1
|
Friedli C, Krajnc N, Hammer HN, Marti S, Zrzavy T, Evangelopoulos ME, Kapsali I, Rommer P, Berger T, Chan A, Bsteh G, Hoepner R. Different lymphocyte counts of multiple sclerosis patients treated with ofatumumab and ocrelizumab: A retrospective observational study. J Cent Nerv Syst Dis 2024; 16:11795735241249644. [PMID: 38711956 PMCID: PMC11072073 DOI: 10.1177/11795735241249644] [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: 07/14/2023] [Accepted: 03/08/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Patients with Multiple Sclerosis (pwMS) treated with anti-CD20 (cluster of differentiation) monoclonal antibodies (mAbs) such as ocrelizumab (OCR) and ofatumumab (OFA) show a reduction mainly of B-lymphocytes, but also other lymphocyte subsets can be affected by these treatments. There is limited data on differences between lymphocyte subset counts of pwMS after treatment initiation with OCR or OFA. Objective To compare lymphocyte subset counts after treatment initiation in pwMS treated with OCR and OFA. Methods We analyzed 22 pwMS initiated on OFA and 56 sex-, age- and MS course matched pwMS initiated on OCR from 2 prospectively collected observational MS databases (Bern [n: OFA 14, OCR 44] and Vienna [n: OFA 8, OCR 12]) statistically comparing lymphocyte subset counts (Mann Whitney Test). Results We found that pwMS treated with OCR showed a stronger reduction of CD20 B-lymphocytes (P = .001), and a trend towards lower counts of CD8+ T cells (P = .056) compared to pwMS treated with OFA, whereas reduction of total lymphocyte, CD4+ lymphocyte and NK cell count was equally distributed between both treatments. Conclusion Different effects on lymphocyte subpopulations appear to be present in pwMS after treatment initiation with different anti-CD20 mAbs. Further studies are needed to determine potential effects on anti-CD20 treatment efficacy as well as treatment associated risks such as failed vaccinations and infections.
Collapse
Affiliation(s)
- Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | - Nik Krajnc
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Helly N. Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Stefanie Marti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Tobias Zrzavy
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Maria E. Evangelopoulos
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kapsali
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Paulus Rommer
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Thomas Berger
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Gabriel Bsteh
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| |
Collapse
|
2
|
Diem L, Ovchinnikov A, Friedli C, Hammer H, Kamber N, Chan A, Salmen A, Findling O, Hoepner R. Efficacy and safety of ocrelizumab in patients with relapsing multiple sclerosis: Real-world experience of two Swiss multiple sclerosis centers. Mult Scler Relat Disord 2024; 86:105570. [PMID: 38604001 DOI: 10.1016/j.msard.2024.105570] [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: 01/14/2024] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Ocrelizumab (OCR) is a humanized monoclonal antibody directed against CD-20 positive lymphocytes, mainly B-lymphocytes. OCR is approved for treatment of primary progressive (PPMS) and relapsing multiple sclerosis (RMS). This study aims to provide real-world safety and efficacy data of people with RMS treated with OCR in two Swiss Multiple Sclerosis (MS) centers. METHODS We have conducted a retrospective data analysis using the patient cohorts from the Cantonal Hospital Aarau and Bern University Hospital (RMS: n = 235). Statistical analyses were performed with Mann-Whitney U-Test, Chi-squared test and Spearman-Rho-Correlation. Adjustment for multiple testing was performed by Bonferroni procedure. RESULTS After initiation of OCR, there was a decrease in disease activity in RMS patients. In our study, 152/190 (80.0 %) RMS patients fulfilled the criteria for NEDA-3 12 months and 88/104 (84.6 %) showed NEDA-3 24 months after OCR initiation. The most frequent adverse events (AEs) in our study were infections, taking place in 78/235 (33.2 %) RMS patients. COVID-19 was the most common infection, followed by urinary infections and other respiratory infections and infectious adverse events occurred significantly more frequent in patients with reduced IgG serum concentration. CONCLUSIONS Our real-world study showed OCR being associated with low rates of any type of MS disease activity as indicated by NEDA-3. The adverse event profile is comparable to the known events especially infections and an association between infections and reduced IgG serum concentration was found.
Collapse
Affiliation(s)
- L Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland; Neurocenter, Lucerne Cantonal Hospital, Lucerne, 6000, Switzerland.
