surgical Sciences, Oxford, UK
| | - P I Croucher
- Bone Biology, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - P Juarez
- Biomedical Innovation Department, Center for Scientific Research and Higher Education, Ensenada, Mexico
| | - S El Badri
- Directorate of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Ariaspinilla
- Directorate of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S D'Oronzo
- Department of Biomedical Sciences and Clinical Oncology, University of Bari Aldo Moro, Italy
| | - T A Guise
- M.D. Anderson Cancer Center, Houston, USA
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Gardegaront M, Allard V, Confavreux C, Bermond F, Mitton D, Follet H. Variabilities in µQCT-based FEA of a tumoral bone mice model. J Biomech 2021; 118:110265. [PMID: 33545571 DOI: 10.1016/j.jbiomech.2021.110265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/05/2020] [Revised: 01/04/2021] [Accepted: 01/16/2021] [Indexed: 01/13/2023]
Abstract
A finite element analysis based on Micro-Quantitative Computed Tomography (µQCT) is a method with high potential to improve fracture risk prediction. However, the segmentation process and model generation are generally not automatized in their entirety. Even with a rigorous protocol, the operator might add uncertainties during the creation of the model. The aim of this study was to evaluate a µQCT-based model of mice tumoral and sham tibias in terms of the variabilities induced by the operator and sensitivity to operator-dependent variables (such as model orientation or length). Two different operators generated finite element (FE) models from µCT images of 8 female Balb/c nude mice tibias aged 10 weeks old with bone tumors induced in the right tibia and with sham injection in the left. From these models, predicted failure load was determined for two different boundary conditions: fixed support and spherical joints. The difference between the predicted and experimental failure load of both operators was large (-122% to 93%). The difference in the predicted failure load between operators was less for the spherical joints boundary conditions (9.8%) than for the fixed support (58.3%), p < 0.001, whereas varying the orientation of bone tibia caused more variability for the fixed support boundary condition (44.7%) than for the spherical joints (9.1%), p < 0.002. Varying tibia length had no significant effect, regardless of boundary conditions (<4%). When using the same mesh and same orientation, the difference between operators is non-significant (<6%) for each model. This study showed that the operator influences the failure load assessed by a µQCT-based finite element model of the tumoral and sham mice tibias. The results suggest that automation is needed for better reproducibility.
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Affiliation(s)
- M Gardegaront
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR 1033, 69008 Lyon, France
| | - V Allard
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR 1033, 69008 Lyon, France
| | - C Confavreux
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR 1033, 69008 Lyon, France; Centre Expert des Métastases et d'Oncologie Osseuses (CEMOS), Service de Rhumatologie Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - F Bermond
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - D Mitton
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - H Follet
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR 1033, 69008 Lyon, France.
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Riglet L, Confavreux C, Chaudier P, Pialat JB, Bermond F, Gardegaront M, Follet H, Mitton D. Ex vivo experiments on femurs to assess metastatic bone strength. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1815312] [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: 10/23/2022]
Affiliation(s)
- L. Riglet
- Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T 9406, Lyon, France
| | - C. Confavreux
- Univ Lyon, Univ Claude Bernard Lyon 1, INSERM, UMR 1033, Lyon, France
- CEMOS, Service de Rhumatologie, Centre hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - P. Chaudier
- Service de Chirurgie Orthopédique, Centre hospitalier Lyon Sud, Lyon, France
| | - J.-B Pialat
- Service de Radiologie, Centre hospitalier Lyon Sud, Lyon, France
| | - F. Bermond
- Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T 9406, Lyon, France
| | - M. Gardegaront
- Univ Lyon, Univ Claude Bernard Lyon 1, INSERM, UMR 1033, Lyon, France
| | - H. Follet
- Univ Lyon, Univ Claude Bernard Lyon 1, INSERM, UMR 1033, Lyon, France
| | - D. Mitton
- Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T 9406, Lyon, France
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Gossec L, Flipo RM, Schaeverbeke T, Albert C, Baillet A, Boissier MC, Confavreux C, Cormier G, Dernis E, Gervais Solau E, Godot S, Gottenberg JE, Goupille P, Lassoued S, Lequerre T, Lioté F, Marcelli C, Maugars Y, Nguyen M, Perdriger A, Pers YM, Pertuiset E, Poiroux L, Rosenberg C, Roux C, Ruyssen-Witrand A, Soubrier M, Vergne-Salle P, Zarnitsky C, Fakra E, Marotte H, Lévy-Weil FE. FRI0095 SARILUMAB IMPROVED PATIENT-PERCEIVED IMPACT OF RHEUMATOID ARTHRITIS WHATEVER THE BASELINE DISEASE ACTIVITY: FIRST RESULTS FROM AN INTERVENTIONAL NON CONTROLLED STUDY: SARIPRO, IN MODERATE AND SEVERE RHEUMATOID ARTHRITIS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5518] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Sarilumab, an anti-IL-6R antibody, is approved for the treatment of moderate to severe RA and shown efficacy on disease activity and patient-reported outcomes (PROs). Detailed analyses of drug efficacy from the patient point of view is important. SariPRO is a pragmatic interventional study close to the daily practice.Objectives:To assess the effectiveness of sarilumab on several PROs using the RAID (Rheumatoid Arthritis Impact of Disease) score.Methods:The SariPRO study (NCT 03449758) was a French multicenter interventional study assessing the effects of sarilumab 200 mg on PROs in patients with moderately to severely active RA with an inadequate response or intolerance to conventional synthetic or biologic DMARDs. The primary endpoint was change in total RAID score from baseline to week 24 (RAID ranges 0-10 where 10 is maximal impact). Changes from baseline for RAID, DAS28-ESR and CDAI according to baseline disease activity were analyzed as secondary outcomes. Safety was assessed by monitoring adverse events (AE). All statistical analyses were descriptive, 95% CI was given when appropriate.Results:84 patients were included in 31 centers and 62 were evaluable and analyzed for effectiveness. They had similar characteristics to the 84 patients at baseline and were as expected for an RA population initiating a biologic: mean (SD) age: 59.9 (12.4) years, 71.0% female, disease duration 9.7 (10.3) years, rheumatoid factor positivity 82.5%, ACPA positivity 86.4%, and DAS28=4.9 (11). Total RAID score decreased significantly from 5.7 (2.0) at baseline to 3.3 (2.5) at W24; mean change was -2.4 [95% CI: -3.0; -1.8]. Furthermore, this improvement was noted both for highly and less active patients at baseline: for patients with DAS28-ESR < 5.1 (n=31), mean change was -1.56 [-2.28; -0.83] and for patients with DAS28-ESR≥5.1 (n=27), mean change was -1.98 [-2.91; -1.05]. Changes in DAS28-ESR and CDAI were significant (-2.8 [-3.2; -2.4] and -15.2 [-18.5; -11.8], respectively). AEs were consistent with the safety profile of anti-IL-6R antibodies and with results from RCTs (data not shown).Conclusion:In this real world study, treatment with sarilumab during 24 weeks in RA patients led to an improvement in the total RAID score irrespective of baseline levels of disease activity. This is the first time RAID score is used as the primary endpoint in a study.References:[1]Study was sponsored by Sanofi GenzymeDisclosure of Interests:Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, René-Marc Flipo Consultant of: Johnson and Johnson, MSD France, Novartis, Sanofi, Speakers bureau: Johnson and Johnson, MSD France, Novartis, Sanofi, Thierry Schaeverbeke: None declared, Christine Albert: None declared, Athan Baillet Consultant of: Athan BAILLET has received honorarium fees from Abbvie for his participation as the coordinator of the systematic literature review, marie-Christophe Boissier: None declared, Cyrille Confavreux: None declared, Gregoire CORMIER: None declared, Emmanuelle Dernis Speakers bureau: Lilly, Novartis, Elisabeth Gervais Solau: None declared, Sophie Godot: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Slim Lassoued: None declared, Thierry Lequerre: None declared, Frederic Lioté Consultant of: CME: Nordic Pharma, Christian Marcelli: None declared, Yves Maugars: None declared, Minh Nguyen: None declared, Aleth Perdriger: None declared, Yves-Marie Pers: None declared, Edouard Pertuiset: None declared, Lucile Poiroux: None declared, Carole Rosenberg: None declared, Christian Roux: None declared, Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Martin SOUBRIER: None declared, Pascale Vergne-Salle: None declared, Charles Zarnitsky: None declared, Eric Fakra Consultant of: Janssen, Lundbeck, Otsuka, Sanofi, Hubert MAROTTE Grant/research support from: Bristol Myers Sqibb, Lilly France, MSD, Novartis, Nordic Pharma, Pfizer, SanofiAventis, Consultant of: AbbVie, Amgen, Bristol Myers Sqibb, Lilly France, MSD, Novartis, Nordic Pharma, Pfizer, SanofiAventis, Paid instructor for: Sanofi-Aventis, Speakers bureau: Sanofi-Aventis, Florence E Lévy-Weil Employee of: Sanofi Genzyme employee
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Yailian AL, Estublier C, Rozaire O, Piperno M, Confavreux C, Vignot E, Chapurlat R, Pivot C, Janoly-Dumenil A. Entretiens pharmaceutiques destinés aux patients atteints de polyarthrite rhumatoïde : perceptions et attentes des pharmaciens d’officine. Annales Pharmaceutiques Françaises 2019; 77:146-158. [DOI: 10.1016/j.pharma.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
