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Sabin J, Salas E, Martín-Martínez J, Candeliere-Merlicco A, Barrero FJ, Alonso A, Sánchez-Menoyo JL, Borrega L, Rodríguez-Rodríguez M, Gómez-Gutiérrez M, Eichau S, Hernández-Pérez MÁ, Calles C, Fernández-Díaz E, Carmona O, Orvíz A, López-Real A, López-Muñoz P, Mendoza A, Agüera E, Maurino J, Ballesteros J. Assessing illness-related uncertainty in relapsing-remitting multiple sclerosis: A psychometric analysis of the Mishel Uncertainty of Illness Scale. Mult Scler J Exp Transl Clin 2024; 10:20552173241247680. [PMID: 38638273 PMCID: PMC11025437 DOI: 10.1177/20552173241247680] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
A multicenter study involving 204 adults with relapsing-remitting multiple sclerosis (RRMS) assessed the dimensionality and item characteristics of the Mishel-Uncertainty of Illness Scale (MUIS), a generic self-assessment tool. Mokken analysis identified two dimensions in the MUIS with an appropriate item and overall scale scalability after excluding nonclassifiable items. A refined 12-item MUIS, employing a grade response model, effectively discriminated uncertainty levels among RRMS patients (likelihood ratio test p-value = .03). These findings suggest the potential value of the 12-item MUIS as a reliable measure for assessing uncertainty associated with the course of illness in RRMS.
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Affiliation(s)
- Julia Sabin
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Elisa Salas
- Medical Department, Roche Farma, Madrid, Spain
| | | | | | | | - Ana Alonso
- Department of Neurology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Carmen Calles
- Department of Neurology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Eva Fernández-Díaz
- Department of Neurology, Hospital Universitario de Albacete, Albacete,
Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | - Aida Orvíz
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana López-Real
- Department of Neurology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Amelia Mendoza
- Department of Neurology, Complejo Asistencial de Segovia, Segovia, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba,
Spain
| | | | - Javier Ballesteros
- Department of Neurosciences, University of Basque Country (UPV/EHU), CIBERSAM, Leioa, Spain
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Meca-Lallana JE, Martínez Yélamos S, Eichau S, Llaneza MÁ, Martín Martínez J, Peña Martínez J, Meca Lallana V, Alonso Torres AM, Moral Torres E, Río J, Calles C, Ares Luque A, Ramió-Torrentà L, Marzo Sola ME, Prieto JM, Martínez Ginés ML, Arroyo R, Otano Martínez MÁ, Brieva Ruiz L, Gómez Gutiérrez M, Rodríguez-Antigüedad Zarranz A, Sánchez-Seco VG, Costa-Frossard L, Hernández Pérez MÁ, Landete Pascual L, González Platas M, Oreja-Guevara C. Consensus statement of the Spanish Society of Neurology on the treatment of multiple sclerosis and holistic patient management in 2023. Neurologia 2024; 39:196-208. [PMID: 38237804 DOI: 10.1016/j.nrleng.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 01/25/2024] Open
Abstract
The last consensus statement of the Spanish Society of Neurology's Demyelinating Diseases Study Group on the treatment of multiple sclerosis (MS) was issued in 2016. Although many of the positions taken remain valid, there have been significant changes in the management and treatment of MS, both due to the approval of new drugs with different action mechanisms and due to the evolution of previously fixed concepts. This has enabled new approaches to specific situations such as pregnancy and vaccination, and the inclusion of new variables in clinical decision-making, such as the early use of high-efficacy disease-modifying therapies (DMT), consideration of the patient's perspective, and the use of such novel technologies as remote monitoring. In the light of these changes, this updated consensus statement, developed according to the Delphi method, seeks to reflect the new paradigm in the management of patients with MS, based on the available scientific evidence and the clinical expertise of the participants. The most significant recommendations are that immunomodulatory DMT be started in patients with radiologically isolated syndrome with persistent radiological activity, that patient perspectives be considered, and that the term "lines of therapy" no longer be used in the classification of DMTs (> 90% consensus). Following diagnosis of MS, the first DMT should be selected according to the presence/absence of factors of poor prognosis (whether epidemiological, clinical, radiological, or biomarkers) for the occurrence of new relapses or progression of disability; high-efficacy DMTs may be considered from disease onset.
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Affiliation(s)
- J E Meca-Lallana
- Unidad de Neuroinmunología Clínica y CSUR Esclerosis Múltiple, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca)/Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, Universidad Católica San Antonio (UCAM), Murcia, Spain.
| | - S Martínez Yélamos
- Unidad de Esclerosis Múltiple «EMxarxa», Servicio de Neurología. H.U. de Bellvitge, IDIBELL, Departament de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain
| | - S Eichau
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M Á Llaneza
- Servicio de Neurología, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - J Martín Martínez
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - V Meca Lallana
- Servicio de Neurología, Hospital Universitario La Princesa, Madrid, Spain
| | - A M Alonso Torres
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - E Moral Torres
- Servicio de Neurología, Complejo Hospitalario y Universitario Moisès Broggi, Barcelona, Spain
| | - J Río
- Servicio de Neurología, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - C Calles
- Servicio de Neurología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - A Ares Luque
- Servicio de Neurología, Complejo Asistencial Universitario de León, León, Spain
| | - L Ramió-Torrentà
- Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial de Girona (UNIEMTG), Hospital Universitari Dr. Josep Trueta y Hospital Santa Caterina. Grupo Neurodegeneració i Neuroinflamació, IDIBGI. Departamento de Ciencias Médicas, Universidad de Girona, Girona, Spain
| | - M E Marzo Sola
- Servicio de Neurología, Hospital San Pedro, Logroño, Spain
| | - J M Prieto
- Servicio de Neurología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M L Martínez Ginés
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Arroyo
- Servicio de Neurología, Hospital Universitario Quirón Salud Madrid, Madrid, Spain
| | - M Á Otano Martínez
- Servicio de Neurología, Hospital Universitario de Navarra, Navarra, Spain
| | - L Brieva Ruiz
- Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida, Spain
| | - M Gómez Gutiérrez
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | - V G Sánchez-Seco
- Servicio de Neurología, Hospital Universitario de Toledo, Toledo, Spain
| | - L Costa-Frossard
- CSUR de Esclerosis Múltiple, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Á Hernández Pérez
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - L Landete Pascual
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - M González Platas
- Servicio de Neurología, Hospital Universitario de Canarias, La Laguna, Spain
| | - C Oreja-Guevara
- Departamento de Neurología, Hospital Clínico San Carlos, IdISSC, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
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Meca-Lallana JE, Prieto González JM, Caminero Rodríguez AB, Olascoaga Urtaza J, Alonso AM, Durán Ferreras E, Espinosa R, Dotor J, Romera M, Ares Luque A, Pérez Ruiz D, Calles C, Hernández MA, Hervás García M, Mendoza Rodríguez A, Berdei Montero Y, Téllez N, Herrera Varó N, Sotoca J, Presas-Rodríguez S, Querol Gutierrez LA, Hervás Pujol M, Batlle Nadal J, Martín Ozaeta G, Gubieras Lillo L, Martínez Yélamos S, Ramió-Torrentà L, Mallada Frechin J, Belenguer Benavides A, Gascón-Giménez F, Casanova B, Landete Pascual L, Berenguer L, Navarro L, Gómez Gutierrez M, Durán C, Rodríguez Regal A, Álvarez E, García-Estévez DA, López Real AM, Llaneza González MA, Marzo Sola ME, Sánchez-Menoyo JL, Oterino A, Villaverde González R, Castillo-Triviño T, Álvarez de Arcaya A, Llarena C. Effectiveness and Safety of Teriflunomide in Relapsing-Remitting Multiple Sclerosis and Improvements in Quality of Life: Results from the Real-World TERICARE Study. Neurol Ther 2023; 12:2177-2193. [PMID: 37861931 PMCID: PMC10630277 DOI: 10.1007/s40120-023-00557-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Teriflunomide is a once-daily oral immunomodulator approved for relapsing forms of multiple sclerosis (MS) or relapsing-remitting multiple sclerosis (RRMS; depending on the local label), based on extensive evidence from clinical trials and a real-world setting on efficacy, tolerability and patient-reported benefits. The TERICARE study assessed the impact of teriflunomide treatment over 2 years on health-related quality of life (HRQoL) and some of the most common and disabling symptoms of MS, such as fatigue and depression. METHODS This prospective observational study in Spain included RRMS patients treated with teriflunomide for ≤ 4 weeks. The following patient-reported outcomes (PROs) were collected at baseline and every 6 months for 2 years: the 29-item Multiple Sclerosis Impact Scale version 2 (MSIS-29), the 21-item Modified Fatigue Impact Scale (MFIS-21), the Beck Depression Inventory (BDI-II), the Short Form (SF)-Qualiveen and the Treatment Satisfaction Questionnaire for Medication v1.4 (TSQM). Annualised relapse rate (ARR), disability progression according to the Expanded Disability Status Scale (EDSS), and no evidence of disease activity (NEDA-3) were also assessed. RESULTS A total of 325 patients were analysed. Patients had a mean (SD) age of 43.2 years (10.4), a mean baseline EDSS score of 1.75 (1.5), a mean number of relapses in the past 2 years of 1.5 (0.7), and 64% had received prior disease-modifying therapy (DMT). Patients showed significant improvements in the psychological domain of MSIS-29 from 35.9 (26.6) at baseline to 29.4 (25.5) at 18 months (p = 0.004) and 29.0 (24.6) at 24 months (p = 0.002). Levels of fatigue and depression were also reduced. After 2 years of treatment with teriflunomide, ARR was reduced to 0.17 (95% CI 0.14-0.21) from the baseline of 0.42 (95% CI 0.38-0.48), representing a 60.1% reduction. Mean EDSS scores remained stable during the study, and 79.9% of patients showed no disability progression. 54.7% of patients achieved NEDA-3 in the first 12 months, which increased to 61.4% during months 12-24. Patients reported increased satisfaction with treatment over the course of the study, regardless of whether they were DMT naive or not. CONCLUSION Teriflunomide improves psychological aspects of HRQoL and maintains low levels of fatigue and depression. Treatment with teriflunomide over 2 years is effective in reducing ARR and disability progression.