| | - A Ovchinnikov
- Department of Neurology, Cantonal Hospital Aarau (Kantonsspital Aarau), Tellstrasse, Aarau, Switzerland
| | - C Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland; Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | - H Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - N Kamber
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - A Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - A Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - O Findling
- Department of Neurology, Cantonal Hospital Aarau (Kantonsspital Aarau), Tellstrasse, Aarau, Switzerland
| | - R Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| |
Collapse
|
3
|
Thränhardt P, Veselaj A, Friedli C, Wagner F, Marti S, Diem L, Hammer H, Radojewski P, Wiest R, Chan A, Hoepner R, Salmen A. Sex differences in multiple sclerosis relapse presentation and outcome: a retrospective, monocentric study of 134 relapse events. Ther Adv Neurol Disord 2024; 17:17562864241237853. [PMID: 38532803 PMCID: PMC10964455 DOI: 10.1177/17562864241237853] [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: 09/14/2023] [Accepted: 02/07/2024] [Indexed: 03/28/2024] Open
Abstract
Background Reporting of sex-specific analyses in multiple sclerosis (MS) is sparse. Disability accrual results from relapses (relapse-associated worsening) and independent thereof (progression independent of relapses). Objectives A population of MS patients during relapse treated per standard of care was analyzed for sex differences and short-term relapse outcome (3-6 months) as measured by Expanded Disability Status Scale (EDSS) change. Design Single-center retrospective study. Methods We analyzed 134 MS relapses between March 2016 and August 2020. All events required relapse treatment (steroids and/or plasma exchange). Demographic, disease, and paraclinical characteristics [cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI)] were displayed separated by sex. Multivariable linear regression was run to identify factors associated with short-term EDSS change. Results Mean age at relapse was 38.4 years (95% confidence interval: 36.3-40.4) with a proportion of 71.6% women in our cohort. Smoking was more than twice as prevalent in men (65.8%) than women (32.3%). In- and after-relapse EDSSs were higher in men [men: 3.3 (2.8-3.9), women: 2.7 (2.4-3.0); men: 3.0 (1.3-3.6); women: 1.8 (1.5-2.1)] despite similar relapse intervention. Paraclinical parameters revealed no sex differences. Our primary model identified female sex, younger age, and higher EDSS at relapse to be associated with EDSS improvement. A higher immunoglobulin G (IgG) quotient (CSF/serum) was associated with poorer short-term outcome [mean days between first relapse treatment and last EDSS assessment 130.2 (79.3-181.0)]. Conclusion Sex and gender differences are important in outcome analyses of MS relapses. Effective treatment regimens need to respect putative markers for a worse outcome to modify long-term prognosis such as clinical and demographic variables, complemented by intrathecal IgG synthesis. Prospective trials should be designed to address these differences and confirm our results.
Collapse
Affiliation(s)
- Pauline Thränhardt
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Admirim Veselaj
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | - Franca Wagner
- University Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translational Imaging Center, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Stefanie Marti
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Piotr Radojewski
- University Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translational Imaging Center, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Roland Wiest
- University Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translational Imaging Center, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, St Josef-Hospital Bochum, Ruhr-University Bochum, Gudrunstrasse 56, Bochum 44791, GermanyDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Schwarzwald A, Salmen A, León Betancourt AX, Diem L, Hammer H, Radojewski P, Rebsamen M, Kamber N, Chan A, Hoepner R, Friedli C. Anti-neurochondrin antibody as a biomarker in primary autoimmune cerebellar ataxia-a case report and review of the literature. Eur J Neurol 2023; 30:1135-1147. [PMID: 36437687 DOI: 10.1111/ene.15648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/14/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Neuronal autoantibodies can support the diagnosis of primary autoimmune cerebellar ataxia (PACA). Knowledge of PACA is still sparce. This article aims to highlight the relevance of anti-neurochondrin antibodies and possible therapeutical consequences in people with PACA. METHODS This is a case presentation and literature review of PACA associated with anti-neurochondrin antibodies. RESULTS A 33-year-old man noticed reduced control of the right leg in May 2020. During his first clinic appointment at our institution in September 2021, he complained about gait imbalance, fine motor disorders, tremor, intermittent diplopia and slurred speech. He presented a pancerebellar syndrome with stance, gait and limb ataxia, scanning speech and oculomotor dysfunction. Within 3 months the symptoms progressed. An initial cerebral magnetic resonance imaging, June 2020, was normal, but follow-up imaging in October 2021 and July 2022 revealed marked cerebellar atrophy (29% volume loss). Cerebrospinal fluid analysis showed lymphocytic pleocytosis of 11 x 103 /L (normal range 0-4) and oligoclonal bands type II. Anti-neurochondrin antibodies (immunoglobulin G) were detected in serum (1:10,000) and cerebrospinal fluid (1:320, by cell-based indirect immunofluorescence assay and immunoblot, analysed by the EUROIMMUN laboratory). After ruling out alternative causes and neoplasia, diagnosis of PACA was given and immunotherapy (steroids and cyclophosphamide) was started in January 2022. In March 2022 a stabilization of disease was observed. CONCLUSION Cerebellar ataxia associated with anti-neurochondrin antibodies has only been described in 19 cases; however, the number of unrecognized PACAs may be higher. As anti-neurochondrin antibodies target an intracellular antigen and exhibit a mainly cytotoxic T-cell-mediated pathogenesis, important therapeutic implications may result. Because of the severe and rapid clinical progression, aggressive immunotherapy was warranted. This case highlights the need for rapid diagnosis and therapy in PACA, as stabilization and even improvement of symptoms are attainable.
Collapse
Affiliation(s)
- Anina Schwarzwald
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Clinic Bethesda, Neurorehabilitation, Parkinson Centre, Epileptology, Tschugg, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
León Betancourt A, Schwarzwald A, Millonig A, Oberholzer M, Sabater L, Hammer H, Kamber N, Diem L, Chan A, Hoepner R, Salmen A, Friedli C. Anti-kelchlike protein 11 antibody-associated encephalitis: Two case reports and review of the literature. Eur J Neurol 2023; 30:1801-1814. [PMID: 36815561 DOI: 10.1111/ene.15758] [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: 11/21/2022] [Revised: 01/19/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND PURPOSE Kelchlike protein 11 antibodies (KLHL11-IgGs) were first described in 2019 as a marker of paraneoplastic neurological syndromes (PNSs). They have mostly been associated with testicular germ cell tumors (tGCTs). METHODS Two patients with KLHL11-IgG encephalitis are reported, and the literature is comprehensively reviewed. RESULTS Patient 1 had been in remission from a tGCT 10 years prior. He developed episodic vertigo and diplopia progressing over a few days. Treatment with corticosteroids (CSs) was started a few days after symptom onset. Patient 2 had transient diplopia, which resolved spontaneously. Visual problems persisted for 7 months, when he additionally developed a progressive cerebellar syndrome. One year after onset, CS treatment was started. Initial magnetic resonance imaging was unremarkable in both patients, but analysis of cerebrospinal fluid (CSF) revealed chronic inflammation. KLHL11-IgG was positive in both patients (Patient 1 only in CSF, Patient 2 in serum). Neoplastic screening has so far not revealed any signs of active underlying malignancy. We found 15 publications of 112 patients in total with KLHL11-IgG encephalitis. Most patients (n = 82) had a cerebellar syndrome with or without signs of rhombencephalitis. The most common symptoms were ataxia (n = 82) and vertigo (n = 47), followed by oculomotor disturbances (n = 35) and hearing disorders (n = 31). Eighty of 84 patients had a GCT as an underlying tumor. CONCLUSIONS Our cases demonstrate classical symptoms of KLHL11-IgG encephalitis. Early diagnosis and therapy are imperative. As with other PNSs, clinical awareness is needed and further studies are required especially in regard to therapeutic management.