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Louazon T, Bacchetta J, Restier L, Belmalih A, Confavreux C, Marotte S, Loras-Duclaux I, Lachaux A, Chambrier C, Peretti N. HR-pQCT : une nouvelle technique d’imagerie. Un statut osseux rassurant chez les adolescents en nutrition parentérale au long cours. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.175] [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: 10/27/2022]
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Lavie C, Rollot F, Durand-Dubief F, Marignier R, Ionescu I, Casey R, Moreau T, Tourniaire P, Hutchinson M, D’Hooghe MB, Laplaud DA, Clavelou P, De Sèze J, Debouverie M, Brassat D, Pelletier J, Lebrun-Frenay C, Le Page E, Castelnovo G, Berger E, Hautecoeur P, Heinzlef O, Durelli L, Clerico M, Trojano M, Patti F, Vukusic S, Alpérovitch A, Carton H, d’Hooghe M, Hommes O, Hutchinson M, Adeleine P, Biron A, Cortinovis-Tourniaire P, Grimaud J, Hours M, Moreau T, Vukusic S, Confavreux C, Chauplannaz G, Confavreux C, Cortinovis-Tourniaire P, Grimaud J, Latombe D, Moreau T, Clanet M, Lau G, Rumbach L, Goas J, Rouhart F, Mazingue A, Roullet E, Madigand M, Hautecoeur P, Brunet P, Edan G, Allaire C, Riffault G, Leche J, Benoit T, Simonin C, Ziegler F, Baron J, Rivrain Y, Dumas R, Loche D, Bourrin J, Huttin B, Delisse B, Gibert I, Boulay C, Verceletto M, Durand G, Bonneviot G, Gil R, Hedreville M, Belair C, Poitevin R, Devoize J, Wyremblewski P, Delestre F, Setiey A, Comi G, Filippi M, Ghezzi A, Martinelli V, Rossi P, Zaffaroni M, Tola M, Amato M, Fioretti C, Meucci G, Inglese M, Mancardi G, Gambi D, Thomas A, Cavazzuti M, Citterio A, Heltberg A, Hansen H, Fernandez O, Romero F, Arbizu T, Hernandez J, De Andres de Frutos C, Geffner Sclarky D, Aladro Benito Y, Reyes Yanes P, Aguilar M, Burguera J, Yaya R, Bonakim Dib W, Arzua-Mouronte D, d’Hooghe M, Sindic C, Carton H, Medaer R, Roose H, Geens K, Guillaume D, Van Zandycke M, Janssens J, Cornette M, Mol L, Weilbach F, Flachenecker P, Hartung H, Haas J, Tendolkar I, Sindrn E, Kölmel H, Reichel D, Rauch M, Preuss S, Poser S, Mauch E, Strausser-Fuchs S, Kolleger H, Hawkins S, Howell S, Rees J, Thompson A, Johnson M, Boggild M, Gregory R, Bates D, Bone I, Hutchinson M, Polman C, Frequin S, Jongen P, Hommes O, Correia de Sa J, Rio M, Huber S, Lechner-Scott J, Kappos L, Ionescu I, Cornu C, Confavreux C, Vukusic S, El-Etr M, Baulieu E, El-Etr M, Schumacher M, Ionescu I, Confavreux C, Cornu C, Vukusic S, Hartung H, Miller D, Hutchinson M, Pugeat M, d’Archangues C, Conard J, Ménard J, Sitruk-Ware R, Pelissier C, Dat S, Belaïsch-Allard J, Athéa N, Büschsenschutz D, Lyon-Caen O, Gonsette R, Boissel J, Ffrench P, Durand-Dubief F, Cotton F, Pachai C, Bracoud L, Vukusic S, Ionescu I, Androdias G, Marignier R, Chauplannaz G, Laplaud D, Wiertlewski S, Lanctin-Garcia C, Moreau T, Couvreur G, Madinier G, Clavelou P, Taithe F, Aufauvre D, Guy N, Ferrier A, De Sèze J, Collongues N, Debouverie M, Viala F, Brassat D, Gerdelat-Mas A, Henry P, Pelletier J, Rico-Lamy A, Lebrun-Frenay C, Lepage E, Deburghraeve V, Edan G, Castelnovo G, Berger E, Hautecoeur P, Blondiau M, Heinzlef O, Coustans M, Clerc C, Rieu L, Lauxerois M, Hinzelin G, Ouallet J, Minier D, Vion P, Gromaire-Fayolle N, Derache N, Thouvenot E, Sallansonnet-Froment M, Tourniaire P, Toureille L, Borgel F, Stankoff B, Grimaud J, Moroianu C, Guennoc A, Tournier-Gervason C, Peysson S, Trojano M, Patti F, D’Amico E, Motti L, Zaffaroni M, Durelli L, Tavella A. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS. Mult Scler 2018; 25:591-600. [DOI: 10.1177/1352458518763080] [Citation(s) in RCA: 8] [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: 11/17/2022]
Abstract
Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.
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Affiliation(s)
- Caroline Lavie
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Fabien Rollot
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | | | - Romain Marignier
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Centre de Recherche en Neurosciences de Lyon,
INSERM U1028, CNRS UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France;
Université de Lyon 1, Lyon, France
| | - Iuliana Ionescu
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Romain Casey
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | - Thibault Moreau
- Department of Neurology, EA4184, University Hospital of
Dijon, Dijon, France
| | | | - Michael Hutchinson
- School of Medicine and Medical Science, University College
Dublin, Dublin, Ireland/Department of Neurology, St Vincent’s University Hospital,
Dublin, Ireland
| | - Marie Béatrice D’Hooghe
- National MS Center Melsbroek, Melsbroek, Belgium; Center
for Neurosciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - David-Axel Laplaud
- Service de Neurologie, CHU de Nantes, CIC015 INSERM,
Nantes, France/INSERM UMR1064, Nantes, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand,
Clermont-Ferrand, France/INSERM UMR1107, Clermont Université, Université d’Auvergne,
Neuro-Dol, Clermont-Ferrand, France
| | - Jérôme De Sèze
- Department of Neurology, Clinical Investigation Center
INSERM 1434, Hôpitaux Universitaires de Strasbourg, FMTS INSERM 1119, Strasbourg,
France
| | - Marc Debouverie
- EA 4360 APEMAC, University of Lorraine, Nancy,
France/Department of Neurology, Nancy University Hospital, Nancy, France
| | - David Brassat
- Pôle Neurosciences, CHU Toulouse Purpan, Toulouse,
France/INSERM U1043, CNRS UMR 5282, Université Toulouse III, Toulouse, France
| | - Jean Pelletier
- Service de Neurologie, Hôpital de la Timone, Pôle de
Neurosciences Cliniques, AP-HM, Aix-Marseille Université, Marseille, France/CNRS,
Aix-Marseille Université, CRMBM UMR7339, Marseille, France
| | | | - Emmanuelle Le Page
- Clinical Neuroscience Centre, CIC-P 1414 INSERM, Rennes
University Hospital, Rennes, France
| | | | - Eric Berger
- Department of Neurology, CHU Besançon, Besançon,
France
| | - Patrick Hautecoeur
- Service de Neurologie, Groupement des Hôpitaux de
l’Institut Catholique de Lille, Lille, France
| | - Olivier Heinzlef
- Department of Neurology, Hôpital CHI de
Poissy/Saint-Germain-en-Laye, Paris, France
| | - Luca Durelli
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Marinella Clerico
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and
Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences, and Advanced
Technologies, G.F. Ingrassia, Multiple Sclerosis Center, University of Catania, Catania,
Italy
| | - Sandra Vukusic
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques
(OFSEP), Lyon, France/Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS
UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France/Université de Lyon
1, Lyon, France
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Delpuech B, Confavreux C, Bouazza L, Geraci S, Clezardin P, Mitton D, Follet H. Effect of intra-tibial injection on mechanical properties of mouse bone. Comput Methods Biomech Biomed Engin 2017; 20:57-58. [DOI: 10.1080/10255842.2017.1382859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- B. Delpuech
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC, UMR_T9406, 69622 Lyon, France
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS, UMR 1033, 69008 Lyon, France
| | - C. Confavreux
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS, UMR 1033, 69008 Lyon, France
- Rheumatology Department, Hôpital Edouard Herriot, Civil Hospices of Lyon, Lyon, France
| | - L. Bouazza
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS, UMR 1033, 69008 Lyon, France
| | - S. Geraci
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS, UMR 1033, 69008 Lyon, France
| | - P. Clezardin
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS, UMR 1033, 69008 Lyon, France
| | - D. Mitton
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC, UMR_T9406, 69622 Lyon, France
| | - H. Follet
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS, UMR 1033, 69008 Lyon, France
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10
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Kuhle J, Hardmeier M, Disanto G, Gugleta K, Ecsedi M, Lienert C, Amato MP, Baum K, Buttmann M, Bayas A, Brassat D, Brochet B, Confavreux C, Edan G, Färkkilä M, Fredrikson S, Frontoni M, D'Hooghe M, Hutchinson M, De Keyser J, Kieseier BC, Kümpfel T, Rio J, Polman C, Roullet E, Stolz C, Vass K, Wandinger KP, Kappos L. A 10-year follow-up of the European multicenter trial of interferon β-1b in secondary-progressive multiple sclerosis. Mult Scler 2015; 22:533-43. [PMID: 26362898 DOI: 10.1177/1352458515594440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore long-term effects of treatment and prognostic relevance of variables assessed at baseline and during the European secondary progressive multiple sclerosis (SPMS) trial of interferon beta 1b (IFNB-1b). METHODS We assessed 362 patients (60% female; median age 41 years; Expanded Disability Status Scale (EDSS): 5.5; 51% randomized to IFNB-1b) for their EDSS and treatment history after 10 years. Non-parametric analysis of covariance (ANCOVA) and multivariate linear regression models were applied. RESULTS Median EDSS was 6.0 at the end of the randomized controlled trial (RCT), in the IFNB-1b and placebo groups, and 7.0 in long-term follow-up patients (those receiving IFNB-1b in the RCT were 6.5 and those receiving placebo in the RCT were 7.0; p = 0.086). 24 patients (6.6%) were deceased. The EDSS at baseline and the EDSS change during the RCT were the most important predictors of the EDSS 10 years later (partial R(2): 0.47). The ability to predict changes in EDSS 10 years after the RCT was limited (R(2): 0.12). Magnetic resonance imaging (MRI) measures remained in the predictive models, but explained < 5% of the variability. CONCLUSIONS The results from this analysis did not provide convincing evidence to support a favorable long-term outcome in those patients allocated IFNB-1b during the RCT, in our SPMS cohort. The progressive stage of the disease remains largely unpredictable by clinical and conventional MRI measures, so better prognostic markers are needed.