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Affiliation(s)
- José E Meca-Lallana
- Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit, Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca)/Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio, Murcia, Spain.
| | - José M Prieto González
- Neurology Service, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Ana M Alonso
- Neurology Service, Hospital Regional Universitario Málaga, Málaga, Spain
| | | | - Raúl Espinosa
- Neurology Unit, Hospital Universitario Jerez de La Frontera, Cádiz, Spain
| | - Julio Dotor
- Neurology Service, Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mercedes Romera
- Neurology Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | | | - Carmen Calles
- Neurology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Miguel A Hernández
- Neurology Service, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Miguel Hervás García
- Neurology Service, Hospital Insular Universitario de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Nieves Téllez
- Neurology Service, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | - Javier Sotoca
- Neurology Department, Hospital Mútua Terrassa, Barcelona, Spain
| | - Silvia Presas-Rodríguez
- MS-Neuroimmunology Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Luis A Querol Gutierrez
- Neuromuscular Diseases Unit-Autoimmune Neurology-Neuromuscular Lab, Neurology Department-Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | | | | | | | | | - Sergio Martínez Yélamos
- Multiple Sclerosis Unit, Hospital Universitario de Bellvitge, Institut Català de la Salut, Barcelona, Spain
| | - Lluís Ramió-Torrentà
- Neurology Department, Hospital Universitario Dr. Josep Trueta i Santa Caterina, Girona, Spain
| | | | | | | | | | | | | | - Laura Navarro
- Neurology Department, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Carmen Durán
- Neurology Service, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - Ana Rodríguez Regal
- Neurology Service, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Elena Álvarez
- Neurology Service, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Ana M López Real
- Neurology Service, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | | | - Agustín Oterino
- Neurology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Cristina Llarena
- Neurology Service, Hospital Universitario Basurto, Bilbao, Spain
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Fernández Ó, Montalban X, Agüera E, Aladro Y, Alonso A, Arroyo R, Brieva L, Calles C, Costa-Frossard L, Eichau S, M. García-Domínguez J, Hernández MÁ, Landete L, Llaneza M, Llufriu S, Meca-Lallana JE, Meca-Lallana V, Mongay-Ochoa N, Moral E, Oreja-Guevara C, Torrentà LRI, Téllez N, Romero-Pinel L, Rodríguez-Antigüedad A. [15th Post-ECTRIMS Meeting: a review of the latest developments presented at the 2022 ECTRIMS Congress (Part II)]. Rev Neurol 2023; 77:47-60. [PMID: 37403243 PMCID: PMC10662183 DOI: 10.33588/rn.7702.2023168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION On 4 and 5 November 2022, Madrid hosted the 15th edition of the Post-ECTRIMS Meeting, where neurologists specialised in multiple sclerosis outlined the latest developments presented at the 2022 ECTRIMS Congress, held in Amsterdam from 26 to 28 October. AIM To synthesise the content presented at the 15th edition of the Post-ECTRIMS Meeting, in an article broken down into two parts. DEVELOPMENT This second part describes the new developments in terms of therapeutic strategies for escalation and de-escalation of disease-modifying therapies (DMT), when and in whom to initiate or switch to highly effective DMT, the definition of therapeutic failure, the possibility of treating radiologically isolated syndrome and the future of personalised treatment and precision medicine. It also considers the efficacy and safety of autologous haematopoietic stem cell transplantation, different approaches in clinical trial design and outcome measures to assess DMT in progressive stages, challenges in the diagnosis and treatment of cognitive impairment, and treatment in special situations (pregnancy, comorbidity and the elderly). In addition, results from some of the latest studies with oral cladribine and evobrutinib presented at ECTRIMS 2022 are shown.
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Affiliation(s)
- Óscar Fernández
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaEspaña
| | - Xavier Montalban
- Hospital Universitari Vall d’Hebron-CEMCAT. BarcelonaHospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATBarcelonaEspaña
| | - Eduardo Agüera
- Hospital Universitario Reina Sofía. MadridHospital Universitario Reina SofíaHospital Universitario Reina SofíaMadridEspaña
| | - Yolanda Aladro
- Hospital Universitario de Getafe. Getafe, MadridHospital Universitario de GetafeHospital Universitario de GetafeMadridEspaña
| | - Ana Alonso
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaEspaña
| | - Rafael Arroyo
- Hospital Universitario Quirónsalud. MadridHospital Universitario QuirónsaludHospital Universitario QuirónsaludMadridEspaña
| | - Luis Brieva
- Hospital Universitari Arnau de Vilanova- Universitat de Lleida. LleidaHospital Universitari Arnau de Vilanova- Universitat de LleidaHospital Universitari Arnau de Vilanova- Universitat de LleidaLleidaEspaña
| | - Carmen Calles
- Hospital Universitario Son Espases. Palma de MallorcaHospital Universitario Son EspasesHospital Universitario Son EspasesPalma de MallorcaEspaña
| | - Lucienne Costa-Frossard
- Hospital Universitario Ramón y Cajal. MadridHospital Universitario Ramón y CajalHospital Universitario Ramón y CajalMadridEspaña
| | - Sara Eichau
- Hospital Universitario Virgen Macarena. SevillaHospital Universitario Virgen MacarenaHospital Universitario Virgen MacarenaSevillaEspaña
| | - José M. García-Domínguez
- Hospital Universitario Gregorio Marañón. MadridHospital Universitario Gregorio MarañónHospital Universitario Gregorio MarañónMadridEspaña
| | - Miguel Á. Hernández
- Hospital Nuestra Señora de Candelaria. Santa Cruz de Tenerife. ValenciaHospital Nuestra Señora de CandelariaHospital Nuestra Señora de CandelariaValenciaEspaña
| | - Lamberto Landete
- Hospital Universitario Doctor Peset. ValenciaHospital Universitario Doctor PesetHospital Universitario Doctor PesetValenciaEspaña
| | - Miguel Llaneza
- Complejo Hospitalario Universitario de Ferrol. El Ferrol, La CoruñaComplejo Hospitalario Universitario de FerrolComplejo Hospitalario Universitario de FerrolLa CoruñaEspaña
| | - Sara Llufriu
- Hospital Clínic de Barcelona e IDIBAPS. BarcelonaHospital Clínic de Barcelona e IDIBAPSHospital Clínic de Barcelona e IDIBAPSBarcelonaEspaña
| | - José E. Meca-Lallana
- Hospital Clínico Universitario Virgen de la Arrixaca. MurciaHospital Clínico Universitario Virgen de la ArrixacaHospital Clínico Universitario Virgen de la ArrixacaMurciaEspaña
| | - Virginia Meca-Lallana
- Hospital Universitario de La Princesa. MadridHospital Universitario de La PrincesaHospital Universitario de La PrincesaMadridEspaña
| | - Neus Mongay-Ochoa
- Hospital Universitari Vall d’Hebron-CEMCAT. BarcelonaHospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATBarcelonaEspaña
| | - Ester Moral
- Hospital Sant Joan Despí Moisès Broggi. Sant Joan Despí, BarcelonaHospital Sant Joan Despí Moisès BroggiHospital Sant Joan Despí Moisès BroggiBarcelonaEspaña
| | - Celia Oreja-Guevara
- Hospital Clínico San Carlos-IdISSC-UCM. MadridHospital Clínico San Carlos-IdISSC-UCMHospital Clínico San Carlos-IdISSC-UCMMadridEspaña
| | - Lluís Ramió i Torrentà
- Hospital Universitari de Girona Dr. Josep Trueta-IDIBGIHospital Universitari de Girona Dr. Josep Trueta-IDIBGIHospital Universitari de Girona Dr. Josep Trueta-IDIBGIGironaEspaña
- Hospital Santa Caterina. Universitat de Girona. GironaUniversitat de GironaUniversitat de GironaGironaEspaña
- Departamento de Cièncias Médicas. Universitat de Girona. GironaUniversitat de GironaUniversitat de GironaGironaEspaña
| | - Nieves Téllez
- Hospital Clínico Universitario de Valladolid. ValladolidHospital Clínico Universitario de ValladolidHospital Clínico Universitario de ValladolidValladolidEspaña
| | - Lucía Romero-Pinel
- Hospital Universitari de Bellvitge- IDIBELL. L’Hospitalet de Llobregat, BarcelonaHospital Universitari de Bellvitge- IDIBELLHospital Universitari de Bellvitge- IDIBELLBarcelonaEspaña
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Fernández Ó, Montalban X, Agüera E, Aladro Y, Alonso A, Arroyo R, Brieva L, Calles C, Costa-Frossard L, Eichau S, García-Domínguez JM, Hernández MÁ, Landete L, Llaneza M, Llufriu S, Meca-Lallana JE, Meca-Lallana V, Mongay-Ochoa N, Moral E, Oreja-Guevara C, Ramió-Torrentà L, Téllez N, Romero-Pinel L, Rodríguez-Antigüedad A. [15th Post-ECTRIMS Meeting: a review of the latest developments presented at the 2022 ECTRIMS Congress (Part I)]. Rev Neurol 2023; 77:19-30. [PMID: 37365721 PMCID: PMC10663806 DOI: 10.33588/rn.7701.2023167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION On 4 and 5 November 2022, Madrid hosted the 15th edition of the Post-ECTRIMS Meeting, where neurologists specialised in multiple sclerosis (MS) outlined the most relevant novelties presented at the 2022 ECTRIMS Congress, held in Amsterdam from 26 to 28 October. AIM To synthesise the content presented at the 15th edition of the Post-ECTRIMS Meeting, in an article broken down into two parts. DEVELOPMENT In this first part, the initial events involved in the onset of MS, the role played by lymphocytes and the migration of immune system cells into the central nervous system are presented. It describes emerging biomarkers in body fluids and imaging findings that are predictive of disease progression and useful in the differential diagnosis of MS. It also discusses advances in imaging techniques which, together with a better understanding of the agents involved in demyelination and remyelination processes, provide a basis for dealing with remyelination in the clinical setting. Finally, the mechanisms triggering the inflammatory reaction and neurodegeneration involved in MS pathology are reviewed.