Collapse
Affiliation(s)
- Alejandro León Betancourt
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anina Schwarzwald
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Alban Millonig
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Michael Oberholzer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lidia Sabater
- Neuroimmunology Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Fundació Clínic per a la Recerca Biomèdica, University Hospital Barcelona, Barcelona, Spain
| | - Helly Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
6
|
Friedli C, Wagner F, Hammer HN, Kamber N, Wiest R, Diem L, Chan A, Salmen A, Hoepner R. Leptomeningeal enhancement under different MS immunotherapies: A monocentric retrospective cohort study of 214 patients. Mult Scler 2023; 29:63-73. [PMID: 36113094 DOI: 10.1177/13524585221122210] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Leptomeningeal inflammation in patients with multiple sclerosis (MS) mainly affects meningeal B-cell follicle-like structures linked to cortical and subpial lesions and can be visualized as leptomeningeal enhancement (LME). OBJECTIVE To evaluate the evolution of LME under different MS immunotherapies. METHODS A total of 214 MS patients treated with anti-CD20 therapies or fingolimod at the university hospital Bern were screened for LME. Magnetic resonance imaging (MRI) and medical records were retrospectively evaluated, and comparative statistics were applied. RESULTS We compared MS patients treated with anti-CD20 therapies (128 patients (59.8%)) or fingolimod (86 patients (40.2%)). Of 128 anti-CD20-treated patients, 108 (84.4%) had no LME, 11 (8.6%) had persistent LME, and 9 (7.0%) showed resolution of LME. Of 86 fingolimod-treated MS patients, 81 (94.2%) had no LME and 5 (5.8%) persistent LME. Patients with LME persistence were older than those without or resolution of LME (p = 0.039). Resolution of LME was more frequent during anti-CD20 compared with fingolimod treatment (p = 0.019). CONCLUSION We observed LME resolution under treatment with anti-CD20 therapies. As LME might play an important role in cerebral gray matter pathology in MS, further investigations including extensions to higher field strengths, correlation with clinical phenotypes, and comparison with other immunotherapies are needed.
Collapse
Affiliation(s)
- Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Helly Noemi Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
7
|
Rebsamen M, Friedli C, Radojewski P, Diem L, Chan A, Wiest R, Salmen A, Rummel C, Hoepner R. Multiple sclerosis as a model to investigate SARS-CoV-2 effect on brain atrophy. CNS Neurosci Ther 2022; 29:538-543. [PMID: 36479826 PMCID: PMC9873510 DOI: 10.1111/cns.14050] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Data on structural brain changes after infection with SARS-CoV-2 is sparse. We postulate multiple sclerosis as a model to study the effects of SARS-CoV-2 on brain atrophy due to the unique availability of longitudinal imaging data in this patient group, enabling assessment of intraindividual brain atrophy rates. METHODS Global and regional cortical gray matter volumes were derived from structural MRIs using FreeSurfer. A linear model was fitted to the measures of the matching pre-SARS-CoV-2 images with age as an explanatory variable. The residuals were used to determine whether the post-SARS-CoV-2 volumes differed significantly from the baseline. RESULTS Fourteen RRMS patients with a total of 113 longitudinal magnetic resonance images were retrospectively analyzed. We found no acceleration of brain atrophy after infection with SARS-CoV-2 for global gray matter volume (p = 0.17). However, on the regional level, parahippocampal gyri showed a tendency toward volume reduction (p = 0.0076), suggesting accelerated atrophy during or after infection. CONCLUSIONS Our results illustrate the opportunity of using longitudinal MRIs from existing MS registries to study brain changes associated with SARS-CoV-2 infections. We would like to address the global MS community with a call for action to use the available cohorts, reproduce the proposed analysis, and pool the results.