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Affiliation(s)
- J Kuhle
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel/Blizard Institute, Queen Mary University of London, Barts, UK/London School of Medicine and Dentistry, UK University Hospital Basel, Switzerland
| | - M Hardmeier
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - G Disanto
- Blizard Institute, Queen Mary University of London, Barts, UK/London School of Medicine and Dentistry, UK. Neurocentre of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - K Gugleta
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - M Ecsedi
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - C Lienert
- Department of Medicine, Neurology, Kantonsspital Baselland Bruderholz, Switzerland
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Italy
| | - K Baum
- Department of Neurology, Klinik Hennigsdorf, Germany
| | - M Buttmann
- Department of Neurology, University of Würzburg, Germany
| | - A Bayas
- Department of Neurology, Klinikum Augsburg, Germany
| | - D Brassat
- Unité Institut national de la santé et de la recherche médicale (INSERM) 563, Centre hospitalier universitaire Purpan, Toulouse, France
| | - B Brochet
- Department of Neurology, and INSERM-CHU CIC-P 0005, Centre hospitalier universitaire de Bordeaux, France
| | - C Confavreux
- Centre de coordination EDMUS pour la sclérose en plaques, Hôpital Neurologique Pierre-Wertheimer, Lyon, France
| | - G Edan
- Department of Neurology, Centre hospitalier universitaire Pontchaillou, Rennes, France
| | - M Färkkilä
- Department of Neurology, Central Hospital, Helsinki University, Finland
| | - S Fredrikson
- Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - M Frontoni
- Department of Neurological Sciences, University of Rome La Sapienza, Italy
| | - M D'Hooghe
- Department of Neurology, National MS Center, Melsbroek, Belgium/Vrije Universiteit Brussel, Belgium
| | - M Hutchinson
- Saint Vincent's University Hospital, University College Dublin, Ireland
| | - J De Keyser
- Departments of Neurology, University Medical Center Groningen, Netherlands
| | - B C Kieseier
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany
| | - J Rio
- MS Center of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Polman
- MS Center Amsterdam, Vrije University Medical Center, Netherlands
| | - E Roullet
- Department of Neurology, Hôpital Tenon, Paris, France
| | - C Stolz
- PAREXEL International GmbH, Berlin, Germany
| | - K Vass
- University Clinic of Neurology, Medical University of Vienna, Austria
| | - K P Wandinger
- University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - L Kappos
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
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Pelletier S, Bacchetta J, Boutroy S, Confavreux C, Chapurlat R, Drai J, Arkouche W, Fouque D, Guebre-Egziabher F. Relations entre adipokines, composition corporelle et qualité osseuse mesurée en HR-pQCT chez les patients en hémodialyse. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.023] [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: 10/23/2022]
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12
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Kuhle J, Disanto G, Dobson R, Adiutori R, Bianchi L, Topping J, Bestwick JP, Meier UC, Marta M, Costa GD, Runia T, Evdoshenko E, Lazareva N, Thouvenot E, Iaffaldano P, Direnzo V, Khademi M, Piehl F, Comabella M, Sombekke M, Killestein J, Hegen H, Rauch S, D’Alfonso S, Alvarez-Cermeño JC, Kleinová P, Horáková D, Roesler R, Lauda F, Llufriu S, Avsar T, Uygunoglu U, Altintas A, Saip S, Menge T, Rajda C, Bergamaschi R, Moll N, Khalil M, Marignier R, Dujmovic I, Larsson H, Malmestrom C, Scarpini E, Fenoglio C, Wergeland S, Laroni A, Annibali V, Romano S, Martínez AD, Carra A, Salvetti M, Uccelli A, Torkildsen Ø, Myhr KM, Galimberti D, Rejdak K, Lycke J, Frederiksen JL, Drulovic J, Confavreux C, Brassat D, Enzinger C, Fuchs S, Bosca I, Pelletier J, Picard C, Colombo E, Franciotta D, Derfuss T, Lindberg RLP, Yaldizli Ö, Vécsei L, Kieseier BC, Hartung HP, Villoslada P, Siva A, Saiz A, Tumani H, Havrdová E, Villar LM, Leone M, Barizzone N, Deisenhammer F, Teunissen C, Montalban X, Tintoré M, Olsson T, Trojano M, Lehmann S, Castelnovo G, Lapin S, Hintzen R, Kappos L, Furlan R, Martinelli V, Comi G, Ramagopalan SV, Giovannoni G. Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study. Mult Scler 2015; 21:1013-24. [DOI: 10.1177/1352458514568827] [Citation(s) in RCA: 196] [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] [Received: 10/10/2014] [Accepted: 11/19/2014] [Indexed: 11/15/2022]
Abstract
Background and objective: We explored which clinical and biochemical variables predict conversion from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS) in a large international cohort. Methods: Thirty-three centres provided serum samples from 1047 CIS cases with at least two years’ follow-up. Age, sex, clinical presentation, T2-hyperintense lesions, cerebrospinal fluid (CSF) oligoclonal bands (OCBs), CSF IgG index, CSF cell count, serum 25-hydroxyvitamin D3 (25-OH-D), cotinine and IgG titres against Epstein-Barr nuclear antigen 1 (EBNA-1) and cytomegalovirus were tested for association with risk of CDMS. Results: At median follow-up of 4.31 years, 623 CIS cases converted to CDMS. Predictors of conversion in multivariable analyses were OCB (HR = 2.18, 95% CI = 1.71–2.77, p < 0.001), number of T2 lesions (two to nine lesions vs 0/1 lesions: HR = 1.97, 95% CI = 1.52–2.55, p < 0.001; >9 lesions vs 0/1 lesions: HR = 2.74, 95% CI = 2.04–3.68, p < 0.001) and age at CIS (HR per year inversely increase = 0.98, 95% CI = 0.98–0.99, p < 0.001). Lower 25-OH-D levels were associated with CDMS in univariable analysis, but this was attenuated in the multivariable model. OCB positivity was associated with higher EBNA-1 IgG titres. Conclusions: We validated MRI lesion load, OCB and age at CIS as the strongest independent predictors of conversion to CDMS in this multicentre setting. A role for vitamin D is suggested but requires further investigation.