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Affiliation(s)
- Óscar Fernández
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaSpain
| | - Xavier Montalban
- Hospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATBarcelonaSpain
| | - Eduardo Agüera
- Hospital Universitario Reina SofíaHospital Universitario Reina SofíaHospital Universitario Reina SofíaBarcelonaSpain
| | - Yolanda Aladro
- Hospital Universitario de Getafe. Getafe, MadridHospital Universitario de GetafeHospital Universitario de GetafeMadridSpain
| | - Ana Alonso
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaSpain
| | - Rafael Arroyo
- Hospital Universitario QuirónsaludHospital Universitario QuirónsaludHospital Universitario QuirónsaludBarcelonaSpain
| | - Luis Brieva
- Hospital Universitari Arnau de Vilanova- Universitat de Lleida. LleidaHospital Universitari Arnau de Vilanova- Universitat de LleidaHospital Universitari Arnau de Vilanova- Universitat de LleidaLleidaSpain
| | - Carmen Calles
- Hospital Universitario Son Espases. Palma de MallorcaHospital Universitario Son EspasesHospital Universitario Son EspasesPalma de MallorcaSpain
| | - Lucienne Costa-Frossard
- Hospital Universitario Ramón y CajalHospital Universitario Ramón y CajalHospital Universitario Ramón y CajalBarcelonaSpain
| | - Sara Eichau
- Hospital Universitario Virgen Macarena. SevillaHospital Universitario Virgen MacarenaHospital Universitario Virgen MacarenaSevillaSpain
| | - José M. García-Domínguez
- Hospital Universitario Gregorio MarañónHospital Universitario Gregorio MarañónHospital Universitario Gregorio MarañónBarcelonaSpain
| | - Miguel Á. Hernández
- Hospital Nuestra Señora de Candelaria. Santa Cruz de TenerifeHospital Nuestra Señora de CandelariaHospital Nuestra Señora de CandelariaSanta Cruz de TenerifeSpain
| | - Lamberto Landete
- Hospital Universitario Doctor Peset. ValenciaHospital Universitario Doctor PesetHospital Universitario Doctor PesetValenciaSpain
| | - Miguel Llaneza
- Complejo Hospitalario Universitario de Ferrol. El Ferrol, La CoruñaComplejo Hospitalario Universitario de FerrolComplejo Hospitalario Universitario de FerrolEl FerrolSpain
| | - Sara Llufriu
- Hospital Clínic de Barcelona e IDIBAPS. BarcelonaHospital Clínic de Barcelona e IDIBAPSHospital Clínic de Barcelona e IDIBAPSBarcelonaSpain
| | - José E. Meca-Lallana
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaSpain
| | - Virginia Meca-Lallana
- Hospital Clínico Universitario Virgen de la Arrixaca. MurciaHospital Clínico Universitario Virgen de la ArrixacaHospital Clínico Universitario Virgen de la ArrixacaMurciaSpain
| | - Neus Mongay-Ochoa
- Hospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATBarcelonaSpain
| | - Ester Moral
- Hospital Sant Joan Despí Moisès Broggi. Sant Joan Despí, BarcelonaHospital Sant Joan Despí Moisès BroggiHospital Sant Joan Despí Moisès BroggiBarcelonaSpain
| | - Celia Oreja-Guevara
- Hospital Clínico San Carlos-IdISSC-UCM. MadridHospital Clínico San Carlos-IdISSC-UCMHospital Clínico San Carlos-IdISSC-UCMMadridSpain
| | - Lluís Ramió-Torrentà
- Departamento de Cièncias Médicas. Universitat de Girona. GironaUniversitat de GironaUniversitat de GironaGironaSpain
| | - Nieves Téllez
- Hospital Clínico Universitario de Valladolid. ValladolidHospital Clínico Universitario de ValladolidHospital Clínico Universitario de ValladolidValladolidSpain
| | - Lucía Romero-Pinel
- Hospital Universitari de Bellvitge- IDIBELL. L’Hospitalet de Llobregat, BarcelonaHospital Universitari de Bellvitge- IDIBELLHospital Universitari de Bellvitge- IDIBELLBarcelonaSpain
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Sainz de la Maza S, Maurino J, Castillo-Triviño T, Borges M, Sebastián Torres B, Sotoca J, Alonso Torres AM, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco MR, Dotor García-Soto J, Rodríguez-Regal A, Navarro-Cantó L, Agüera-Morales E, Garcés M, Carmona O, Gabaldón-Torres L, Forero L, Hervás M, Gómez-Ballesteros R. Hopelessness in Patients with Early-Stage Relapsing-Remitting Multiple Sclerosis. Patient Prefer Adherence 2023; 17:1431-1439. [PMID: 37337517 PMCID: PMC10277026 DOI: 10.2147/ppa.s411069] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
Background Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS. Methods A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients' characteristics and state hopelessness. Results A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=<0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders. Conclusion Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.
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Affiliation(s)
| | | | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari Vall d´Hebrón, Barcelona, Spain
| | | | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | - Ana Rodríguez-Regal
- Department of Neurology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | | | - Moisés Garcés
- Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervás
- Department of Neurology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
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Sainz de la Maza S, Gómez-Ballesteros R, Borges M, Martín-Martínez J, Sotoca J, Alonso A, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco-Quílez MR, Dotor García-Soto J, del Campo-Amigo M, Navarro-Cantó L, Agüera E, Garcés-Redondo M, Carmona O, Gabaldón-Torres L, Forero L, Hervàs M, Medrano N, Maurino J, Castillo-Triviño T. Detecting disability using self-reported and clinical assessments in early-stage relapsing-remitting multiple sclerosis: Looking for a complementary approach. Mult Scler J Exp Transl Clin 2023; 9:20552173231169475. [PMID: 37187856 PMCID: PMC10176560 DOI: 10.1177/20552173231169475] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/23/2023] [Indexed: 05/17/2023] Open
Abstract
Disability accrual is mainly driven by progression independent of relapse activity, which is present even in early stages of relapsing-remitting multiple sclerosis (RRMS) and sometimes overlooked. This multicenter, non-interventional study evaluated whether patient-reported outcomes measures (PROMs) could capture disability in 189 early-stage RRMS patients (mean age: 36.1 ± 9.4 years, 71.4% female, mean disease duration: 1.4 ± 0.8 years, median EDSS: 1.0). The 9-Hole Peg Test (9-HPT), NeuroQoL Upper Extremity (NeuroQoL-UE), Timed 25-Foot Walk (T25-FW), Multiple Sclerosis Walking Scale (MSWS-12), Symbol Digit Modalities Test (SDMT), and Perceived Deficits Questionnaire (PDQ-5) were used to assess hand function, gait, and cognition, respectively. These functions were at least mildly affected in this early-stage population, finding significant correlations between PROMs and clinical assessments. PROMs could enable early-stage RRMS patients to communicate their perceived disability in different domains, assisting clinicians in disease monitoring and decision making.
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Affiliation(s)
- Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario
Ramón y Cajal, IRyCIS, Universidad de Alcalá, Madrid, Spain
| | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen
Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari Mútua
Terrassa, Terrassa, Spain
| | - Ana Alonso
- Department of Neurology, Hospital Regional
Universitario de Málaga, Málaga, Spain
| | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de
Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación
Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari
Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de
Vilanova, Lleida, Spain
| | | | | | - María del Campo-Amigo
- Department of Neurology, Complexo Hospitalario
Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de
Elche, Elche, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital
Universitario Reina Sofía, Córdoba, Spain
| | - Moisés Garcés-Redondo
- Department of Neurology, Hospital Clínico Universitario
Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut
Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital
Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervàs
- Department of Neurology, Consorci Corporació Sanitària
Parc Taulí, Sabadell, Spain
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Gascón-Giménez F, Alcalá C, Ramió-Torrentà L, Montero P, Matías-Guiu J, Gómez-Esteve I, Oreja-Guevara C, Gil-Perotín S, Blanco Y, Carcelén M, Quintanilla-Bordás C, Costa L, Villar LM, Martínez-Rodriguez JE, Domínguez JA, Calles C, González I, Sotoca J, Oterino A, Lucas-Jimenez C, Pérez-Miralles F, Casanova B. Treatment of multiple sclerosis with rituximab: A Spanish multicenter experience. Front Neurol 2023; 14:1060696. [PMID: 36959824 PMCID: PMC10027934 DOI: 10.3389/fneur.2023.1060696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/09/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Rituximab (RTX) is considered a potential therapeutic option for relapsing-remitting (RRMS) and progressive forms (PMS) of multiple sclerosis (MS). The main objective of this work was to investigate the effectiveness and safety of rituximab in MS. Patients and methods Observational multicenter study of clinical and radiological effectiveness and safety of rituximab in RRMS and PMS. Results A total of 479 rituximab-treated patients were included in 12 Spanish centers, 188 RRMS (39.3%) and 291 (60.7%) PMS. Despite standard treatment, the annualized relapse rate (ARR) the year before RTX was 0.63 (SD: 0.8) and 156 patients (41%) had at least one gadolinium-enhanced lesion (GEL) on baseline MRI. Mean EDSS had increased from 4.3 (SD: 1.9) to 4.8 (SD: 1.7) and almost half of the patients (41%) had worsened at least one point. After a median follow-up of 14.2 months (IQR: 6.5-27.2), ARR decreased by 85.7% (p < 0.001) and GEL by 82.9%, from 0.41 to 0.07 (p < 0.001). A significant decrease in EDSS to 4.7 (p = 0.046) was observed after 1 year of treatment and this variable remained stable during the second year of therapy. There was no evidence of disease activity in 68% of patients. Infusion-related symptoms were the most frequent side effect (19.6%) and most were mild. Relevant infections were reported only in 18 patients (including one case of probable progressive multifocal leukoencephalopathy). Conclusion Rituximab could be an effective and safe treatment in RRMS, including aggressive forms of the disease. Some selected PMS patients could also benefit from this treatment.
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Affiliation(s)
- Francisco Gascón-Giménez
- Neuroimmunology Unit, Neurology Department, Hospital Clinico Universitario, Valencia, Spain
- *Correspondence: Francisco Gascón-Giménez
| | - Carmen Alcalá
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Paloma Montero
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Irene Gómez-Esteve
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Sara Gil-Perotín
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Yolanda Blanco
- Neurology Department, Clinical Hospital of Barcelona, Barcelona, Spain
| | - María Carcelén
- Neurology Department, General University Hospital of Valencia, Valencia, Spain
| | | | - Lucienne Costa
- Neurology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | - José Andrés Domínguez
- Neuroimmunology Unit, Neurology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Carmen Calles
- Neurology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Inés González
- Neurology Department, Álvaro Cunqueiro Hospital, Vigo, Spain
| | - Javier Sotoca
- Neurology Department, Mutua de Terrasssa University Hospital, Barcelona, Spain
| | - Agustin Oterino
- Neurology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Celia Lucas-Jimenez
- Systems and Applications Engineer Department, Subdirectorate of Information Systems Hospital La Fe, Valencia, Spain
| | | | - Bonaventura Casanova
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
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Meca-Lallana JE, Casanova B, Rodríguez-Antigüedad A, Eichau S, Izquierdo G, Durán C, Río J, Hernández MÁ, Calles C, Prieto-González JM, Ara JR, Uría DF, Costa-Frossard L, García-Merino A, Oreja-Guevara C. Consensus on early detection of disease progression in patients with multiple sclerosis. Front Neurol 2022; 13:931014. [PMID: 35968319 PMCID: PMC9366521 DOI: 10.3389/fneur.2022.931014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Early identification of the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS) can be challenging for clinicians, as diagnostic criteria for SPMS are primarily based on physical disability and a holistic interpretation. Objective To establish a consensus on patient monitoring to identify promptly disease progression and the most useful clinical and paraclinical variables for early identification of disease progression in MS. Methods A RAND/UCLA Appropriateness Method was used to establish the level of agreement among a panel of 15 medical experts in MS. Eighty-three items were circulated to the experts for confidential rating of the grade of agreement and recommendation. Consensus was defined when ≥66% agreement or disagreement was achieved. Results Consensus was reached in 72 out of 83 items (86.7%). The items addressed frequency of follow-up visits, definition of progression, identification of clinical, cognitive, and radiological assessments as variables of suspected or confirmed SPMS diagnosis, the need for more accurate assessment tools, and the use of promising molecular and imaging biomarkers to predict disease progression and/or diagnose SPMS. Conclusion Consensus achieved on these topics could guide neurologists to identify earlier disease progression and to plan targeted clinical and therapeutic interventions during the earliest stages of SPMS.