Collapse
Affiliation(s)
- Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN)University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of BernBernSwitzerland,Graduate School for Cellular and Biomedical SciencesUniversity of BernBernSwitzerland
| | - Christoph Friedli
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging (SCAN)University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of BernBernSwitzerland,Swiss Institute for Translational and Entrepreneurial Medicine, sitem‐inselBernSwitzerland
| | - Lara Diem
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Andrew Chan
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN)University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of BernBernSwitzerland,Swiss Institute for Translational and Entrepreneurial Medicine, sitem‐inselBernSwitzerland
| | - Anke Salmen
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN)University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Robert Hoepner
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| |
Collapse
|
8
|
Diem L, Evangelopoulos ME, Karathanassis D, Natsis V, Kamber N, Hammer H, Friedli C, Chan A, Helbling A, Penner IK, Salmen A, Walther S, Stegmayer K, Hoepner R. Hypogammaglobulinemia: A contributing factor to multiple sclerosis fatigue? Mult Scler Relat Disord 2022; 68:104148. [PMID: 36063730 DOI: 10.1016/j.msard.2022.104148] [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: 06/18/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Fatigue is one of the most disabling and difficult to treat symptoms of autoimmune diseases and frequently presents in people with multiple sclerosis (PwMS). Hypogammaglobulinemia for immunoglobulin G (IgG) affects approximately 8-25% of PwMS. We performed a retrospective analysis to investigate the association of MS-fatigue and IgG hypogammaglobulinemia. METHODS PwMS, treated at Eginition University Hospital Athens or at the University Hospital Bern, were included (n = 134 patients (Bern n = 99; Athens n = 35)). Mann Whitney U-test (MWT), ANOVA test, Chi2 test and multivariable linear regression models were run. RESULTS 97/134 (72.4%) PwMS reported fatigue. In the multivariable linear regression analysis, IgG serum concentration (-1.6, 95%CI -2.7 - -0.5, p = 0.006), daytime sleepiness (0.8, 95%CI 0.2-1.4, p = 0.009), and a depressive mood (1.1, 95%CI 0.8-1.4, p < 0.001) were significantly associated with fatigue. The impact of IgG serum concentration (-2.9 95%CI -4.7 - -1.1, p = 0.002) remained significant also in the subcohort of PwMS without depressive symptoms or daytime sleepiness. CONCLUSIONS We found an association between IgG hypogammaglobulinemia and fatigue in PwMS (Level of Evidence IV), which might be translated to other autoimmune diseases. It bears a potential therapeutic consequence considering IgG supplementation strategies, if our finding can be validated prospectively.
Collapse
Affiliation(s)
- L Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland.
| | - M E Evangelopoulos
- Department of Neurology, Aiginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D Karathanassis
- Department of Neurology, Aiginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - V Natsis
- Department of Neurology, Aiginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - N Kamber
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - H Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - C Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - A Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - A Helbling
- Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - I K Penner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - A Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - S Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern, Switzerland
| | - K Stegmayer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern, Switzerland
| | - R Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| |
Collapse
|
9
|
Rebsamen M, McKinley R, Radojewski P, Pistor M, Friedli C, Hoepner R, Salmen A, Chan A, Reyes M, Wagner F, Wiest R, Rummel C. Reliable brain morphometry from contrast-enhanced T1w-MRI in patients with multiple sclerosis. Hum Brain Mapp 2022; 44:970-979. [PMID: 36250711 PMCID: PMC9875932 DOI: 10.1002/hbm.26117] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 01/28/2023] Open
Abstract
Brain morphometry is usually based on non-enhanced (pre-contrast) T1-weighted MRI. However, such dedicated protocols are sometimes missing in clinical examinations. Instead, an image with a contrast agent is often available. Existing tools such as FreeSurfer yield unreliable results when applied to contrast-enhanced (CE) images. Consequently, these acquisitions are excluded from retrospective morphometry studies, which reduces the sample size. We hypothesize that deep learning (DL)-based morphometry methods can extract morphometric measures also from contrast-enhanced MRI. We have extended DL+DiReCT to cope with contrast-enhanced MRI. Training data for our DL-based model were enriched with non-enhanced and CE image pairs from the same session. The segmentations were derived with FreeSurfer from the non-enhanced image and used as ground truth for the coregistered CE image. A longitudinal dataset of patients with multiple sclerosis (MS), comprising relapsing remitting (RRMS) and primary progressive (PPMS) subgroups, was used for the evaluation. Global and regional cortical thickness derived from non-enhanced and CE images were contrasted to results from FreeSurfer. Correlation coefficients of global mean cortical thickness between non-enhanced and CE images were significantly larger with DL+DiReCT (r = 0.92) than with FreeSurfer (r = 0.75). When comparing the longitudinal atrophy rates between the two MS subgroups, the effect sizes between PPMS and RRMS were higher with DL+DiReCT both for non-enhanced (d = -0.304) and CE images (d = -0.169) than for FreeSurfer (non-enhanced d = -0.111, CE d = 0.085). In conclusion, brain morphometry can be derived reliably from contrast-enhanced MRI using DL-based morphometry tools, making additional cases available for analysis and potential future diagnostic morphometry tools.