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Affiliation(s)
- J Kuhle
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK/ Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - G Disanto
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - R Dobson
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - R Adiutori
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - L Bianchi
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - J Topping
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - JP Bestwick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and the London School for Medicine and Dentistry, UK
| | - U-C Meier
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - M Marta
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
| | - G Dalla Costa
- Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy
| | - T Runia
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands
| | - E Evdoshenko
- Centre of Multiple Sclerosis, City Clinical Hospital#31, Russia
| | - N Lazareva
- Centre of Multiple Sclerosis, City Clinical Hospital#31, Russia
| | - E Thouvenot
- Institut de Génomique Fonctionelle, CNRS UMR5203, INSERM U661, Université Montpellier 1, Université Montpellier, France, and Hôpital Carémeau, France
| | - P Iaffaldano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - V Direnzo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - M Khademi
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - F Piehl
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - M Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - M Sombekke
- Departments of Neurology and Clinical Chemistry, MS Center, Neurocampus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands and BioMS-eu network
| | - J Killestein
- Departments of Neurology and Clinical Chemistry, MS Center, Neurocampus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands and BioMS-eu network
| | - H Hegen
- Department of Neurology, Innsbruck Medical University, Austria
| | - S Rauch
- Department of Radiology, Innsbruck Medical University, Austria
| | - S D’Alfonso
- Department of Health Sciences and IRCAD, Eastern Piedmont University, Italy
| | | | - P Kleinová
- Department of Neurology, Charles University in Prague, Czech Republic
| | - D Horáková
- Department of Neurology, Charles University in Prague, Czech Republic
| | - R Roesler
- Department of Neurology, CSF Laboratory and MS Outpatient Unit, University of Ulm, Germany
| | - F Lauda
- Department of Neurology, CSF Laboratory and MS Outpatient Unit, University of Ulm, Germany
| | - S Llufriu
- Center for Neuroimmunology and Department of Neurology. Institut d’investigacions Biomèdiques August Pi Sunyer (IDIBAPS) – Hospital Clinic of Barcelona, Spain
| | - T Avsar
- Dr Orhan Öcalgiray Molecular Biology-Biotechnology and Genetics Research Centre, Istanbul Technical University, Turkey
| | - U Uygunoglu
- Department of Neurology, Istanbul University, Turkey
| | - A Altintas
- Department of Neurology, Istanbul University, Turkey
| | - S Saip
- Department of Neurology, Istanbul University, Turkey
| | - T Menge
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Germany
| | - C Rajda
- Department of Neurology, University of Szeged, Hungary
| | | | - N Moll
- Pôle de Neurosciences Cliniques, Service de Neurologie, Centre de Résonance Magnétique Biologique et Médicale, Centre Hospitalier Universitaire Timone, Laboratoire d’histocompatibilité, Etablissement Français du Sang Alpes Méditerrannée, Aix Marseille Université, France
| | - M Khalil
- Department of Neurology, Medical University of Graz, Austria
| | - R Marignier
- Department of Neurology, Université de Lyon, Université Claude Bernard-Lyon 1, France
| | - I Dujmovic
- Clinic of Neurology, Belgrade University School of Medicine, Serbia
| | - H Larsson
- Unit of Functional Imaging, Glostrup Hospital, University of Copenhagen, Denmark
| | - C Malmestrom
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - E Scarpini
- Neurology Unit, Dept. of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Policlinico
| | - C Fenoglio
- Neurology Unit, Dept. of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Policlinico
| | - S Wergeland
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Norway
| | - A Laroni
- Department of Neurology, University of Genoa, Italy
| | - V Annibali
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Italy
| | - S Romano
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Italy
| | - AD Martínez
- Department of Neurology of Hospital Británico of Buenos Aires, Argentina
| | - A Carra
- Department of Neurology of Hospital Británico of Buenos Aires, Argentina
| | - M Salvetti
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Italy
| | - A Uccelli
- Department of Neurology, University of Genoa, Italy
| | - Ø Torkildsen
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Norway
| | - KM Myhr
- Department of Neurology, University of Genoa, Italy
| | - D Galimberti
- Neurology Unit, Dept. of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Policlinico
| | - K Rejdak
- Department of Neurology, Medical University of Lublin, Poland
| | - J Lycke
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - JL Frederiksen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - J Drulovic
- Clinic of Neurology, Belgrade University School of Medicine, Serbia
| | - C Confavreux
- Department of Neurology, Université de Lyon, Université Claude Bernard-Lyon 1, France
| | - D Brassat
- Department of Neurology, University of Toulouse, France
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Austria
| | - S Fuchs
- Department of Neurology, Medical University of Graz, Austria
| | - I Bosca
- MS Unit, Neurology Department, La Fe University and Polytechnic Hospital, Instituto de investigación Sanitaria La Fe, Spain
| | - J Pelletier
- Pôle de Neurosciences Cliniques, Service de Neurologie, Centre de Résonance Magnétique Biologique et Médicale, Centre Hospitalier Universitaire Timone, Laboratoire d’histocompatibilité, Etablissement Français du Sang Alpes Méditerrannée, Aix Marseille Université, France
| | - C Picard
- Pôle de Neurosciences Cliniques, Service de Neurologie, Centre de Résonance Magnétique Biologique et Médicale, Centre Hospitalier Universitaire Timone, Laboratoire d’histocompatibilité, Etablissement Français du Sang Alpes Méditerrannée, Aix Marseille Université, France
| | - E Colombo
- C. Mondino National Neurological Institute, Italy
| | - D Franciotta
- C. Mondino National Neurological Institute, Italy
| | - T Derfuss
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - RLP Lindberg
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - Ö Yaldizli
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - L Vécsei
- Department of Neurology, University of Szeged, Hungary
| | - BC Kieseier
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Germany
| | - HP Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Germany
| | - P Villoslada
- Center for Neuroimmunology and Department of Neurology. Institut d’investigacions Biomèdiques August Pi Sunyer (IDIBAPS) – Hospital Clinic of Barcelona, Spain
| | - A Siva
- Department of Neurology, Istanbul University, Turkey
| | - A Saiz
- Center for Neuroimmunology and Department of Neurology. Institut d’investigacions Biomèdiques August Pi Sunyer (IDIBAPS) – Hospital Clinic of Barcelona, Spain
| | - H Tumani
- Department of Neurology, CSF Laboratory and MS Outpatient Unit, University of Ulm, Germany
| | - E Havrdová
- Department of Neurology, Charles University in Prague, Czech Republic
| | - LM Villar
- Department of Neurology and Immunology, Hospital Ramón y Cajal, Spain
| | - M Leone
- MS Centre, SCDU Neurology, Head and Neck Department, AOU Maggiore della Carità, Italy
| | - N Barizzone
- Department of Health Sciences and IRCAD, Eastern Piedmont University, Italy
| | - F Deisenhammer
- Department of Neurology, Innsbruck Medical University, Austria
| | - C Teunissen
- Departments of Neurology and Clinical Chemistry, MS Center, Neurocampus Amsterdam, VU University Medical Centre Amsterdam, The Netherlands and BioMS-eu network
| | - X Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - M Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - T Olsson
- Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - S Lehmann
- Institut de Génomique Fonctionelle, CNRS UMR5203, INSERM U661, Université Montpellier 1, Université Montpellier, France, and Hôpital Carémeau, France
| | - G Castelnovo
- Institut de Génomique Fonctionelle, CNRS UMR5203, INSERM U661, Université Montpellier 1, Université Montpellier, France, and Hôpital Carémeau, France
| | - S Lapin
- Centre of Multiple Sclerosis, City Clinical Hospital#31, Russia
| | - R Hintzen
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands
| | - L Kappos
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland
| | - R Furlan
- Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy
| | - V Martinelli
- Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy
| | - G Comi
- Department of Neurology and INSPE, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Italy
| | - SV Ramagopalan
- Department of Physiology, Anatomy and Genetics and Medical Research Council Functional Genomics Unit, University of Oxford, UK
| | - G Giovannoni
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK
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Lionnet C, Carra C, Ayrignac X, Levade T, Gayraud D, Castelnovo G, Besson G, Androdias G, Vukusic S, Confavreux C, Zaenker C, De Seze J, Collongues N, Blanc F, Tranchant C, Wallon D, Hannequin D, Gerdelat-Mas A, Brassat D, Clanet M, Zephir H, Outteryck O, Vermersch P, Labauge P. [Cerebrotendinous xanthomatosis: a multicentric retrospective study of 15 adults, clinical and paraclinical typical and atypical aspects]. Rev Neurol (Paris) 2014; 170:445-53. [PMID: 24746394 DOI: 10.1016/j.neurol.2014.01.675] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 01/13/2014] [Accepted: 01/16/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cerebrotendinous xanthomatosis, a metabolic leukodystrophy with an autosomal recessive inheritance, is secondary to deficiency of sterol 27-hydroxylase, an enzyme involved in cholesterol catabolism. Classical symptoms include clinical or infraclinical xanthomas affecting the skin and tendons, early cataracts, neurological signs and diarrhea. Brain imaging reveals involvement of the dentate nuclei and periventricular white matter hyperintensities. The diagnosis is based on an increased cholestanol level in serum, confirmed by the presence of a mutation in the CYP27A1 gene. Treatment is based on chenodeoxycholic acid. METHOD We report a retrospective multicentric study of 15 cases of cerebrotendinous xanthomatosis diagnosed in French adults. Clinical, molecular and MRI findings were recorded in all patients. RESULTS The average age at diagnosis was 39years (range 27-65). Disease onset occurred in childhood in 73% of patients and in adulthood in 27%. All patients with a pediatric onset were diagnosed during adulthood (age range 28-65years). Clinical symptoms variably associated cerebellar syndrome, pyramidal syndrome, cognitive decline, epilepsy, neuropathy (sought in 10 of our patients, present in forms in 8), psychiatric disorders, cataract and xanthomas. One patient had an atypical presentation: monoparesis associated with xanthomas. Brain MRI was abnormal in all: findings consisted in T2-weighted hyperintensity of the dentate nuclei (47%), periventricular leuoencephalopathy (73%) which preferentially involved the posterior cerebral part (60%), leucoencephalopathy with a vascular pattern (7%), hyperintensity of the cortico-spinal tracts (53%), globi pallidi, corpus callosum and cerebral atrophy (33%). Serum cholestanol was elevated in 93% of patients. The most frequent mutation was 1183C>T (n=5/15). Under treatment with chenodeoxycholic acid, eight patients improved initially, followed by stabilization in five of them, and worsening in the others. Four patients died. CONCLUSION Patients with the xanthoma-neurological disorder association should be tested for cerebrotendinous xanthomatosis. The disease often begins in childhood with a diagnostic delay but also in adulthood. Involvement of the dentate nuclei is specific but not sensitive and the supratentorial leucoencephalopathy is not specific but with an antero-posterior gradient. A vascular distribution and involvement of the corpus callosum are possible. Serum cholestanol assay is very reliable: an elevated level provides the diagnosis, which must nevertheless be confirmed by molecular biology.