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Affiliation(s)
- José E. Meca-Lallana
- CSUR Multiple Sclerosis and Clinical Neuroimmunology Unit, Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
- *Correspondence: José E. Meca-Lallana
| | - Bonaventura Casanova
- Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Carmen Durán
- Department of Neurology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Jordi Río
- CEMCAT, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - Miguel Ángel Hernández
- Department of Neurology, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Carmen Calles
- Department of Neurology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José M. Prieto-González
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - José Ramón Ara
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Dionisio F. Uría
- Department of Neurology, Hospital Universitario de Cabueñes, Gijón, Spain
| | | | | | - Celia Oreja-Guevara
- Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
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Meca-Lallana JE, Gómez-Ballesteros R, Pérez-Miralles F, Forero L, Sepúlveda M, Calles C, Martínez-Ginés ML, González-Suárez I, Boyero S, Romero-Pinel L, Sempere ÁP, Meca-Lallana V, Querol L, Costa-Frossard L, Prefasi D, Maurino J. Impact of Neuromyelitis Optica Spectrum Disorder on Quality of Life from the Patients' Perspective: An Observational Cross-Sectional Study. Neurol Ther 2022; 11:1101-1116. [PMID: 35524037 PMCID: PMC9075919 DOI: 10.1007/s40120-022-00356-6] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Neuromyelitis optica spectrum disorder (NMOSD) is associated with a reduced health-related quality of life (HRQoL). The purpose of this study was to describe the impact of NMOSD on HRQoL from the patients’ perspective and its relationship with other disease factors. Methods An observational, cross-sectional study was conducted at 13 neuroimmunology clinics in Spain. Patients with NMOSD diagnosis (2015 Wingerchuk criteria) were included. The 29-item Multiple Sclerosis Impact Scale (MSIS-29) was used to assess the HRQoL. Different questionnaires were used to measure symptom severity, stigma, mood disorders, pain, fatigue, and difficulties in the workplace. Factors that impact HRQoL were identified by Spearman’s correlation and multivariate linear regression analysis. Results Seventy-one patients were included (mean age 47.4 ± 14.9 years, 80.3% female, mean time since disease onset 9.9 ± 8.1 years). The median Expanded Disability Status Scale score was 3.0 (1.5–4.5). The mean (± SD) physical and psychological MSIS-29 sub-scores were 41.9 ± 16.8 and 20.9 ± 8.3, respectively. Fatigue and body pain were the most prevalent symptoms. Depressive symptoms were found in 44.3% (n = 31) of patients. The physical MSIS-29 dimension showed the highest correlation with symptom severity (ρ = 0.85584, p < 0.0001), whereas the highest correlations for psychological MSIS-29 dimension were pain, MSIS-29 physical dimension, and depression (ρ = 0.76487, 0.72779, 0.71380; p < 0.0001, respectively). Pain was a predictor of both dimensions of MSIS-29. Conclusion Fatigue, pain, and depressive symptoms are frequent problems among patients with NMOSD, impacting on their quality of life. Assessment of patient-oriented outcomes may be useful to achieve a holistic approach, allowing early specific interventions.
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Affiliation(s)
- José E Meca-Lallana
- Clinical Neuroimmunology Unit and Multiple Sclerosis CSUR, Department of Neurology, Hospital Universitario "Virgen de la Arrixaca", IMIB-Arrixaca, Murcia, Spain
| | | | - Francisco Pérez-Miralles
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María Sepúlveda
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | - Lucía Romero-Pinel
- Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Luis Querol
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Sainz de la Maza S, Maurino J, Borges M, Martín-Martínez J, Sotoca J, Alonso A, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco MR, García-Soto JD, Campo-Amigo MD, Navarro-Cantó L, Agüera E, Garcés M, Carmona O, Gabaldón-Torres L, Forero L, Hervás M, de Alda LR, Gómez-Ballesteros R, Castillo-Triviño T. Measuring productivity loss in early relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 58:103398. [PMID: 35216781 DOI: 10.1016/j.msard.2021.103398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their autonomy and capacity to maintain employment. OBJECTIVE The aim of this study was to assess the impact on work productivity in early-stage relapsing-remitting multiple sclerosis (RRMS). METHODS A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. Absenteeism, presenteeism, and unpaid work loss due to RRMS were measured using the Valuation of Lost Productivity (VOLP) questionnaire. The EDSS, SymptoMScreen, 5-item Modified Fatigue Impact Scale, Hospital Anxiety and Depression Scale, Symbol Digit Modalities Test, and Multiple Sclerosis Work Difficulties Questionnaire were used to gather information on disability, patients' perception of symptom severity, fatigue, mood/anxiety, cognition, and problems in the workplace, respectively. Associations between the VOLP and clinical and work outcomes were analyzed using Spearman's rank correlations. RESULTS A total of 189 patients were included. Mean age (SD) was 36.1 ± 9.4 years and 71.4% were female. Mean disease duration was 1.2 ± 0.8 years. Median EDSS score was 1.0 (IQR 0, 2.0). One hundred thirty patients (68.8%) were working for pay or self-employed. Fifty-three patients (40.8%) reported absence from work in the past 3 months with an average of 14.3 absent workdays. Their health problems resulted in the loss of 3.4% of their actual work time in the past 7 days. Thirty patients got help (11.8 h) with their unpaid work activities in the past 7 days. Absenteeism was significantly correlated with anxiety and depression (rho=0.298 and 0.291, p<0.001), fatigue (rho=0.214, p = 0.014), and symptom severity (rho=0.213, p = 0.015). Presenteeism was significantly correlated with fatigue (rho=0.375, p<0.001), symptom severity (rho=0.373, p<0.001), depression (rho=0.263, p = 0.008), and disability (rho=0.215, p = 0.031). CONCLUSIONS Productivity loss even in a RRMS population with short disease duration stresses the need for more efficient treatment control of disease activity from earlier stages.
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Affiliation(s)
| | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Ana Alonso
- Department of Neurology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Maria R Blasco
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - María Del Campo-Amigo
- Department of Neurology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Moisés Garcés
- Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervás
- Department of Neurology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
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Meca-Lallana J, Gómez-Ballesteros R, Pérez-Miralles F, Forero L, Sepúlveda M, Calles C, Martínez-Ginés ML, González-Suárez I, Boyero S, Romero-Pinel L, Sempere AP, Meca-Lallana V, Querol L, Costa-Frossard L, Prefasi D, Mauriño J. Impact of neuromyelitis optica spectrum disorder on quality of life: Assessing the patients' perspective. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meca-Lallana JE, Maurino J, Pérez-Miralles F, Forero L, Sepúlveda M, Calles C, Martínez-Ginés ML, González-Suárez I, Boyero S, Romero-Pinel L, Sempere ÁP, Meca-Lallana V, Querol L, Costa-Frossard L, Prefasi D, Gómez-Ballesteros R, Ballesteros J. Quantifying the patient´s perspective in neuromyelitis optica spectrum disorder: Psychometric properties of the SymptoMScreen questionnaire. PLoS One 2021; 16:e0255317. [PMID: 34324586 PMCID: PMC8320986 DOI: 10.1371/journal.pone.0255317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background The assessment of self-reported outcomes in neuromyelitis optica spectrum disorder (NMOSD) is limited by the lack of validated disease-specific measures. The SymptoMScreen (SyMS) is a patient-reported questionnaire for measuring symptom severity in different domains affected by multiple sclerosis (MS), but has not been thoroughly evaluated in NMOSD. The aim of this study was to assess the psychometric properties of the SyMS in a sample of patients with NMOSD. Methods A non-interventional, cross-sectional study in adult subjects with NMOSD (Wingerchuk 2015 criteria) was conducted at 13 neuroimmunology clinics applying the SyMS. A non-parametric item response theory procedure, Mokken analysis, was performed to assess the underlying dimensional structure and scalability of items and overall questionnaire. All analyses were performed with R (v4.0.3) using the mokken library. Results A total of 70 patients were studied (mean age: 47.5 ± 15 years, 80% female, mean Expanded Disability Status Scale score: 3.0 [interquartile range 1.5, 4.5]). Symptom severity was low (median SyMS score: 19.0 [interquartile range 10.0, 32.0]). The SyMS showed a robust internal reliability (Cronbach’s alpha: 0.90 [95% confidence interval 0.86, 0.93]) and behaved as a unidimensional scale with all items showing scalability coefficients > 0.30. The overall SyMS scalability was 0.45 conforming to a medium scale according to Mokken’s criteria. Fatigue and body pain were the domains with the highest scalability coefficients. The SyMS was associated with disability (rho: 0.586), and physical and psychological quality of life (rho: 0.856 and 0.696, respectively). Conclusions The SyMS shows appropriate psychometric characteristics and may constitute a valuable and easy-to-implement option to measure symptom severity in patients with NMOSD.