Collapse
Affiliation(s)
- Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional NeuroradiologyUniversity of Bern, Inselspital, Bern University HospitalBernSwitzerland,Graduate School for Cellular and Biomedical SciencesUniversity of BernBernSwitzerland
| | - Richard McKinley
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional NeuroradiologyUniversity of Bern, Inselspital, Bern University HospitalBernSwitzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional NeuroradiologyUniversity of Bern, Inselspital, Bern University HospitalBernSwitzerland,Swiss Institute for Translational and Entrepreneurial MedicineBernSwitzerland
| | - Maximilian Pistor
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Christoph Friedli
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Robert Hoepner
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Anke Salmen
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Andrew Chan
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Mauricio Reyes
- ARTORG Center for Biomedical ResearchUniversity of BernBernSwitzerland
| | - Franca Wagner
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional NeuroradiologyUniversity of Bern, Inselspital, Bern University HospitalBernSwitzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional NeuroradiologyUniversity of Bern, Inselspital, Bern University HospitalBernSwitzerland,Swiss Institute for Translational and Entrepreneurial MedicineBernSwitzerland
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional NeuroradiologyUniversity of Bern, Inselspital, Bern University HospitalBernSwitzerland
| |
Collapse
|
10
|
Diem L, Schwarzwald A, Friedli C, Hammer H, Gomes‐Fregolente L, Warncke J, Weber L, Kamber N, Chan A, Bassetti C, Salmen A, Hoepner R. Multidimensional phenotyping of the post-COVID-19 syndrome: A Swiss survey study. CNS Neurosci Ther 2022; 28:1953-1963. [PMID: 35975339 PMCID: PMC9538958 DOI: 10.1111/cns.13938] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/10/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Post-COVID-19 syndrome affects approximately 10-25% of people after a COVID-19 infection, irrespective of initial COVID-19 severity. The aim of this project was to assess the clinical characteristics, course, and prognosis of post-COVID-19 syndrome using a systematic multidimensional approach. PATIENTS AND METHODS An online survey of people with suspected and confirmed COVID-19 and post-COVID-19 syndrome, distributed via Swiss COVID-19 support groups, social media, and our post-COVID-19 consultation, was performed. A total of 8 post-infectious domains were assessed with 120 questions. Data were collected from October 15 to December 12, 2021, and 309 participants were included. Analysis of clinical phenomenology of post-COVID-19 syndrome was performed using comparative statistics. RESULTS The three most prevalent post-COVID-19 symptoms in our survey cohort were fatigue (288/309, 93.2%), pain including headache (218/309, 70.6%), and sleep-wake disturbances (mainly insomnia and excessive daytime sleepiness, 145/309, 46.9%). Post-COVID-19 syndrome had an impact on work ability, as more than half of the respondents (168/268, 62.7%) reported an inability to work, which lasted on average 26.6 weeks (95% CI 23.5-29.6, range 1-94, n = 168). Quality of life measured by WHO-5 Well-being Index was overall low in respondents with post-COVID-19 syndrome (mean, 95% CI 9.1 [8.5-9.8], range 1-25, n = 239). CONCLUSION Fatigue, pain, and sleep-wake disturbances were the main symptoms of the post-COVID-19 syndrome in our cohort and had an impact on the quality of life and ability to work in a majority of patients. However, survey respondents reported a significant reduction in symptoms over 12 months. Post-COVID-19 syndrome remains a significant challenge. Further studies to characterize this syndrome and to explore therapeutic options are therefore urgently needed.
Collapse
Affiliation(s)
- Lara Diem
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Anina Schwarzwald
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Christoph Friedli
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Helly Hammer
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Livia Gomes‐Fregolente
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland,Graduate School for Health SciencesUniversity of BernBernSwitzerland
| | - Jan Warncke
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Lea Weber
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Nicole Kamber
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Andrew Chan
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Claudio Bassetti
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Anke Salmen
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Robert Hoepner
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| |
Collapse
|
11
|
Hoepner R, Kamm CP, Friedli C, Salmen A, Chan A. Is COVID-19 severity associated with reduction in T lymphocytes in anti-CD20-treated people with Multiple Sclerosis or Neuromyelitis Optica Spectrum Disorder? CNS Neurosci Ther 2022; 28:971-973. [PMID: 35411701 PMCID: PMC9062573 DOI: 10.1111/cns.13841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/14/2023] Open
Affiliation(s)
- Robert Hoepner
- Department of NeurologyInselspitalBern University Hospital and University of BernBernSwitzerland
| | - Christian P Kamm
- Department of NeurologyInselspitalBern University Hospital and University of BernBernSwitzerland
- NeurocentreCantonal Hospital LucerneLucerneSwitzerland
| | - Christoph Friedli
- Department of NeurologyInselspitalBern University Hospital and University of BernBernSwitzerland
| | - Anke Salmen
- Department of NeurologyInselspitalBern University Hospital and University of BernBernSwitzerland
| | - Andrew Chan
- Department of NeurologyInselspitalBern University Hospital and University of BernBernSwitzerland
| |
Collapse
|
12
|
Diem L, Fregolente-Gomes L, Warncke JD, Hammer H, Friedli C, Kamber N, Jung S, Bigi S, Funke-Chambour M, Chan A, Bassetti CL, Salmen A, Hoepner R. Fatigue in Post-COVID-19 Syndrome: Clinical Phenomenology, Comorbidities and Association With Initial Course of COVID-19. J Cent Nerv Syst Dis 2022; 14:11795735221102727. [PMID: 35633835 PMCID: PMC9130865 DOI: 10.1177/11795735221102727] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Post-COVID-19 syndrome affects approximately 10-25% of people suffering from
COVID-19 infection, irrespective of initial COVID-19 severity. Fatigue is
one of the major symptoms, occurring in 30-90% of people with post-COVID-19
syndrome. This study aims at describing factors associated with fatigue in
people with Post-COVID-19 seen in our newly established Post-Covid
clinic. Methods This retrospective single center study included 42 consecutive patients
suffering from Post-COVID-19 syndrome treated at the Department of
Neurology, University Hospital Bern, between 11/2020 and05/2021. Clinical
phenomenology of Post-COVID-19 syndrome with a special focus on fatigue and
risk factor identification was performed using Mann-Whitney U Test, Pearson
Correlation, and Chi-Quadrat-Test. Results Fatigue (90.5%) was the most prevalent Post-COVID-19 symptom followed by
depressive mood (52.4%) and sleep disturbance (47.6%). Fatigue was in mean
severe (Fatigue severity scale (FSS) mean 5.5 points (95% Confidence
interval (95CI) 5.1 - 5.9, range .9 - 6.9, n = 40), and it was unrelated to
age, COVID-19 severity or sex. The only related factors with fatigue
severity were daytime sleepiness and depressed mood. Conclusion Fatigue is the main symptom of the Post-COVID-19 syndrome in our cohort.