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Affiliation(s)
- C Lionnet
- Service de neurologie, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - C Carra
- Service de neurologie, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - X Ayrignac
- Service de neurologie, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - T Levade
- Laboratoire de biochimie, hôpital Rangueil, CHU de Toulouse, 1, avenue J.-Poulhès, 31403 Toulouse, France
| | - D Gayraud
- Service de neurologie, centre hospitalier du pays d'Aix, avenue des Tamaris, 13616 Aix-en-Provence cedex 1, France
| | - G Castelnovo
- Service de neurologie, hôpital Caremeau, CHU de Nîmes, place du Professeur-Debré, 30029 Nîmes cedex 4, France
| | - G Besson
- Service de neurologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - G Androdias
- Service de neurologie, hôpital Pierre-Wertheimer, CHU de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - S Vukusic
- Service de neurologie, hôpital Pierre-Wertheimer, CHU de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - C Confavreux
- Service de neurologie, hôpital Pierre-Wertheimer, CHU de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - C Zaenker
- Cabinet privé, 64, rue Robert-Schuman, 68000 Colmar, France
| | - J De Seze
- Service de neurologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - N Collongues
- Service de neurologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - F Blanc
- Service de neurologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - C Tranchant
- Service de neurologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - D Wallon
- Service de neurologie, CHU de Rouen, 1, rue Germont, 70031 Rouen, France
| | - D Hannequin
- Service de neurologie, CHU de Rouen, 1, rue Germont, 70031 Rouen, France
| | - A Gerdelat-Mas
- Service de neurologie, hôpital Purpan, CHU de Toulouse, place du Docteur-Baylac, 31059 Toulouse cedex 9, France
| | - D Brassat
- Service de neurologie, hôpital Purpan, CHU de Toulouse, place du Docteur-Baylac, 31059 Toulouse cedex 9, France
| | - M Clanet
- Service de neurologie, hôpital Purpan, CHU de Toulouse, place du Docteur-Baylac, 31059 Toulouse cedex 9, France
| | - H Zephir
- Service de neurologie D, hôpital Roger-Salengro, CHU de Lille, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - O Outteryck
- Service de neurologie D, hôpital Roger-Salengro, CHU de Lille, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - P Vermersch
- Service de neurologie D, hôpital Roger-Salengro, CHU de Lille, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - P Labauge
- Service de neurologie, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
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Boulogne S, Roggerone S, Deiana G, Derex L, Vukusic S, Confavreux C, Nighoghossian N. [Sequential MRI imaging of progressive bilateral rostro-caudal medullary infarction]. Rev Neurol (Paris) 2014; 170:277-9. [PMID: 24726038 DOI: 10.1016/j.neurol.2014.01.677] [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: 10/28/2013] [Revised: 01/04/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
Bilateral medial medullary infarction is exceptional. Initial symptoms can be misleading, even for a trained neurologist. We report two patients who presented progressive quadriplegia, anarthia and dysphagia. Sequential MRI showed progressive constitution of the characteristic "heart appearance" sign.
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Affiliation(s)
- S Boulogne
- Service de neurologie vasculaire, hôpital neurologique Pierre-Wertheimer, 35, boulevard Pinel, 69500 Bron, France
| | - S Roggerone
- Service de neurologie A, hôpital neurologique Pierre-Wertheimer, 35, boulevard Pinel, 69500 Bron, France
| | - G Deiana
- Service de radiologie, hôpital neurologique Pierre-Wertheimer, 35, boulevard Pinel, 69500 Bron, France
| | - L Derex
- Service de neurologie vasculaire, hôpital neurologique Pierre-Wertheimer, 35, boulevard Pinel, 69500 Bron, France
| | - S Vukusic
- Service de neurologie A, hôpital neurologique Pierre-Wertheimer, 35, boulevard Pinel, 69500 Bron, France
| | - C Confavreux
- Service de neurologie A, hôpital neurologique Pierre-Wertheimer, 35, boulevard Pinel, 69500 Bron, France
| | - N Nighoghossian
- Service de neurologie vasculaire, hôpital neurologique Pierre-Wertheimer, 35, boulevard Pinel, 69500 Bron, France.
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Michel L, Vukusic S, De Seze J, Ducray F, Ongagna JC, Lefrère F, Jacq-Foucher M, Confavreux C, Wiertlewski S, Laplaud DA. Mycophenolate mofetil in multiple sclerosis: a multicentre retrospective study on 344 patients. J Neurol Neurosurg Psychiatry 2014; 85:279-83. [PMID: 23704316 DOI: 10.1136/jnnp-2013-305298] [Citation(s) in RCA: 25] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Mycophenolate mofetil (MMF) is an immunosuppressive agent, sometimes used as a disease-modifying therapy for multiple sclerosis (MS). Several studies have reported the relative safety of this treatment but, to date, its efficacy has rarely been described. We performed a retrospective study to assess the safety and efficacy of MMF in patients with MS. METHODOLOGY Three French MS centres included all of their patients treated by MMF. The main outcome criterion was annualised relapse rate (ARR) in the 1 year period after onset of MMF compared with the 1 year control period. Treatment with another immunosuppressive drug, such as mitoxantrone or cyclophosphamide, in the 2 years preceding initiation of MMF was included in a subgroup analysis. MMF safety and progression of the Expanded Disability Status Scale (EDSS) score were also assessed. RESULTS 344 patients were included; 149 patients were previously treated with another immunosuppressant (IS group). Mean MMF treatment duration was 25.3±1.1 months. During the 1 year control period, ARR was 1.11±0.08, and for the 1 year treatment period, ARR was reduced significantly to 0.35±0.05 (p<0.0001, Wilcoxon paired test). Adverse events (occurring in 11% of patients) were mainly digestive disorders, benign infections, asthenia and transitory lymphopenia. Concerning the progression of disability, in the subgroup of patients without previous immunosuppressant treatment, EDSS remained stable between initiation and 1 year after the beginning of MMF. INTERPRETATION Our results suggest that MMF can improve or stabilise MS patients and can be used as an alternative therapy.
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Affiliation(s)
- L Michel
- Service de Neurologie, CHU Nantes, , Nantes, France
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16
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Collongues N, Marignier R, Jacob A, Leite MI, Siva A, Paul F, Zephir H, Akman-Demir G, Elsone L, Jarius S, Papeix C, Mutch K, Saip S, Wildemann B, Kitley J, Karabudak R, Aktas O, Kuscu D, Altintas A, Palace J, Confavreux C, De Seze J. Characterization of neuromyelitis optica and neuromyelitis optica spectrum disorder patients with a late onset. Mult Scler 2013; 20:1086-94. [PMID: 24323817 DOI: 10.1177/1352458513515085] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [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: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few data are available for patients with a late onset (≥ 50 years) of neuromyelitis optica (LONMO) or neuromyelitis optica spectrum disease (LONMOSD), defined by an optic neuritis/longitudinally extensive transverse myelitis with aquaporin-4 antibodies (AQP4-Ab). OBJECTIVE To characterize LONMO and LONMOSD, and to analyze their predictive factors of disability and death. METHODS We identified 430 patients from four cohorts of NMO/NMOSD in France, Germany, Turkey and UK. We extracted the late onset patients and analyzed them for predictive factors of disability and death, using the Cox proportional model. RESULTS We followed up on 63 patients with LONMO and 45 with LONMOSD during a mean of 4.6 years. This LONMO/LONMOSD cohort was mainly of Caucasian origin (93%), women (80%), seropositive for AQP4-Ab (85%) and from 50 to 82.5 years of age at onset. No progressive course was noted. At last follow-up, the median Expanded Disability Status Scale (EDSS) scores were 5.5 and 6 in the LONMO and LONMOSD groups, respectively. Outcome was mainly characterized by motor disability and relatively good visual function. At last follow-up, 14 patients had died, including seven (50%) due to acute myelitis and six (43%) because of opportunistic infections. The EDSS 4 score was independently predicted by an older age at onset, as a continuous variable after 50 years of age. Death was predicted by two independent factors: an older age at onset and a high annualized relapse rate. CONCLUSION LONMO/LONMOSD is particularly severe, with a high rate of motor impairment and death.