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Affiliation(s)
- José E. Meca-Lallana
- Department of Neurology, Clinical Neuroimmunology Unit and Multiple Sclerosis CSUR, Hospital Universitario “Virgen de la Arrixaca”, IMIB-Arrixaca, Murcia, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma, Madrid, Spain
- * E-mail:
| | - Francisco Pérez-Miralles
- Department of Neurology, Unit of Neuroimmunology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María Sepúlveda
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | - Lucía Romero-Pinel
- Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ángel P. Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Luis Querol
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Javier Ballesteros
- Department of Neurosciences and CIBERSAM, University of Basque Country (UPV/EHU), Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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Fernández O, Montalban X, Aladro Y, Alonso A, Arroyo R, Calles C, Castillo-Triviño T, Comabella M, Costa-Frossard L, Forero L, Ginestal R, Landete L, Llaneza M, Llufriu S, Martínez-Ginés ML, Meca-Lallana J, Mendibe M, Oreja-Guevara C, Oterino A, Prieto JM, Ramió-Torrentà L, Romero-Pinel L, Téllez N, Rodríguez-Antigüedad A. 13th Post-ECTRIMS Meeting: review of the new developments presented at the 2020 ECTRIMS Congress (I). Rev Neurol 2021; 72:397-406. [PMID: 34042168 DOI: 10.33588/rn.7211.2021172] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION For more than a decade, following the ECTRIMS Congress, the Post-ECTRIMS Meeting has been held in Spain, where neurologists with expertise in multiple sclerosis (MS) from all over the country meet to review the most relevant latest developments presented at the ECTRIMS congress (on this occasion held together with ACTRIMS). AIM This article, published in two parts, summarises the presentations that took place at the Post-ECTRIMS Meeting, held online on 16 and 17 October 2020. DEVELOPMENT This first part includes the latest results regarding the impact of the environment and lifestyle on risk of MS and its clinical course, and the role of epigenetics and genetic factors on these processes. Findings from preclinical and clinical research on the lymphocyte subtypes identified and the involvement of lymphoid follicles and meningeal involvement in the disease are discussed. Changes in brain structure are addressed at the microscopic and macroscopic levels, including results from high-resolution imaging techniques. The latest advances on biomarkers for the diagnosis and prognosis of MS, and on the involvement of the microbiome in these patients are also reported. Finally, results from patient registries on the impact of COVID-19 in MS patients are outlined. CONCLUSIONS There have been new data on MS risk factors, the impact of MS at the cellular and structural level, the role of the microbiome in the disease, biomarkers, and the relationship between COVID-19 and MS.
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Affiliation(s)
- O Fernández
- Hospital Regional Universitario de Málaga, Málaga, España
| | - X Montalban
- Hospital Universitario Vall d'Hebron-CEMCAT, Barcelona, España
| | - Y Aladro
- Hospital Universitario de Getafe, 28905 Getafe, España
| | - A Alonso
- Hospital Regional Universitario de Málaga, Málaga, España
| | - R Arroyo
- Hospital Universitario Quirónsalud, Madrid, España
| | - C Calles
- Hospital Universitari Son Espases, Palma de Mallorca, España
| | | | - M Comabella
- Hospital Universitario Vall d'Hebron-CEMCAT, Barcelona, España
| | | | - L Forero
- Hospital Universitario Puerta del Mar, 11009 Cádiz, España
| | - R Ginestal
- Hospital Universitario Clínico de Madrid, Madrid, España
| | - L Landete
- Hospital Universitario Doctor Peset, Valencia, España
| | - M Llaneza
- Complejo Hospitalario Universitario de Ferrol, Ferrol, España
| | - S Llufriu
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | | | - J Meca-Lallana
- Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España
| | - M Mendibe
- Hospital Universitario de Cruces, Bilbao, España
| | | | - A Oterino
- Hospital Universitario Central de Asturias, Oviedo, España
| | - J M Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, España
| | - Ll Ramió-Torrentà
- Hospital Universitari Dr. Josep Trueta, 17007 Girona, España.,Hospital de Santa Caterina-IDIBGI, Salt, España
| | - L Romero-Pinel
- Hospital Universitario de Bellvitge , Hospitalet de Ll., España
| | - N Téllez
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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Fernández O, Montalban X, Aladro Y, Alonso A, Arroyo R, Calles C, Castillo-Triviño T, Comabella M, Costa-Frossard L, Forero L, Ginestal R, Landete L, Llaneza M, Llufriu S, Martínez-Ginés ML, Meca-Lallana J, Mendibe M, Oreja-Guevara C, Oterino A, Prieto JM, Ramió-Torrentà L, Romero-Pinel L, Téllez N, Rodríguez-Antigüedad A. 13th Post-ECTRIMS Meeting: review of the new developments presented at the 2020 ECTRIMS Congress (II). Rev Neurol 2021; 72:433-442. [PMID: 34109999 DOI: 10.33588/rn.7212.2021173] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION For more than a decade, after the ECTRIMS Congress, Spain has hosted the Post-ECTRIMS meeting, where neurologists with expertise in multiple sclerosis (MS) meet to review the new developments presented at the ECTRIMS. AIM This article, published in two parts, summarises the presentations of the post-ECTRIMS meeting, held online on 16 and 17 October 2020. DEVELOPMENT This second part highlights the importance of gender and age in understanding the pathology of the disease and optimising its management. The advances made in paediatric MS, from a neuropsychological and neuroimaging point of view, are presented. In turn, special attention is paid to the findings that contribute to a more personalised approach to therapy and to choosing the best treatment strategy (pharmacological and non-pharmacological) for each patient. Similarly, results related to possible strategies to promote remyelination are addressed. Although there are no major advances in the treatment of progressive forms, some quantitative methods for the classification of these patients are highlighted. In addition, the study also includes results on potential tools for assessment and treatment of cognitive deficits, and some relevant aspects observed in the spectrum of neuromyelitis optica disorders. Finally, the results of the papers considered as breaking news at the ECTRIMS-ACTRIMS are detailed. CONCLUSIONS Most of the advances presented were related to the knowledge of paediatric MS, remyelination strategies and cognitive assessment in MS.
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Affiliation(s)
- O Fernández
- Hospital Regional Universitario de Málaga, Málaga, España
| | - X Montalban
- Hospital Universitario Vall d'Hebron-CEMCAT, Barcelona, España
| | - Y Aladro
- Hospital Universitario de Getafe, 28905 Getafe, España
| | - A Alonso
- Hospital Regional Universitario de Málaga, Málaga, España
| | - R Arroyo
- Hospital Universitario Quirónsalud, Madrid, España
| | - C Calles
- Hospital Universitari Son Espases, Palma de Mallorca, España
| | | | - M Comabella
- Hospital Universitario Vall d'Hebron-CEMCAT, Barcelona, España
| | | | - L Forero
- Hospital Universitario Puerta del Mar, 11009 Cádiz, España
| | - R Ginestal
- Hospital Universitario Clínico de Madrid, Madrid, España
| | - L Landete
- Hospital Universitario Doctor Peset, Valencia, España
| | - M Llaneza
- Complejo Hospitalario Universitario de Ferrol, Ferrol, España
| | - S Llufriu
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | | | - J Meca-Lallana
- Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España
| | - M Mendibe
- Hospital Universitario de Cruces, Bilbao, España
| | | | - A Oterino
- Hospital Universitario Central de Asturias, Oviedo, España
| | - J M Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, España
| | - Ll Ramió-Torrentà
- Hospital Universitari Dr. Josep Trueta, 17007 Girona, España.,Hospital de Santa Caterina-IDIBGI, Salt, España
| | - L Romero-Pinel
- Hospital Universitario de Bellvitge , Hospitalet de Ll., España
| | - N Téllez
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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Meca-Lallana JE, Prefasi D, Pérez-Miralles F, Forero L, Sepúlveda M, Calles C, Martínez-Ginés ML, González-Suárez I, Boyero S, Romero-Pinel L, Sempere ÁP, Meca-Lallana V, Querol L, Costa-Frossard L, de Castro-Trapiello H, Canal N, Maurino J. Perception of Stigma in Patients with Neuromyelitis Optica Spectrum Disorder. Patient Prefer Adherence 2021; 15:713-719. [PMID: 33880015 PMCID: PMC8052114 DOI: 10.2147/ppa.s305707] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perception of stigma was associated with low self-esteem, psychological problems, and decreased health-seeking behavior among patients with different neurological disorders. The purpose of this study was to assess stigmatization and its impact in patients with neuromyelitis optica spectrum disorder (NMOSD). METHODS A non-interventional study was conducted at thirteen neuroimmunology clinics in Spain. Patients with a diagnosis of NMOSD (2015 Wingerchuk criteria) were included. The 8-item Stigma Scale for Chronic Illness (SSCI-8), the Expanded Disability Status Scale (EDSS), the 29-item Multiple Sclerosis Impact Scale (MSIS-29), the Beck Depression Inventory-Fast Screen (BDI-FS), the MOS Pain Effects Scale (MOS-PES) and the Fatigue Impact Scale for Daily Use (D-FIS) were used to assess the perception of stigma, disability, quality of life, mood, pain, and fatigue, respectively. Associations between outcome measures were analyzed using Spearman's rank correlation. RESULTS Seventy-one patients were studied (mean age: 47.4 years ± 14.9, 81.7% female, mean time since disease onset: 9.9 years ± 8.1). The median EDSS score was 3.0 (interquartile range 1.5, 4.5). Stigma prevalence was 61.4% (n=43). Thirty-one patients (43.6%) had depression. The SSCI-8 score showed a significant correlation with both physical (rho=0.576, p<0.0001) and psychological (rho=0.608, p<0.0001) MSIS-29 scales scores, EDSS score (rho=0.349, p=0.0033), BDI-FS score (rho= 0.613, p<0.0001), MOS-PES score (rho= 0.457, p<0.0001), and D-FIS score (rho=0.556, p<0.0001). CONCLUSION Stigma is a common phenomenon affecting over 6 out of 10 patients with NMOSD. Understanding stigma may be useful to develop educational strategies improving NMOSD knowledge.