Further studies describing this syndrome are needed to prepare the
healthcare systems for the challenge of treating patients with Post-COVID-19
syndrome.
Collapse
Affiliation(s)
- Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Livia Fregolente-Gomes
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Jan D Warncke
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Sandra Bigi
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse, Bern, Switzerland
| | - Manuela Funke-Chambour
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Claudio L Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| |
Collapse
|
13
|
Hammer H, Kamber N, Friedli C, Hoepner R, Diem L, Chan A, Salmen A. [Primary CNS Vasculitis - An Overview]. Ther Umsch 2022; 79:247-253. [PMID: 35583022 DOI: 10.1024/0040-5930/a001358] [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: 11/19/2022]
Abstract
Primary CNS Vasculitis - An Overview Abstract. Cerebral vasculitis, especially the primary vasculitis of the central nervous systems (primary CNS vasculitis), are rare inflammatory diseases of the small- and medium-sized vessels of the CNS. The pathogenesis of primary CNS vasculitis is unclear. Infectious triggers are hypothesized to induce an activation of the immune system with resulting inflammation of the blood vessels within the CNS. Clinically, primary CNS vasculitis presents heterogeneously with leading symptoms such as headache, memory impairment and other neurological deficits. A broad diagnostic work-up prior to treatment initiation is crucial. Treatment consists of immunotherapy (pulse and maintenance therapy) and requires long-term neurological treatment and follow-up due to the increased risk of recurrence of the disease.
Collapse
Affiliation(s)
- Helly Hammer
- Universitätsklinik für Neurologie, Inselspital, Universitätsspital Bern und Universität Bern
| | - Nicole Kamber
- Universitätsklinik für Neurologie, Inselspital, Universitätsspital Bern und Universität Bern
| | - Christoph Friedli
- Universitätsklinik für Neurologie, Inselspital, Universitätsspital Bern und Universität Bern
| | - Robert Hoepner
- Universitätsklinik für Neurologie, Inselspital, Universitätsspital Bern und Universität Bern
| | - Lara Diem
- Universitätsklinik für Neurologie, Inselspital, Universitätsspital Bern und Universität Bern
| | - Andrew Chan
- Universitätsklinik für Neurologie, Inselspital, Universitätsspital Bern und Universität Bern
| | - Anke Salmen
- Universitätsklinik für Neurologie, Inselspital, Universitätsspital Bern und Universität Bern
| |
Collapse
|
14
|
Pistor M, Hammer H, Salmen A, Hoepner R, Friedli C. Application of the “risk of ambulatory disability” (RoAD) score in a “real‐world” single‐center multiple sclerosis cohort. CNS Neurosci Ther 2022; 28:792-795. [PMID: 35060326 PMCID: PMC8981428 DOI: 10.1111/cns.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Maximilian Pistor
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Bern Switzerland
| | - Helly Hammer
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Bern Switzerland
| | - Anke Salmen
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Bern Switzerland
| | - Robert Hoepner
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Bern Switzerland
| | - Christoph Friedli
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Bern Switzerland
| |
Collapse
|
15
|
Chaloulos-Iakovidis P, Wagner F, Weber L, Diem L, Chan A, Salmen A, Friedli C, Hoepner R. Predicting conversion to multiple sclerosis in patients with radiologically isolated syndrome: a retrospective study. Ther Adv Neurol Disord 2021; 14:17562864211030664. [PMID: 34349838 PMCID: PMC8287642 DOI: 10.1177/17562864211030664] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Aims To retrospectively analyse the Bernese radiologically isolated syndrome (RIS) cohort with the goal of developing a prediction score for conversion to multiple sclerosis (MS). Methods A total of 31 patients with RIS were identified by screening medical records of neurological patients seen at the University Hospital of Bern between 2004 and 2017 for the diagnoses 'radiologically isolated syndrome' and 'RIS' adhering to 2009 Okuda recommendations. We analysed clinical, paraclinical and magnetic resonance imaging data during a maximum follow-up period of 3 years and identified significant predictors of conversion to MS. Results Data were available for 31 patients meeting 2009 Okuda RIS criteria. During the 3 years of follow up, 5/31 RIS patients converted to relapsing-remitting (RR) MS. In our univariate analysis, gadolinium (Gd) enhancement, brainstem and cerebellar hemisphere lesions, immune cell count and albumin concentration in cerebrospinal fluid (CSF), and anti-nuclear antibody (ANA) positivity in serum were identified as significant predictors of conversion to MS. Integrating these factors into our 'RIS-MS prediction score' enabled us to calculate a cut-off for prediction of conversion to MS within 3 years with high specificity [1.0, 95% confidence interval (CI) 0.84-1.00) and acceptable sensitivity (0.6, 95% CI 0.17-0.93)]. Conclusion Our RIS-MS prediction score, if validated in an independent cohort, integrating radiological (Gd enhancement, brainstem and cerebellar hemisphere lesions) and paraclinical factors (ANA in serum, cell count and albumin in CSF) could be a useful prognostic tool for early recognition of RIS patients with a high risk of clinical progression to MS.