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Affiliation(s)
- N Collongues
- Department of Neurology, Hautepierre Hospital, University of Strasbourg, France
| | - R Marignier
- Department of Neurology, Pierre Wertheimer Hospital, University of Lyon, France
| | - A Jacob
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - M I Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - A Siva
- Department of Neurology, Istanbul University, Turkey
| | - F Paul
- Neurocure, Charité University Medicine Berlin, Germany
| | - H Zephir
- Department of Neurology, Robert Salengro Hospital, University of Lille Nord de France, France
| | - G Akman-Demir
- Department of Neurology, Istanbul University, Turkey
| | - L Elsone
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - S Jarius
- Division of Molecular Neuroimmunology, University of Heidelberg, Germany
| | - C Papeix
- Department of Neurology, Groupe Hospitalier Pitié Salpétrière, Paris, France
| | - K Mutch
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - S Saip
- Department of Neurology, Istanbul University, Turkey
| | - B Wildemann
- Division of Molecular Neuroimmunology, University of Heidelberg, Germany
| | - J Kitley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - R Karabudak
- Department of Neurology, Hacettepe University, Ankara, Turkey
| | - O Aktas
- Department of Neurology, Heinrich-Heine-University of Düsseldorf, Germany
| | - D Kuscu
- Department of Neurology, Bakýrkoy Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - A Altintas
- Department of Neurology, Istanbul University, Turkey
| | - J Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | | | - J De Seze
- Department of Neurology, Hautepierre Hospital, University of Strasbourg, France
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Lycke J, Arnold D, Cohen J, Coles A, Confavreux C, Fox E, Hartung HP, Havrdova E, Selmaj K, Weiner H, Brinar V, Giovannoni G, Stojanovic M, Lake S, Margolin D, Panzara M, Compston D. Adverse event profile of alemtuzumab over time in treatment-naïve patients with early, active relapsing–/INS;remitting multiple sclerosis (RRMS; CARE-MS I study). J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Balcer L, Arnold D, Cohen J, Coles A, Confavreux C, Fox E, Hartung HP, Havrdova E, Selmaj K, Weiner H, Brinar V, Giovannoni G, Stojanovic M, Cinar A, Margolin D, Panzara M, Compston D. Alemtuzumab improves visual outcomes in treatment-naïve patients with relapsing–/INS;remitting multiple sclerosis (RRMS): Analysis from the phase 3 CARE-MS I study. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Margolin D, Rizzo M, Smith G, Arnold D, Cohen J, Coles A, Confavreux C, Fox E, Hartung HP, Havrdova E, Selmaj K, Weiner H, Brinar V, Giovannoni G, Miller T, Stojanovic M, Twyman C, Lake S, Panzara M, Compston D. Alemtuzumab treatment has no adverse impact on sperm quality, quantity, or motility: A CARE-MS substudy. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Collongues N, Marignier R, Siva A, Paul F, Palace J, Confavreux C, De Seze J. Caractérisation de la neuromyélite optique et des pathologies du même spectre débutant après 50 ans. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roggerone S, Marignier R, Durand-Dubief F, Chenevier F, Benoit A, Vukusic S, Confavreux C. Lésions encéphaliques cavitaires profuses au cours d’une aquaporinopathie auto-immune. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ionescu I, Chenevier F, Marignier R, Roggerone S, Dubief FD, Vukusic S, Confavreux C. Myasthénie généralisée sévère et réfractaire : conditions de l’efficacité de l’immunosuppression une expérience de 20 ans sur 20 malades. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.104] [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: 10/27/2022]
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Durand-Dubief F, Belaroussi B, Armspach JP, Dufour M, Roggerone S, Vukusic S, Hannoun S, Sappey-Marinier D, Confavreux C, Cotton F. Reliability of longitudinal brain volume loss measurements between 2 sites in patients with multiple sclerosis: comparison of 7 quantification techniques. AJNR Am J Neuroradiol 2012; 33:1918-24. [PMID: 22790248 DOI: 10.3174/ajnr.a3107] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Brain volume loss is currently a MR imaging marker of neurodegeneration in MS. Available quantification algorithms perform either direct (segmentation-based techniques) or indirect (registration-based techniques) measurements. Because there is no reference standard technique, the assessment of their accuracy and reliability remains a difficult goal. Therefore, the purpose of this work was to assess the robustness of 7 different postprocessing algorithms applied to images acquired from different MR imaging systems. MATERIALS AND METHODS Nine patients with MS were followed longitudinally over 1 year (3 time points) on two 1.5T MR imaging systems. Brain volume change measures were assessed using 7 segmentation algorithms: a segmentation-classification algorithm, FreeSurfer, BBSI, KN-BSI, SIENA, SIENAX, and JI algorithm. RESULTS Intersite variability showed that segmentation-based techniques and SIENAX provided large and heterogeneous values of brain volume changes. A Bland-Altman analysis showed a mean difference of 1.8%, 0.07%, and 0.79% between the 2 sites, and a wide length agreement interval of 11.66%, 7.92%, and 11.94% for the segmentation-classification algorithm, FreeSurfer, and SIENAX, respectively. In contrast, registration-based algorithms showed better reproducibility, with a low mean difference of 0.45% for BBSI, KN-BSI and JI, and a mean length agreement interval of 1.55%. If SIENA obtained a lower mean difference of 0.12%, its agreement interval of 3.29% was wider. CONCLUSIONS If brain atrophy estimation remains an open issue, future investigations of the accuracy and reliability of the brain volume quantification algorithms are needed to measure the slow and small brain volume changes occurring in MS.
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Affiliation(s)
- F Durand-Dubief
- Service de Neurologie A et Fondation Eugène Devic EDMUS pour la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69677 Bron Cedex, France.
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Hannoun S, Durand-Dubief F, Confavreux C, Ibarrola D, Streichenberger N, Cotton F, Guttmann CRG, Sappey-Marinier D. Diffusion tensor-MRI evidence for extra-axonal neuronal degeneration in caudate and thalamic nuclei of patients with multiple sclerosis. AJNR Am J Neuroradiol 2012; 33:1363-8. [PMID: 22383236 DOI: 10.3174/ajnr.a2983] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MS is an inflammatory demyelinating disease affecting both WM and GM. While WM lesions are easily visualized by conventional MR imaging, the detection of GM alterations remains challenging. This diffusion tensor MR imaging study aimed to detect and characterize diffuse microscopic alterations in 2 deep GM structures, the caudate nucleus and the thalamus, in patients with RR and SP MS. The relationship between diffusivity markers, and atrophy of the caudate and the thalamus, as well as brain lesion load and clinical status of the patients was also explored. MATERIALS AND METHODS Twenty-three RR and 18 SP patients, along with 27 healthy controls, underwent MR imaging examination including anatomic and DTI acquisitions. Volumes, mean FA, and MD of the caudate and the thalamus, as well as WM lesion volumes, were assessed. RESULTS FA was significantly (P < .001) increased in the caudate and the thalamus of patients with MS compared with controls, and was higher in SP compared with RR patients. Increased FA was associated with volume decreases of caudate (r = -0.712; P < .001) and thalamus (r = -0.407; P < .01) in patients with MS. WM T2 lesion load was significantly associated with caudate (r = 0.611; P < .001) and thalamic (r = 0.354; P < .05) FA. Caudate FA, and, to a lesser extent, thalamic FA, were associated with functional deficits, as measured by EDSS and MSFC. CONCLUSIONS Increased FA in the caudate and the thalamus may constitute a sensitive marker of MS pathologic processes, such as loss of dendrites and/or swelling of neuronal cell bodies.
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Affiliation(s)
- S Hannoun
- CREATIS, UMR 5220 CNRS & U1044 INSERM, Université Claude Bernard-Lyon1, University of Lyon, France
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25
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Freedman MS, Wolinsky JS, Wamil B, Confavreux C, Comi G, Kappos L, Olsson TP, Miller A, Benzerdjeb H, Li H, Simonson C, O'Connor PW. Teriflunomide added to interferon- in relapsing multiple sclerosis: A randomized phase II trial. Neurology 2012; 78:1877-85. [DOI: 10.1212/wnl.0b013e318258f7d4] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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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Selmaj K, Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Fox E, Giovannoni G, Hartung H, Havrdova E, Stojanovic M, Weiner H, Lake S, Margolin D, Oyuela P, Panzara M, Compston A. Incidence of Autoimmunity in a Phase 3 Trial: Comparison of Alemtuzumab and Rebif(R) in Multiple Sclerosis I (CARE-MS I) (S41.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.006] [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] Open
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Havrdova E, Arnold D, Cohen J, Coles A, Confavreux C, Fox E, Hartung H, Selmaj K, Weiner H, Brinar V, Giovannoni G, Stojanovic M, Lake S, Margolin D, Oyuela P, Panzara M, Compston A. Infections in Phase 3 Study: Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis I (CARE-MS I) (S41.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Michel L, Vukusic S, De Seze J, Ducray F, Ongagna JC, Confavreux C, Laplaud D, Wiertlewski S. Mycophenolate Mofetil as a Monotherapy in Multiple Sclerosis: A Multicenter Retrospective Study on 362 Patients (P04.144). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Miller A, Lublin F, O'Connor P, Wolinsky J, Comi G, Kappos L, Freedman M, Olsson T, Dive-Pouletty C, Bego-Le-Bagousse G, Confavreux C. Effect of Teriflunomide on Relapses with Sequelae and Relapse Leading to Hospitalization in a Population with Relapsing Forms of Multiple Sclerosis: Results from the TEMSO Study (S30.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.003] [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] Open
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Fox E, Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Giovannoni G, Hartung H, Havrdova E, Selmaj K, Stojanovic M, Weiner H, Lake S, Margolin D, Panzara M, Compston A. Relapse Outcomes with Alemtuzumab vs. Rebif(R) in Treatment-Naive Relapsing-Remitting Multiple Sclerosis (CARE-MS I): Secondary and Tertiary Endpoints (PD5.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd5.004] [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: 11/15/2022] Open
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Coles A, Brinar V, Arnold D, Cohen J, Confavreux C, Fox E, Hartung H, Havrdova E, Selmaj K, Weiner H, Giovannoni G, Stojanovic M, Lake S, Margolin D, Panzara M, Compston A. Efficacy and Safety Results from Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis I (CARE-MS I): A Phase 3 Study in Relapsing-Remitting Treatment-Naive Patients (S01.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.006] [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: 11/15/2022] Open
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Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Fisher E, Fox E, Giovannoni G, Hartung H, Havrdova E, Selmaj K, Weiner H, Stojanovic M, Lake S, Margolin D, Panzara M, Compston A. Effect of Alemtuzumab vs. Rebif(R) on Brain MRI Measurements: Results of CARE-MS I, a Phase 3 Study (S11.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Cohen J, Twyman C, Arnold D, Coles A, Confavreux C, Fox E, Hartung H, Havrdova E, Selmaj K, Weiner H, Miller T, Lake S, Margolin D, Panzara M, Compston A. Efficacy and Safety Results from Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis II (CARE-MS II): A Phase 3 Study in Relapsing-Remitting Multiple Sclerosis Patients Who Relapsed on Prior Therapy (S01.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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Polman C, Havrdova E, Confavreux C, Rudick R. Relationship between Timed 25-Foot Walk Walking Speed and Health-Related Quality of Life in AFFIRM and SENTINEL (P07.097). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.097] [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] Open
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Freedman M, O'Connor P, Wolinsky J, Confavreux C, Comi G, Kappos L, Olsson T, Truffinet P, Dukovic D, Miller A. Teriflunomide Increases the Proportion of Patients Free from Disease Activity in the TEMSO Phase III Study (PD5.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd5.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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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Bourre B, Marignier R, Zéphir H, Papeix C, Brassat D, Castelnovo G, Collongues N, Vukusic S, Labauge P, Outteryck O, Fontaine B, Vermersch P, Confavreux C, de Seze J. Neuromyelitis optica and pregnancy. Neurology 2012; 78:875-9. [PMID: 22402855 DOI: 10.1212/wnl.0b013e31824c466f] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [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] Open
Abstract
OBJECTIVE The purpose of our study was to assess the influence of pregnancy on the course of neuromyelitis optica (NMO) and the impact of epidural analgesia and breastfeeding on its activity in the postpartum period. METHODS We performed a retrospective study of patients with NMO diagnosed according to Wingerchuk criteria. We noted the number of relapses during the year before pregnancy (BP), during pregnancy (first trimester, second trimester, third trimester), and the year after (Y + 1: first trimester, second trimester [PP2], and third and fourth trimesters postpartum). Epidural analgesia and breastfeeding were recorded. Disability was evaluated with the Kurtzke Expanded Disability Status Scale (EDSS). The annualized relapse rate (ARR) was calculated. RESULTS We identified 124 patients (85 female) in the French NOMADMUS cohort on November 1, 2010. A total of 20 women (including 25 pregnancies) were informative with complete files. Comparisons between the ARR of each period and BP (1.0 ± 0.09) only showed an increased tendency for PP2 (0.8 ± 0.06, p = 0.07). Epidural analgesia and breastfeeding had no influence on the course of NMO. The EDSS score increased from 1.5 ± 1.7 BP to 2.6 ± 1.9 Y + 1 (p = 0.027). CONCLUSION This study shows that pregnancy influences the activity of NMO, a finding that justifies close medical monitoring. We found no evidence to suggest that either epidural analgesia or breastfeeding has an aggravating effect on NMO.