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Affiliation(s)
- Jose E Meca-Lallana
- Clinical Neuroimmunology Unit and Multiple Sclerosis CSUR. Department of Neurology. Hospital Universitario “Virgen de la Arrixaca”, IMIB-Arrixaca, Murcia, Spain
| | | | - Francisco Pérez-Miralles
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María Sepúlveda
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | - Lucía Romero-Pinel
- Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Luis Querol
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Neus Canal
- Department of Statistics, IQVIA, Barcelona, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma, Madrid, Spain
- Correspondence: Jorge Maurino Roche Farma, Ribera Del Loira, 50, Madrid, 28042, SpainTel +34 913 24 81 00 Email
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Otero-Romero S, Rodríguez-García J, Vilella A, Ara J, Brieva L, Calles C, Carmona O, Casanova V, Costa-Frossard L, Eichau S, García-Merino J, Garcia-Vidal C, González-Platas M, Llaneza M, Martínez-Ginés M, Meca-Lallana J, Prieto J, Rodríguez-Antigüedad A, Tintoré M, Blanco Y, Moral E. Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2020.02.010] [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: 02/07/2023] Open
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Toboso I, Tejeda-Velarde A, Alvarez-Lafuente R, Arroyo R, Hegen H, Deisenhammer F, Sainz de la Maza S, Alvarez-Cermeño JC, Izquierdo G, Paramo D, Oliva P, Casanova B, Agüera-Morales E, Franciotta D, Gastaldi M, Fernández O, Urbaneja P, Garcia-Dominguez JM, Romero F, Laroni A, Uccelli A, Perez-Sempere A, Saiz A, Blanco Y, Galimberti D, Scarpini E, Espejo C, Montalban X, Rasche L, Paul F, González I, Álvarez E, Ramo C, Caminero AB, Aladro Y, Calles C, Eguía P, Belenguer-Benavides A, Ramió-Torrentà L, Quintana E, Martínez-Rodríguez JE, Oterino A, López de Silanes C, Casanova LI, Landete L, Frederiksen J, Bsteh G, Mulero P, Comabella M, Hernández MA, Espiño M, Prieto JM, Pérez D, Otano M, Padilla F, García-Merino JA, Navarro L, Muriel A, Frossard LC, Villar LM. New Algorithms Improving PML Risk Stratification in MS Patients Treated With Natalizumab. Front Neurol 2020; 11:579438. [PMID: 33408681 PMCID: PMC7780851 DOI: 10.3389/fneur.2020.579438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 12/22/2022] Open
Abstract
Overview: We assessed the role of age and disease activity as new factors contributing to establish the risk of progressive multifocal leucoencephalopathy in multiple sclerosis patients treated with natalizumab in 36 University Hospitals in Europe. We performed the study in 1,307 multiple sclerosis patients (70.8% anti-John Cunninghan virus positive antibodies) treated with natalizumab for a median time of 3.28 years. Epidemiological, clinical, and laboratory variables were collected. Lipid-specific IgM oligoclonal band status was available in 277 patients. Factors associated with progressive multifocal leucoencephalopathy onset were explored by uni- and multivariate logistic regression. Results: Thirty-five patients developed progressive multifocal leucoencephalopathy. The multivariate analysis identified anti-John Cunninghan virus antibody indices and relapse rate as the best predictors for the onset of this serious opportunistic infection in the whole cohort. They allowed to stratify progressive multifocal leucoencephalopathy risk before natalizumab initiation in individual patients [area under the curve (AUC) = 0.85]. The risk ranged from <1/3,300 in patients with anti-John Cunninghan virus antibody indices <0.9 and relapse rate >0.5, to 1/50 in the opposite case. In patients with lipid-specific IgM oligoclonal bands assessment, age at natalizumab onset, anti-John Cunninghan virus antibody indices, and lipid-specific IgM oligoclonal band status predicted progressive multifocal leucoencephalopathy risk (AUC = 0.92). The absence of lipid-specific IgM oligoclonal bands was the best individual predictor (OR = 40.94). The individual risk ranged from <1/10,000 in patients younger than 45 years at natalizumab initiation, who showed anti John Cunningham virus antibody indices <0.9 and lipid-specific IgM oligoclonal bands to 1/33 in the opposite case. Conclusions: In a perspective of personalized medicine, disease activity, anti-lipid specific IgM oligoclonal bands, anti Jonh Cunninghan virus antibody levels, and age can help tailor natalizumab therapy in multiple sclerosis patients, as predictors of progressive multifocal leucoencephalopathy.
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Affiliation(s)
- Inmaculada Toboso
- Immunology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | - Roberto Alvarez-Lafuente
- Instituto de Investigación Sanitaria San Carlos (IDISSC), Hospital Clinico San Carlos, Madrid, Spain
| | - Rafael Arroyo
- Department of Neurology, Hospital Universitario Quiron Salud, Madrid, Spain
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | | - Guillermo Izquierdo
- Neurology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Dolores Paramo
- Neurology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Pedro Oliva
- Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Diego Franciotta
- Istituti di Recovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Istituti di Recovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Oscar Fernández
- Neurology Department, Hospital Regional Universitario, Malaga, Spain
| | - Patricia Urbaneja
- Neurology Department, Hospital Regional Universitario, Malaga, Spain
| | | | - Fernando Romero
- Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alicia Laroni
- University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Uccelli
- University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | - Angel Perez-Sempere
- Neurology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Albert Saiz
- Neurology Service, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Neurology Service, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Daniela Galimberti
- Centro Dino Ferrari, Fondazione Ca' Granda, Istituti di Recovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico, University of Milan, Milan, Italy
| | - Elio Scarpini
- Centro Dino Ferrari, Fondazione Ca' Granda, Istituti di Recovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico, University of Milan, Milan, Italy
| | - Carmen Espejo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ludwig Rasche
- Department of Neurology, NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- Department of Neurology, NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Inés González
- Neurology Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Elena Álvarez
- Neurology Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Cristina Ramo
- Neurology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ana B Caminero
- Neurology Department, Hospital Nuestra Señora de Sonsoles, Avila, Spain
| | - Yolanda Aladro
- Neurology Department, Hospital Universitario Getafe, Getafe, Spain
| | - Carmen Calles
- Neurology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pablo Eguía
- Neurology Department, Hospital Doctor Jose Molina Orosa, Arrecife, Spain
| | | | | | - Ester Quintana
- Neurology Department, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | | | - Agustín Oterino
- Neurology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Luis I Casanova
- Neurology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain
| | - Lamberto Landete
- Neurology Department, Hospital Universitario Dr. Peset, Valencia, Spain
| | | | - Gabriel Bsteh
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Patricia Mulero
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel A Hernández
- Neurology Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Mercedes Espiño
- Immunology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - José M Prieto
- Neurology Department, Hospital Clínico de Santiago, Santiago de Compostela, Spain
| | - Domingo Pérez
- Neurology Department, Hospital del Bierzo, Ponferrada, Spain
| | - María Otano
- Neurology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - Laura Navarro
- Neurology Department, Hospital General de Elche, Elche, Spain
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Univesitario Ramon y Cajal, Instituto Ramon y Cajal para la Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | - Luisa M Villar
- Immunology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
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Otero-Romero S, Rodríguez-García J, Vilella A, Ara JR, Brieva L, Calles C, Carmona O, Casanova V, Costa-Frossard L, Eichau S, García-Merino JA, Garcia-Vidal C, González-Platas M, Llaneza M, Martínez-Ginés M, Meca-Lallana JE, Prieto JM, Rodríguez-Antigüedad A, Tintoré M, Blanco Y, Moral E. Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement. Neurologia 2020; 36:50-60. [PMID: 32561334 DOI: 10.1016/j.nrl.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The recent development of highly effective treatments for multiple sclerosis (MS) and the potential risk of infectious complications require the development of prevention and risk minimisation strategies. Vaccination is an essential element of the management of these patients. This consensus statement includes a series of recommendations and practical scenarios for the vaccination of adult patients with MS who are eligible for highly effective immunosuppressive treatments. METHODOLOGY A formal consensus procedure was followed. Having defined the scope of the statement, we conducted a literature search on recommendations for the vaccination of patients with MS and specific vaccination guidelines for immunosuppressed patients receiving biological therapy for other conditions. The modified nominal group technique methodology was used to formulate the recommendations. DEVELOPMENT Vaccination in patients who are candidates for immunosuppressive therapy should be considered before starting immunosuppressive treatment providing the patient's clinical situation allows. Vaccines included in the routine adult vaccination schedule, as well as some specific ones, are recommended depending on the pre-existing immunity status. If immunosuppressive treatment is already established, live attenuated vaccines are contraindicated. For vaccines with a correlate of protection, it is recommended to monitor the serological response in an optimal interval of 1-2 months from the last dose.
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Affiliation(s)
- S Otero-Romero
- Servicio de Medicina Preventiva, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España; Centro de Esclerosis Múltiple de Catalunya (Cemcat), Departamento de Neurología/Neuroimmunología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España.
| | - J Rodríguez-García
- Servicio de Medicina Preventiva, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - A Vilella
- Servicio de Medicina Preventiva, Hospital Clínic, Universidad de Barcelona-ISGlobal, Barcelona, España
| | - J R Ara
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - L Brieva
- Servicio de Neurología. IRBLLEIDA. Hospital Arnau de Vilanova, Lérida, España
| | - C Calles
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - O Carmona
- Servicio de Neurología, Fundació Salut Empordà, Figueras, Gerona, España
| | - V Casanova
- Unidad de Esclerosis Múltiple, Hospital Universitario La Fe, Valencia, España
| | - L Costa-Frossard
- Servicio de Neurología, Fundación para la Investigación Biomédica IRyCIS, Hospital Ramón y Cajal, Madrid, España
| | - S Eichau
- Unidad CSUR de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - C Garcia-Vidal
- Departamento de Enfermedades Infecciosas, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - M González-Platas
- Servicio de Neurología, Hospital Universitario de Canarias, Tenerife, España
| | - M Llaneza
- Sección de Neurología, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España
| | | | - J E Meca-Lallana
- CSUR Esclerosis Múltiple, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, Universidad Católica San Antonio, Murcia, España
| | - J M Prieto
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - A Rodríguez-Antigüedad
- Servicio de Neurología, Hospital Universitario Cruces-Osakidetza, Baracaldo, Vizcaya, España
| | - M Tintoré
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Departamento de Neurología/Neuroimmunología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España
| | - Y Blanco
- Servicio de Neurología, Hospital Clinic, Barcelona, España
| | - E Moral
- Servicio de Neurología, Hospital Moises Broggi y Hospital General de L'Hospitalet, Hospitalet de Llobregat, Barcelona, España
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Casanova B, Lacruz L, Villar ML, Domínguez JA, Gadea MC, Gascón F, Mallada J, Hervás D, Simó-Castelló M, Álvarez-Cermeño JC, Calles C, Olascoaga J, Ramió-Torrentà L, Alcalá C, Cervelló A, Boscá I, Pérez-Mirallles FC, Coret F. Different clinical response to interferon beta and glatiramer acetate related to the presence of oligoclonal IgM bands in CSF in multiple sclerosis patients. Neurol Sci 2018; 39:1423-1430. [PMID: 29882169 DOI: 10.1007/s10072-018-3442-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the efficacy of interferon beta (IFNβ) and glatiramer acetate (GA) related to the presence of oligoclonal M bands (OCMB) in the cerebrospinal fluid in relapsing-remitting multiple sclerosis (RRMS). METHOD This is an observational, multicenter and retrospective study with prospectively collected data of patients that started treatment with IFNβ or GA. Treatment decision was made blinded to the OCMB status. Time to first attack after starting therapy was compared by using Kaplan-Meier curves, and adjustment by Cox regression analysis was performed. RESULTS Two hundred and fifty-six patients entered in the study (141-55% received IFNβ; 115-45% received GA). After a mean follow-up of 41 and 65 months, 54.7% of patients remained free from further attacks (RF). The proportion of RF patients was higher in the GA group than in the IFNβ group (72.2 vs. 40.4%, p < 0.001). The IFNβ patients with OCMB+ presented the poorest response, 31.3% RF vs. 48.1% in IFNβ without OCMB, p = 0.03. CONCLUSION OCMB in CSF could be a biomarker of treatment response in multiple sclerosis.