Collapse
Affiliation(s)
- Panagiotis Chaloulos-Iakovidis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, Bern, CH-3010, Switzerland
| | - Franca Wagner
- Department of Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lea Weber
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| |
Collapse
|
16
|
Friedli C, Diem L, Hammer H, Kamber N, Suter-Riniker F, Leib S, Chan A, Hirzel C, Hoepner R, Salmen A. Negative SARS-CoV2-antibodies after positive COVID-19-PCR nasopharyngeal swab in patients treated with anti-CD20 therapies. Ther Adv Neurol Disord 2021; 14:17562864211016641. [PMID: 34046087 PMCID: PMC8135211 DOI: 10.1177/17562864211016641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, 3010, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Stephen Leib
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Cédric Hirzel
- Department of infectious diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
17
|
Diem L, Friedli C, Chan A, Salmen A, Hoepner R. Vaccine Hesitancy in Patients With Multiple Sclerosis: Preparing for the SARS-CoV-2 Vaccination Challenge. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/3/e991. [PMID: 33811158 PMCID: PMC8018793 DOI: 10.1212/nxi.0000000000000991] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/03/2021] [Indexed: 12/02/2022]
Abstract
Objective Vaccine hesitancy is a complex public health issue referring to concerns about safety, efficacy, or need for vaccination. Using pneumococcal vaccination, which is recommend in anti-CD20–treated multiple sclerosis (MS) patients, as a model, we assessed vaccination behavior in patients with MS to prepare for the upcoming SARS-CoV-2 vaccination challenge. Methods By a medical chart review, we retrospectively identified patients with MS treated with ocrelizumab at the University Hospital Bern in 2018–2020. Pneumococcal vaccination was discussed with the patients during clinical visits and highlighted in the after-visit summary addressed to the general practitioner before ocrelizumab initiation as part of our clinical standard of care. Results Pneumococcal vaccination was performed in 71/121 (58.7%) of patients, and 50/121 (41.3%) patients were not vaccinated. Patients who did not get a pneumococcal vaccination were younger (no vaccination vs vaccination; mean [95% CI] 40.1 [36.1–44.1] vs 45.4 [41.9–48.8], p = 0.028) and had more frequently a relapsing remitting disease course (no vaccination vs vaccination, n [%]; 43/50 [86.0%] vs 49/71 [69.0%], p = 0.031). Furthermore, patients who did not get vaccination had more frequently a history of comorbid psychiatric disorder (no vaccination vs vaccination, n (%); 12/50 [24.0] vs 7/71 [9.8], p = 0.035). Conclusion Our study demonstrated that in our single-center cohort, 41.3% of patients with MS do not get the recommended pneumococcal vaccination. Future research should focus on vaccine hesitancy in the vulnerable cohort of patients with MS to improve the safety of MS immunotherapies.
Collapse
Affiliation(s)
- Lara Diem
- From the Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland.
| | - Christoph Friedli
- From the Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Andrew Chan
- From the Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Anke Salmen
- From the Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Robert Hoepner
- From the Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| |
Collapse
|
18
|
Diem L, Hoepner R, Bagnoud M, Salmen A, Chan A, Friedli C. Natalizumab induced blood eosinophilia: A retrospective pharmacovigilance cohort study and review of the literature. J Neuroimmunol 2021; 353:577505. [PMID: 33548621 DOI: 10.1016/j.jneuroim.2021.577505] [Citation(s) in RCA: 3] [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: 12/03/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe frequency of natalizumab related eosinophilia and clinical symptoms of eosinophilic disease in our monocentric cohort. METHODS Comparison of clinical characteristics of 115 natalizumab treated and 116 untreated RRMS patients and review of literature. RESULTS 38% of natalizumab treated patients had eosinophilia, which occurred significantly more frequently compared to untreated MS patients (3%, p-value<0.001). In symptomatic patients, mean eosinophil counts were significantly higher than in asymptomatic patients and symptoms developed within one year. DISCUSSION Eosinophilia is a side effect of natalizumab and mostly asymptomatic. However, few patients develop within one year after start of natalizumab an eosinophilic disease as severe side effect.
Collapse
Affiliation(s)
- L Diem
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M Bagnoud
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - A Salmen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Friedli
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
19
|
Veselaj K, Kamber N, Briner M, Friedli C, Diem L, Guse K, Miclea A, Wiest R, Wagner F, Grabe H, Abegg M, Horn MP, Bigi S, Chan A, Hoepner R, Salmen A. Evaluation of diagnostic criteria and red flags of myelin oligodendrocyte glycoprotein encephalomyelitis in a clinical routine cohort. CNS Neurosci Ther 2020; 27:426-438. [PMID: 33047894 PMCID: PMC7941167 DOI: 10.1111/cns.13461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/25/2020] [Revised: 09/05/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022] Open
Abstract
Aims Myelin oligodendrocyte glycoprotein antibodies (MOG‐IgG) have been proposed to define “MOG encephalomyelitis” (MOG‐EM), with published diagnostic and “red flag” criteria. We aimed to evaluate these criteria in a routine clinical setting. Methods We retrospectively analyzed patients with borderline/positive MOG‐IgG and applied the diagnostic and red flag criteria to determine likelihood of MOG‐EM diagnosis. Para‐/clinical parameters were described and analyzed with chi‐square test. Results In total, 37 patients fulfilled MOG‐EM diagnostic criteria (female‐to‐male ratio: 1.6:1, median onset age: 28.0 years [IQR 18.5‐40.5], n = 8 with pediatric onset). In 24/37, red flags were present, predominantly MOG‐IgG at assay cutoff and/or MRI lesions suggestive of multiple sclerosis (MS). As proposed in the consensus criteria, these patients should rather be described as “possible” MOG‐EM. Of these, we classified 13 patients as “unlikely” MOG‐EM in the presence of the red flag “borderline MOG‐IgG” with negative MOG‐IgG retest or coincidence of ≥1 additional red flag. This group mainly consisted of patients diagnosed with MS (n = 11). Frequency of cerebrospinal fluid (CSF‐)—specific oligoclonal bands (OCB) is significantly lower in definite vs possible and unlikely MOG‐EM (P = .0005). Conclusion Evaluation of diagnostic and red flag criteria, MOG‐IgG retesting (incl. change of assay), and CSF‐specific OCB are relevant in clinical routine cohorts to differentiate MOG‐EM from MS.