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Affiliation(s)
- B Bourre
- Department of Neurology, Hôpital Charles Nicolle, Rouen, France.
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Androdias G, Maillet D, Marignier R, Pinède L, Broussolle C, Sève P, Confavreux C, Vukusic S. Efficacité du mycophenolate mofetil dans les atteintes neurologiques centrales liées à la sarcoïdose. Rev Neurol (Paris) 2012. [DOI: 10.1016/s0035-3787(12)70025-5] [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: 10/28/2022]
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Ritzenthaler T, Dailler F, Vukusic S, Confavreux C, Marignier R. First attack of Devic’s neuromyelitis optica following endovascular treatment and rupture of brain arteriovenous malformation. Mult Scler 2011; 17:895-6. [DOI: 10.1177/1352458511401945] [Citation(s) in RCA: 3] [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: 11/15/2022]
Affiliation(s)
- T Ritzenthaler
- Service de Réanimation Neurologique, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon F-69677, France
- Université Lyon 1, Lyon F-69003, France
| | - F Dailler
- Service de Réanimation Neurologique, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon F-69677, France
- Université Lyon 1, Lyon F-69003, France
| | - S Vukusic
- Université Lyon 1, Lyon F-69003, France
- Inserm U 842, Lyon F-69008, France
- Service de Neurologie A, EDMUS Coordinating Center, Fondation Eugène Devic-EDMUS pour la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon F-69677 France
| | - C Confavreux
- Université Lyon 1, Lyon F-69003, France
- Inserm U 842, Lyon F-69008, France
- Service de Neurologie A, EDMUS Coordinating Center, Fondation Eugène Devic-EDMUS pour la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon F-69677 France
| | - R Marignier
- Université Lyon 1, Lyon F-69003, France
- Inserm U 842, Lyon F-69008, France
- Service de Neurologie A, EDMUS Coordinating Center, Fondation Eugène Devic-EDMUS pour la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon F-69677 France
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Petzold A, Marignier R, Verbeek MM, Confavreux C. Glial but not axonal protein biomarkers as a new supportive diagnostic criteria for Devic neuromyelitis optica? Preliminary results on 188 patients with different neurological diseases. J Neurol Neurosurg Psychiatry 2011; 82:467-9. [PMID: 20667859 DOI: 10.1136/jnnp.2009.196550] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Androdias G, Maillet D, Marignier R, Pinede L, Confavreux C, Broussolle C, Vukusic S, Seve P. Mycophenolate mofetil may be effective in CNS sarcoidosis but not in sarcoid myopathy. Neurology 2011; 76:1168-72. [DOI: 10.1212/wnl.0b013e318212aafb] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [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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Orton SM, Wald L, Confavreux C, Vukusic S, Krohn JP, Ramagopalan SV, Herrera BM, Sadovnick AD, Ebers GC. Association of UV radiation with multiple sclerosis prevalence and sex ratio in France. Neurology 2011; 76:425-31. [PMID: 21282589 DOI: 10.1212/wnl.0b013e31820a0a9f] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [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] Open
Abstract
BACKGROUND French farmers and their families constitute an informative population to study multiple sclerosis (MS) prevalence and related epidemiology. We carried out an ecological study to evaluate the association of MS prevalence and ultraviolet (UV) radiation, a candidate climatologic risk factor. METHODS Mean annual and winter (December-March) UVB irradiation values were systematically compared to MS prevalence rates in corresponding regions of France. UVB data were obtained from the solar radiation database (SoDa) service and prevalence rates from previously published data on 2,667 MS cases registered with the national farmer health insurance system, Mutualité Sociale Agricole (MSA). Pearson correlation was used to examine the relationship of annual and winter UVB values with MS prevalence. Male and female prevalence were also analyzed separately. Linear regression was used to test for interaction of annual and winter UVB with sex in predicting MS prevalence. RESULTS There was a strong association between MS prevalence and annual mean UVB irradiation (r = -0.80, p < 0.001) and average winter UVB (r = -0.87, p < 0.001). Both female (r = -0.76, p < 0.001) and male (r = -0.46, p = 0.032) prevalence rates were correlated with annual UVB. Regression modeling showed that the effect of UVB on prevalence rates differed by sex; the interaction effect was significant for both annual UVB (p = 0.003) and winter UVB (p = 0.002). CONCLUSIONS The findings suggest that regional UVB radiation is predictive of corresponding MS prevalence rates and supports the hypothesis that sunlight exposure influences MS risk. The evidence also supports a potential role for gender-specific effects of UVB exposure.
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Affiliation(s)
- S-M Orton
- Wellcome Trust Centre for Human Genetics and Department of Clinical Neurology, University of Oxford, Oxford, UK
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Collongues N, Marignier R, Zéphir H, Blanc F, Vukusic S, Outteryck O, Fleury M, Ruet A, Borgel F, Thouvenot E, Moreau T, Defer G, Derache N, Pelletier J, Audoin B, Debouverie M, Labauge P, Gout O, Camu W, Brassat D, Brochet B, Vermersch P, Confavreux C, Seze JD. High-risk syndrome for neuromyelitis optica: a descriptive and comparative study. Mult Scler 2011; 17:720-4. [DOI: 10.1177/1352458510396923] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Neuromyelitis optica (NMO) frequently begins with a monofocal episode of optic neuritis or myelitis. A concept named high-risk syndrome (HRS) for NMO has been proposed for patients with monofocal episodes and NMO-IgG antibodies. Objective: To describe HRS patients and compare them with NMO patients. Methods: We identified 30 patients with HRS: 18 with extensive myelitis (HRM) and 12 with optic neuritis (HRON), in a database pooling patients from 25 centres in France. Clinical, laboratory/magnetic resonance imaging (MRI) data and outcome were analysed and compared with a national cohort of 125 NMO patients extracted from the same database. Results: Mean follow-up was 4.8 years. Mean age at onset was 42.8 years (range: 12.4–70) with a female:male ratio of 0.9. Asymptomatic lesions were report on visual evoked potentials in 4/8 tested HRM patients and on spinal cord MRI in 2/7 HRON patients. Three patients died, two owing to a cervical lesion. HRS and NMO patients had similar clinical/paraclinical data, except for a predominance of men in the HRS group and a later mean age at onset in the HRM subgroup. Conclusion: The description of HRS patients is compatible with a monofocal form of NMO. Asymptomatic lesions could be included in a new set of NMO diagnostic criteria.
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Affiliation(s)
- N Collongues
- Strasbourg University Hospital, Strasbourg, France
| | | | - H Zéphir
- Lille University Hospital, Lille, France
| | - F Blanc
- Strasbourg University Hospital, Strasbourg, France
| | - S Vukusic
- Lyon University Hospital, Lyon, France
| | | | - M Fleury
- Strasbourg University Hospital, Strasbourg, France
| | - A Ruet
- Bordeaux University Hospital, Bordeaux, France
| | - F Borgel
- Grenoble University Hospital, Grenoble, France
| | - E Thouvenot
- Montpellier University Hospital, Montpellier, France
| | - T Moreau
- Dijon University Hospital, Dijon, France
| | - G Defer
- Caen University Hospital, Caen, France
| | - N Derache
- Caen University Hospital, Caen, France
| | - J Pelletier
- Marseille University Hospital, Marseille, France
| | - B Audoin
- Marseille University Hospital, Marseille, France
| | | | - P Labauge
- Nîmes University Hospital, Nîmes, France
| | - O Gout
- Rothschild Foundation Hospital, Paris, France
| | - W Camu
- Montpellier University Hospital, Montpellier, France
| | - D Brassat
- Toulouse University Hospital, Toulouse, France
| | - B Brochet
- Bordeaux University Hospital, Bordeaux, France
| | | | | | - J de Seze
- Strasbourg University Hospital, Strasbourg, France
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Collongues N, Marignier R, Zéphir H, Papeix C, Fontaine B, Blanc F, Rodriguez D, Fleury M, Vukusic S, Pelletier J, Audoin B, Thouvenot E, Camu W, Barroso B, Ruet A, Brochet B, Vermersch P, Confavreux C, de Seze J. Long-term follow-up of neuromyelitis optica with a pediatric onset. Neurology 2010; 75:1084-8. [PMID: 20855851 DOI: 10.1212/wnl.0b013e3181f39a66] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [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 Neuromyelitis optica (NMO) is a rare inflammatory disease. Average age at onset is 35 years. Few data exist on patients with pediatric-onset NMO (p-NMO), with disease onset before age 18 years. We report the clinical and paraclinical features and long-term outcome of patients with p-NMO and compare them with a large adult-onset NMO (a-NMO) cohort. METHODS We performed a retrospective, multicenter study of patients with p-NMO in pediatric and adult medical centers. We identified 125 patients with NMO (12 p-NMO; 113 a-NMO) fulfilling the 2006 criteria. Data were collected using hospital files and standardized assessment forms for NMO. RESULTS Patients with p-NMO were followed up during a mean 19.3 years. Median age at onset was 14.5 years (4.1-17.9) with a female:male ratio of 3:1. Three patients (25%) fulfilled Paty criteria for multiple sclerosis on first brain MRI, including one patient with acute disseminated encephalomyelitis. Median interval between onset and residual Expanded Disability Status Scale (EDSS) score 4 was 20.7 years, score 6 was 26 years, and score 7 was 28.7 years. Median interval between onset and residual visual loss ≤1/10 was 1.3 years. Compared with a-NMO, p-NMO showed a longer time to EDSS scores 4 and 6, largely explained by the severity of the first myelitis in the a-NMO group. Time to first treatment was longer in the p-NMO group (13.1 vs 3.4 years). CONCLUSION Patients with p-NMO can present a diffuse inflammatory process on first brain MRI and have a longer time to disability than patients with a-NMO.