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Affiliation(s)
| | - Laura Lacruz
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | | | | | | | - Francisco Gascón
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Valencia, Spain
| | | | - David Hervás
- Biostatistical Unit, Institut d'Investigació Sanitaria La Fe, Valencia, Spain
| | - María Simó-Castelló
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Carmen Calles
- Neurological Service, Hospital Son Espases, Mallorca, Spain
| | | | - Lluís Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Dr. Josep Trueta, IDIBGI, Girona, Spain
| | - Carmen Alcalá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Angeles Cervelló
- Neurological Service, Hospital General de València, Valencia, Spain
| | - Isabel Boscá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Francisco Coret
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Valencia, Spain
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Cunill V, Massot M, Clemente A, Calles C, Andreu V, Núñez V, López-Gómez A, Díaz RM, Jiménez MDLR, Pons J, Vives-Bauzà C, Ferrer JM. Relapsing-Remitting Multiple Sclerosis Is Characterized by a T Follicular Cell Pro-Inflammatory Shift, Reverted by Dimethyl Fumarate Treatment. Front Immunol 2018; 9:1097. [PMID: 29896193 PMCID: PMC5986897 DOI: 10.3389/fimmu.2018.01097] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 02/08/2018] [Accepted: 05/02/2018] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) is considered a T cell-mediated autoimmune disease, although several evidences also demonstrate a B cell involvement in its etiology. Follicular T helper (Tfh) cells, a CXCR5-expressing CD4+ T cell subpopulation, are essential in the regulation of B cell differentiation and maintenance of humoral immunity. Alterations in circulating (c)Tfh distribution and/or function have been associated with autoimmune diseases including MS. Dimethyl fumarate (DMF) is a recently approved first-line treatment for relapsing-remitting MS (RRMS) patients whose mechanism of action is not completely understood. The aim of our study was to compare cTfh subpopulations between RRMS patients and healthy subjects and evaluate the impact of DMF treatment on these subpopulations, relating them to changes in B cells and humoral response. We analyzed, by flow cytometry, the distribution of cTfh1 (CXCR3+CCR6-), cTfh2 (CXCR3-CCR6-), cTfh17 (CXCR3-CCR6+), and the recently described cTfh17.1 (CXCR3+CCR6+) subpopulations of CD4+ Tfh (CD45RA-CXCR5+) cells in a cohort of 29 untreated RRMS compared to healthy subjects. CD4+ non-follicular T helper (Th) cells (CD45RA-CXCR5-) were also studied. We also evaluated the effect of DMF treatment on these subpopulations after 6 and 12 months treatment. Untreated RRMS patients presented higher percentages of cTfh17.1 cells and lower percentages of cTfh2 cells consistent with a pro-inflammatory bias compared to healthy subjects. DMF treatment induced a progressive increase in cTfh2 cells, accompanied by a decrease in cTfh1 and the pathogenic cTfh17.1 cells. A similar decrease of non-follicular Th1 and Th17.1 cells in addition to an increase in the anti-inflammatory Th2 subpopulation were also detected upon DMF treatment, accompanied by an increase in naïve B cells and a decrease in switched memory B cells and serum levels of IgA, IgG2, and IgG3. Interestingly, this effect was not observed in three patients in whom DMF had to be discontinued due to an absence of clinical response. Our results demonstrate a possibly pathogenic cTfh pro-inflammatory profile in RRMS patients, defined by high cTfh17.1 and low cTfh2 subpopulations that is reverted by DMF treatment. Monitoring cTfh subsets during treatment may become a biological marker of DMF effectiveness.
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Affiliation(s)
- Vanesa Cunill
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Margarita Massot
- Neurology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Antonio Clemente
- Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain.,Clinical Trials and Methodology Support Platform, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Carmen Calles
- Neurology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Valero Andreu
- Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Vanessa Núñez
- Neurology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Antonio López-Gómez
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Rosa María Díaz
- Neurology Department, Hospital Universitari Son Espases, Palma, Spain
| | - María de Los Reyes Jiménez
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Jaime Pons
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Cristòfol Vives-Bauzà
- Research Unit, Institut d'Investigació Sanitària de les Illes Balears and Hospital Universitari Son Espases, Palma, Spain
| | - Joana Maria Ferrer
- Immunology Department, Hospital Universitari Son Espases, Palma, Spain.,Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
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Sepúlveda M, Armangué T, Sola-Valls N, Arrambide G, Meca-Lallana JE, Oreja-Guevara C, Mendibe M, Alvarez de Arcaya A, Aladro Y, Casanova B, Olascoaga J, Jiménez-Huete A, Fernández-Fournier M, Ramió-Torrentà L, Cobo-Calvo A, Viñals M, de Andrés C, Meca-Lallana V, Cervelló A, Calles C, Rubio MB, Ramo-Tello C, Caminero A, Munteis E, Antigüedad AR, Blanco Y, Villoslada P, Montalban X, Graus F, Saiz A. Neuromyelitis optica spectrum disorders: Comparison according to the phenotype and serostatus. Neurol Neuroimmunol Neuroinflamm 2016; 3:e225. [PMID: 27144216 PMCID: PMC4841645 DOI: 10.1212/nxi.0000000000000225] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/24/2016] [Indexed: 12/20/2022]
Abstract
Objective: To (1) determine the value of the recently proposed criteria of neuromyelitis optica (NMO) spectrum disorder (NMOSD) that unify patients with NMO and those with limited forms (NMO/LF) with aquaporin-4 immunoglobulin G (AQP4-IgG) antibodies; and (2) investigate the clinical significance of the serologic status in patients with NMO. Methods: This was a retrospective, multicenter study of 181 patients fulfilling the 2006 NMO criteria (n = 127) or NMO/LF criteria with AQP4-IgG (n = 54). AQP4-IgG and myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) antibodies were tested using cell-based assays. Results: Patients were mainly white (86%) and female (ratio 6.5:1) with median age at onset 39 years (range 10–77). Compared to patients with NMO and AQP4-IgG (n = 94), those with NMO/LF presented more often with longitudinally extensive transverse myelitis (LETM) (p < 0.001), and had lower relapse rates (p = 0.015), but similar disability outcomes. Nonwhite ethnicity and optic neuritis presentation doubled the risk for developing NMO compared with white race (p = 0.008) or LETM presentation (p = 0.008). Nonwhite race (hazard ratio [HR] 4.3, 95% confidence interval [CI] 1.4–13.6) and older age at onset were associated with worse outcome (for every 10-year increase, HR 1.7, 95% CI 1.3–2.2). Patients with NMO and MOG-IgG (n = 9) had lower female:male ratio (0.8:1) and better disability outcome than AQP4-IgG-seropositive or double-seronegative patients (p < 0.001). Conclusions: In patients with AQP4-IgG, the similar outcomes regardless of the clinical phenotype support the unified term NMOSD; nonwhite ethnicity and older age at onset are associated with worse outcome. Double-seronegative and AQP4-IgG-seropositive NMO have a similar clinical outcome. The better prognosis of patients with MOG-IgG and NMO suggests that phenotypic and serologic classification is useful.
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Affiliation(s)
| | - Thaís Armangué
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | - Mar Mendibe
- Authors' affiliations are listed at the end of the article
| | | | - Yolanda Aladro
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | | | | | | | | | | | | | - Carmen Calles
- Authors' affiliations are listed at the end of the article
| | | | | | - Ana Caminero
- Authors' affiliations are listed at the end of the article
| | - Elvira Munteis
- Authors' affiliations are listed at the end of the article
| | | | - Yolanda Blanco
- Authors' affiliations are listed at the end of the article
| | | | | | - Francesc Graus
- Authors' affiliations are listed at the end of the article
| | - Albert Saiz
- Authors' affiliations are listed at the end of the article
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Muñoz M, Calvo F, Serrano J, Calles C, Laureiro J, Martín L, Gómez-Espí M, Del Valle E. PO-0715: Post-neoadjuvant presacral radiological abnormalities in rectal cancer: Long-term risk factors analysis. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30833-1] [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: 12/01/2022]
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Escalas J, Knöpfel N, Martin-Santiago A, Calles C. Acute transverse myelitis during treatment with etanercept for severe plaque psoriasis. J Am Acad Dermatol 2014; 70:e17-8. [DOI: 10.1016/j.jaad.2013.08.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/19/2013] [Accepted: 08/24/2013] [Indexed: 11/27/2022]
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Fernández V, Valls-Sole J, Relova J, Raguer N, Miralles F, Dinca L, Taramundi S, Costa-Frossard L, Ferrandiz M, Ramió-Torrentà L, Villoslada P, Saiz A, Calles C, Antigüedad A, Alvarez-Cermeño J, Prieto J, Izquierdo G, Montalbán X, Fernández O. Recommendations for the clinical use of motor evoked potentials in multiple sclerosis. Neurología (English Edition) 2013. [DOI: 10.1016/j.nrleng.2013.09.003] [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: 10/26/2022] Open
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Muñoz D, Escartín A, Dapena D, Coret F, Fernández-Uría D, Pérez D, Casanova B, Guijarro-Castro C, Munteis E, del-Campo Amigo M, Pego R, Calles C, García-Rey C, Monsalve N, Sánchez-Matienzo D. Adverse events during the titration phase of interferon-beta in remitting-relapsing multiple sclerosis are not predicted by body mass index nor by pharmacodynamic biomarkers. BMC Neurol 2013; 13:82. [PMID: 23845043 PMCID: PMC3710468 DOI: 10.1186/1471-2377-13-82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 07/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to correlate body mass index or biomarkers with the frequency of common adverse events (AEs) with subcutaneous IFN β-1a during treatment titration in patients with relapsing-remitting multiple sclerosis previously naïve to IFN β. METHODS Eighty-four patients (66.3% females) were followed up during 8 weeks, 25.3% were overweight and 14.5% were obese. RESULTS Biomarkers steadily increased during all study period by 45.3% for β2-microglobulin, 262.8% for olygoadenylate synthetase-1, and 92.8% for neopterin. Overall AE reporting did not vary with the dose or treatment duration. CONCLUSIONS BMI was not predictive of increased risk for AEs. Biomarkers did not discriminate on the frequency of any AE either.
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Affiliation(s)
- Delicias Muñoz
- Department of Neurology, Hospital Xeral-Cies, Pontevedra, Spain
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Schroeder P, Calles C, Benesova T, Macaluso F, Krutmann J. Photoprotection beyond Ultraviolet Radiation – Effective Sun Protection Has to Include Protection against Infrared A Radiation-Induced Skin Damage. Skin Pharmacol Physiol 2010; 23:15-7. [DOI: 10.1159/000257259] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 09/23/2009] [Indexed: 11/19/2022]
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Benesova T, Pfeiffer R, Macaluso F, Calles C, Fritsche E, Abel J, Krutmann J, Schroeder P. The circadian rhythm of primary dermal fibroblasts affects infrared-A-induced gene expression. Cell Commun Signal 2009. [PMCID: PMC4291756 DOI: 10.1186/1478-811x-7-s1-a55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Macaluso F, Calles C, Krutmann J, Schroeder P. Infrared A-radiation alters the intracellular calciumhomeostasis in human dermal fibroblasts. Cell Commun Signal 2009. [PMCID: PMC4291773 DOI: 10.1186/1478-811x-7-s1-a64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Martín-Cancho MF, Sánchez-Margallo FM, Soria F, Díaz-Güemes I, Crisóstomo V, Calles C, Lima JR, Usón-Gargallo J. Physiological Responses to Different Ischemic Periods during Laparoscopic Infrarenal Aortic Cross-Clamping: Evaluation in an Experimental Animal Model. Ann Vasc Surg 2009; 23:506-18. [DOI: 10.1016/j.avsg.2008.12.002] [Citation(s) in RCA: 3] [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] [Received: 07/23/2008] [Revised: 10/20/2008] [Accepted: 12/08/2008] [Indexed: 10/20/2022]
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Schroeder P, Calles C, Krutmann J. Prevention of infrared-A radiation mediated detrimental effects in human skin. Skin Therapy Lett 2009; 14:4-5. [PMID: 19609472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Photoaging and skin damage that is caused by solar radiation is well known. We have recently learned that within the solar spectrum this damage not only results from ultraviolet (UV) radiation, but also from longer wavelengths, in particular near infrared radiation. Accordingly, infrared radiation (IR) has been shown to alter the collagen equilibrium of the dermal extracellular matrix in at least 2 ways: (1) by leading to an increased expression of the collagen degrading enzyme matrixmetalloproteinase-1 while (2) decreasing the de novo synthesis of the collagen itself. Infrared-A (IRA) radiation exposure, therefore, induces similar biological effects to UV, but the underlying mechanisms are substantially different. IRA acts via the mitochondria and therefore protection from IR requires alternative strategies.
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Affiliation(s)
- P Schroeder
- Institut fuer Umweltmedizinische Forschung (IUF) at the University of Duesseldorf, Duesseldorf, Germany
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Fernández-Vigo J, Macarro A, Viguera FJ, Calles C, Usón J. [Photocoagulation guided by fundus camera (new photocoagulation method of the retina with a non-contact and wide field system)]. Arch Soc Esp Oftalmol 2002; 77:559-66. [PMID: 12410420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
PURPOSE To design a device that integrates a laser photocoagulator in a fundus camera so that the functions of both are incorporated for their simultaneous use. This system would allow the visualizacion of the fundus during photocoagulation, with a no-contact, no hand-helped lens technique. MATERIAL AND METHODS To test the device we used a fundus camera Fx500 (Kowa) and a diode laser Oculight SLx (Iris Medical). We analysed the physical and power laser parameters, performing a comprehensive control of the device's safety. In order to measure the error in the precision of the laser, we designed a micrometric test to evaluate the directionality of the beam and the focusing system. Finally, we test the size, time of exposure and intensity necessary to obtain an effective impact. RESULTS With our system, transpupilar photocoagulation fullfils the main safety requirements on laser radiation and illumination in retinoscopy. After diverse adjustments, the laser impacts were placed in the desired retinal areas. The lesions generated in the pig eyes were quite similar to those obtained by conventional techniques and they were time and intensity dependent. CONCLUSIONS Photocoagulation with our sytem is very simple and potentially safe and effective. It may facilitate the photocoagulation process inasmuch as it is more comfortable and user-friendly.
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Affiliation(s)
- J Fernández-Vigo
- Cátedra de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, España.
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Lima MA, Calles C, Lima JR, Martin MF, Crisostomo V, Hernandez FJ, Barrera R, Uson J. Ultrasonographic assessment of metallic clip carotid anastomosis in sheep. Vet Radiol Ultrasound 2002; 43:171-7. [PMID: 11954813 DOI: 10.1111/j.1740-8261.2002.tb01665.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to use ultrasonography to assess an experimental carotid arteriotomy followed by end-to-end anastomosis in the lamb. Animals were subjected to an experimental surgical procedure consisting of a right carotid artery arteriotomy and subsequent end-to-end anastomosis with nonpenetrating metallic clips. Left side arteries were used as control. Duplex ultrasonography was performed postoperatively to assess the evolution of the experimental anastomosis. Measurements were made on the right carotid to assess blood flow, peak systolic velocity, and end diastolic velocity, as well as arterial diameter. Animals were periodically checked during the six-month postoperative period. Operated vessels appeared normal during follow up, with pulsatile movements and size similar to non operated carotid arteries. A hyperechoic band, perpendicular to the vessel main axis, was seen on the longitudinal image in operated arteries, but not in the control group. This band corresponded to the anastomosis area, where the clips were positioned. No image suggestive of thrombosis was observed in any operated artery, and blood flow was maintained through the experiment. Finally, a decrease of vessel lumen diameter was evidenced at the level of the anastomosis during the first 30 postoperative days, but it was not present after the 90th postsurgical day. Duplex ultrasonography is a useful imaging technique for the assessment of anatomical details, acoustical properties of the vascular lumen, and study of the intimal surface and vessel wall in growing arteries subjected to surgery. Metallic clips as suturing technique in arterial anastomosis allow for normal vascular growth, as shown by the evolution of flow velocity and vessel diameter.
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Affiliation(s)
- Marco A Lima
- Minimally Invasive Surgery Centre, Caceres, Spain
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Sobocki J, Thor PJ, Uson J, Diaz-Guemes I, Lipinski M, Calles C, Pascual S. Microchip vagal pacing reduces food intake and body mass. Hepatogastroenterology 2001; 48:1783-7. [PMID: 11813624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND/AIMS Morbid obesity is an increasing problem worldwide. In many patients pharmacotherapy is ineffective and these cases are treated by surgery. Different types of gastroplasty and gastric bypasses have been described. However, all of these ablative surgical methods are irreversible and often replace obesity by other disorders. Neuromodulation of vagal activity is a method of inducing significant changes in stomach motility. We developed a pre-programmed microchip able to pace vagal afferent activity by changing current parameters. The aim of our study was to evaluate long-term effects of vagal neuromodulation on food intake and body mass in rabbits. METHODOLOGY Twenty-seven healthy male adult New Zealand white rabbits were included into the study and divided into three groups: A, B and C, 9 animals each. Microchips were implanted by laparotomy access. Anesthesia was obtained by continuous intravenous infusion of propofol. Microchips were fixed in the preperitoneal pocket and two electrodes were positioned on the posterior vagus in group A by forward, and in group B by backward pacing. Control group C was sham operated by laparotomy and only vagal nerves preparation was performed. The following parameters were estimated: daily solid food and liquids intake, amount of feces, body mass and heart rate. RESULTS Within four weeks after operation body mass in group B had decreased up to 12% (P = 0.029), whereas in group A and C changed to -3% and +2%, respectively. An 87% solid food intake was observed in group A, 60% in group B (P < 0.01), and 143% in group C, compared to preoperative period. No significant differences were observed between groups A, B and C for liquids intake. Total feces weight changes corresponded to solid food intake. Heart rate decreased intraoperatively to 78% and 74% in groups A and B, respectively. CONCLUSIONS Microchip mediated functional gastroplasty significantly reduces food intake and body mass. Obtained results encourage using similar treatment in morbid obesity human patients. However, further studies are required.
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Affiliation(s)
- J Sobocki
- 1st Department of General and GI Surgery, Jagiellonian University, Krakow, Poland.
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Qian Z, Climent S, Maynar M, Usón-Garallo J, Lima-Rodrigues MA, Calles C, Robertson H, Castañeda-Zúñiga WR. A simplified arteriovenous malformation model in sheep: feasibility study. AJNR Am J Neuroradiol 1999; 20:765-70. [PMID: 10369342 PMCID: PMC7056145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND PURPOSE Recently, a swine model of a cerebral arteriovenous malformation (AVM) has been developed that closely resembles a human AVM of the brain. The creation of such a model requires sophisticated neurointerventional techniques. The purpose of this study was to develop a simple and cost-effective AVM animal model that does not require additional endovascular techniques. METHODS A surgical anastomosis was created in seven sheep between the common carotid artery and the ipsilateral jugular vein, followed by ligation of the jugular vein above the anastomosis and of the proximal common carotid artery below the anastomosis. The anastomosis was created on the left side in four animals and on the right side in three. Cerebral angiography from the contralateral carotid artery was performed before and immediately after surgery to delineate the relevant cerebral vascular anatomy and to determine the direction of blood flow. RESULTS An angiographic appearance simulating an AVM was found in all the animals. The ramus anastomoticus and arteria anastomotica functioned as the feeding vessels to the rete mirabile, which represented the nidus in our model, and to the jugular vein, which represented the draining vein from the malformation. Extensive collateral flow through the rete mirabile into the distal segment of the external carotid artery above the ligature was observed angiographically, with retrograde flow through the surgical anastomosis into the jugular vein. CONCLUSION A simple surgically created experimental model for cerebral AVMs was developed in sheep without the need for additional complex endovascular catheter manipulations of intracranial branches. Such an animal model can substantially reduce the cost of research and training in the neurointerventional or radiosurgical management of AVMs.
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Affiliation(s)
- Z Qian
- Department of Radiology, LSU Medical Center at New Orleans, LA 70112, USA
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Parajuá JL, Calles C. [Migrainous infarct in pregnancy]. Rev Neurol 1999; 28:720-3. [PMID: 10363304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
INTRODUCTION AND CLINICAL CASE We present the case of a migrainous patient who had a cerebral infarct during a migrainous crisis. She was 26 weeks pregnant. The infarct, detected on MRI was in the right thalamic region. It presented as left hemiparesia and left hemi-hypo-estesia. Laboratory tests were normal. There was full recovery from the episode. CONCLUSIONS Migraine is considered to be a risk factor per se for stroke, especially in young women. The association of migrainous ictus, which is a diagnosis by exclusion of other aetiologies, and pregnancy is rare, as is apparent on review of the subject. In the Western world, pregnancy is not considered to be a risk factor for ictus. The functional prognosis of migrainous stroke is good, with minimal risk of relapse.
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Affiliation(s)
- J L Parajuá
- Sección de Neurología, Hospital Can Misses, Ibiza, España
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García Berrocal JR, Ramírez Camacho R, Calles C, Sánchez Alonso P. [Sudden deafness secondary to bulbopontine ischemia]. An Otorrinolaringol Ibero Am 1994; 21:417-423. [PMID: 8092449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- J R García Berrocal
- Servicio de Otorrinolaringología, Hospital Puerta de Hierro, Universidad Autónoma de Madrid
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