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Affiliation(s)
- N Collongues
- Department of Neurology, University Hospital of Strasbourg, 1, Place de l'Hôpital, 67091 Strasbourg, France.
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Abstract
Background: The association between epilepsy and multiple sclerosis (MS) is not a coincidence. Objective: Our objective was to compare MS patients with or without history of seizures. Methods: In a population of 5041 MS patients, we identified 102 (2%) patients with epileptic seizures. In 67 patients (1.3%), epileptic seizure could not be explained by any cause other than MS. Results: In these 67 patients, the median age at occurrence of the first epileptic seizure was 33 years. Epilepsy was the initial clinical manifestation of MS in seven patients. In total, 62 patients (92.5%) presented only one or a few seizures, and 18 patients (27%) presented at least one episode of status epilepticus, fatal in two. Compared with MS patients without epilepsy, there was no difference in gender, type of MS course and time from onset of MS to the progressive phase. Conversely, the median age at MS onset was earlier (25.0 years vs. 30, p < 0.0001) and there was a trend for a shorter time from MS onset to non-reversible disability. Conclusions: Our study confirms an increased risk of epileptic seizures in MS patients. It underlines that seizures may be the first observable symptom in MS and the frequency and seriousness of status epilepticus.
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Affiliation(s)
- H Catenoix
- Service de Neurologie Fonctionnelle et d’Epileptologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
- Université de Lyon, Lyon, France
- Institut Fédératif des Neurosciences de Lyon, Lyon, France
| | - R Marignier
- Université de Lyon, Lyon, France
- Institut Fédératif des Neurosciences de Lyon, Lyon, France
- Service de Neurologie A, European Database for Multiple Sclerosis (EDMUS) Coordinating Center
| | - C Ritleng
- Service de Neurologie A, European Database for Multiple Sclerosis (EDMUS) Coordinating Center
- INSERM U 842, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - M Dufour
- Service de Neurologie A, European Database for Multiple Sclerosis (EDMUS) Coordinating Center
- INSERM U 842, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - F Mauguière
- Service de Neurologie Fonctionnelle et d’Epileptologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
- Université de Lyon, Lyon, France
- Institut Fédératif des Neurosciences de Lyon, Lyon, France
| | - C Confavreux
- Université de Lyon, Lyon, France
- Institut Fédératif des Neurosciences de Lyon, Lyon, France
- Service de Neurologie A, European Database for Multiple Sclerosis (EDMUS) Coordinating Center
- INSERM U 842, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - S Vukusic
- Université de Lyon, Lyon, France
- Institut Fédératif des Neurosciences de Lyon, Lyon, France
- Service de Neurologie A, European Database for Multiple Sclerosis (EDMUS) Coordinating Center
- INSERM U 842, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
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Collongues N, Marignier R, Zéphir H, Papeix C, Blanc F, Ritleng C, Tchikviladzé M, Outteryck O, Vukusic S, Fleury M, Fontaine B, Brassat D, Clanet M, Milh M, Pelletier J, Audoin B, Ruet A, Lebrun-Frenay C, Thouvenot E, Camu W, Debouverie M, Créange A, Moreau T, Labauge P, Castelnovo G, Edan G, Le Page E, Defer G, Barroso B, Heinzlef O, Gout O, Rodriguez D, Wiertlewski S, Laplaud D, Borgel F, Tourniaire P, Grimaud J, Brochet B, Vermersch P, Confavreux C, de Seze J. Neuromyelitis optica in France: a multicenter study of 125 patients. Neurology 2010; 74:736-42. [PMID: 20194912 DOI: 10.1212/wnl.0b013e3181d31e35] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There have been few epidemiologic studies on neuromyelitis optica (NMO) and none used the recent 2006 diagnostic criteria. Here we describe the clinical, laboratory, MRI, and disability course of NMO in a French cohort of 125 patients. METHODS We performed an observational, retrospective, multicenter study. Data were collected from September 2007 through August 2008, corresponding to the endpoint of the study. We identified 125 patients fulfilling the 2006 NMO criteria. Selection was made using hospital files and a specific clinical questionnaire for NMO. RESULTS Mean age at onset was 34.5 years (range 4-66) with a mean disease duration of 10 +/- 7.8 years at the endpoint. The patients were mainly (87%) Caucasian, with a female:male ratio of 3:1. In 90% of cases, the association of optic neuritis, longitudinal extensive myelitis, and a Paty-negative initial brain MRI was sufficient to fulfill the supportive criteria. Eighty-eight percent of patients were treated with immunosuppressive therapies. Median delay from onset to Expanded Disability Status Scale (EDSS) score 4 was 7 years; score 6, 10 years; and score 7, 21 years. The first episode of myelitis was immediately followed by an EDSS score > or = 4 in 37.3% of cases, and a severe residual visual loss was observed in 22% of patients after the first episode of optic neuritis. Multivariate analysis did not reveal any predictors of a poor evolution other than a high number of MRI brain lesions at diagnosis, which were predictive of a residual visual acuity < or = 1/10. CONCLUSIONS Our demographic data provide new data on disability in patients with neuromyelitis optica, most of whom were receiving treatment.
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Affiliation(s)
- N Collongues
- Department of Neurology, University Hospital of Strasbourg, 67091 Strasbourg, France.
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Vukusic S, Passante N, Ritleng C, Laforest L, Van Ganse E, Rocher F, Clanet M, Castot A, Confavreux C. 220 Safety of multiple sclerosis patients treated by natalizumab (Network EDMUS). BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041632.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Michel L, Foucher Y, De Sèze J, Vukusic S, Confavreux C, Brassat D, Clavelou P, Ouallet JC, Brochet B, Pelletier J, Labauge P, Lebrun C, Lefrere F, Jacq-Foucher M, Wiertlewski S, Laplaud DA. Étude rétrospective multicentrique évaluant le retentissement des traitements utilisés pour la fécondation in vitro sur le risque de poussées de Sclérose en plaques. Rev Neurol (Paris) 2010. [DOI: 10.1016/s0035-3787(10)70004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maillet D, Vukusic S, Confavreux C, Pinede L, Broussolle C, Sève P. Utilisation du mycophénolate mofétil au cours de la neurosarcoïdose : analyse rétrospective de 10 observations. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.025] [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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Vukusic S, Ionescu I, El-Etr M, Schumacher M, Baulieu E, Cornu C, Confavreux C. The Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPART'MUS) trial: Rationale, objectives and state of advancement. J Neurol Sci 2009; 286:114-8. [DOI: 10.1016/j.jns.2009.08.056] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/19/2009] [Accepted: 08/25/2009] [Indexed: 10/20/2022]
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Tappenden P, Saccardi R, Confavreux C, Sharrack B, Muraro PA, Mancardi GL, Kozak T, Farge-Bancel D, Madan J, Rafia R, Akehurst R, Snowden J. Autologous haematopoietic stem cell transplantation for secondary progressive multiple sclerosis: an exploratory cost-effectiveness analysis. Bone Marrow Transplant 2009; 45:1014-21. [PMID: 19855441 DOI: 10.1038/bmt.2009.305] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment options for secondary progressive multiple sclerosis (SPMS) are limited. Mitoxantrone is routinely used to stabilize disease progression; however, evolving evidence suggests clinical benefit from intensive treatment with autologous haematopoietic stem cell transplantation (HSCT). Given differences in cost and outcomes, preliminary cost-effectiveness studies are warranted if this approach is to be developed for more widespread application in SPMS. We developed a decision-analytic Markov model to explore the potential cost-effectiveness of autologous HSCT versus mitoxantrone in SPMS, using patient-level data from registry sources. The model evaluates the lifetime costs and health outcomes associated with disability progression and relapse. Sensitivity analyses were undertaken to examine the uncertainty surrounding cost-effectiveness outcomes. In the absence of randomised controlled trial (RCT) evidence, conditions for comparative analysis were not ideal. Under optimistic assumptions, HSCT is estimated to cost below pound3000 per quality adjusted life year gained. However, when a strict 6-month sustained progression rule is adopted, HSCT may be less effective and more expensive than mitoxantrone. The model results were sensitive to reducing procedural costs and HSCT-related mortality. We conclude that HSCT could potentially achieve an acceptable level of cost-effectiveness. However, caution should be exercised as large, high-quality RCTs comparing HSCT versus mitoxantrone are necessary to validate these findings.
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Affiliation(s)
- P Tappenden
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
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