Collapse
Affiliation(s)
- Krenar Veselaj
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Myriam Briner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kirsten Guse
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrei Miclea
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hilary Grabe
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mathias Abegg
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael P Horn
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sandra Bigi
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Pediatrics, Division of Child Neurology, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
20
|
McKinley R, Wepfer R, Grunder L, Aschwanden F, Fischer T, Friedli C, Muri R, Rummel C, Verma R, Weisstanner C, Wiestler B, Berger C, Eichinger P, Muhlau M, Reyes M, Salmen A, Chan A, Wiest R, Wagner F. Automatic detection of lesion load change in Multiple Sclerosis using convolutional neural networks with segmentation confidence. Neuroimage Clin 2019; 25:102104. [PMID: 31927500 PMCID: PMC6953959 DOI: 10.1016/j.nicl.2019.102104] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/27/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022]
Abstract
The detection of new or enlarged white-matter lesions is a vital task in the monitoring of patients undergoing disease-modifying treatment for multiple sclerosis. However, the definition of 'new or enlarged' is not fixed, and it is known that lesion-counting is highly subjective, with high degree of inter- and intra-rater variability. Automated methods for lesion quantification, if accurate enough, hold the potential to make the detection of new and enlarged lesions consistent and repeatable. However, the majority of lesion segmentation algorithms are not evaluated for their ability to separate radiologically progressive from radiologically stable patients, despite this being a pressing clinical use-case. In this paper, we explore the ability of a deep learning segmentation classifier to separate stable from progressive patients by lesion volume and lesion count, and find that neither measure provides a good separation. Instead, we propose a method for identifying lesion changes of high certainty, and establish on an internal dataset of longitudinal multiple sclerosis cases that this method is able to separate progressive from stable time-points with a very high level of discrimination (AUC = 0.999), while changes in lesion volume are much less able to perform this separation (AUC = 0.71). Validation of the method on two external datasets confirms that the method is able to generalize beyond the setting in which it was trained, achieving an accuracies of 75 % and 85 % in separating stable and progressive time-points.
Collapse
Affiliation(s)
- Richard McKinley
- Support Center for Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Rik Wepfer
- Support Center for Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lorenz Grunder
- Support Center for Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Fabian Aschwanden
- Support Center for Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Tim Fischer
- Universitätsklinik Balgrist, Zurich, Switzerland
| | - Christoph Friedli
- Univeristy Clinic for Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Raphaela Muri
- Support Center for Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian Rummel
- Support Center for Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Rajeev Verma
- Department of Neuroradiology, Spital Tiefenau, Switzerland
| | | | - Benedikt Wiestler
- Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Christoph Berger
- Center for Translational Cancer Research (TranslaTUM), TU München, Munich, Germany
| | - Paul Eichinger
- Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Mark Muhlau
- Department of Neurology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Mauricio Reyes
- Insel Data Science Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anke Salmen
- Univeristy Clinic for Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andrew Chan
- Univeristy Clinic for Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Franca Wagner
- Support Center for Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
21
|
Zoehner G, Miclea A, Salmen A, Kamber N, Diem L, Friedli C, Bagnoud M, Ahmadi F, Briner M, Sédille-Mostafaie N, Kilidireas C, Stefanis L, Chan A, Hoepner R, Evangelopoulos ME. Reduced serum immunoglobulin G concentrations in multiple sclerosis: prevalence and association with disease-modifying therapy and disease course. Ther Adv Neurol Disord 2019; 12:1756286419878340. [PMID: 31632461 PMCID: PMC6767745 DOI: 10.1177/1756286419878340] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/28/2019] [Accepted: 08/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background: In multiple sclerosis (MS), the frequency of hypogammaglobulinemia is
unknown. We aimed to evaluate the frequency of reduced immunoglobulin (Ig)
concentrations and its association with immunotherapy and disease course in
two independent MS cohorts. Methods: In our retrospective cross-sectional study, MS patients and control patients
with head or neck pain from Bern University Hospital (Bern, Switzerland) and
Eginition University Hospital (Athens, Greece) were included. The lower
limits of normal (LLN) for serum Ig concentration were IgG < 700 mg/dl,
IgM < 40 mg/dl, and IgA < 70 mg/dl. Mann–Whitney U
test, analysis of variance test, and multiple linear regression analysis
were employed. Results: In total, 327 MS patients were retrospectively identified (Bern/Athens:
n = 226/101). Serum IgG concentrations were frequently
under LLN in both MS cohorts (Bern/Athens: 15.5%/14.9%), even when
considering only untreated patients (Bern/Athens: 7.9%/8.6%). MS patients
(n = 327) were significantly more likely to have IgG
concentrations below LLN and below 600 mg/dl in comparison with controls
(n = 58) (p = 0.015 and 0.047,
respectively). Between both patient groups, no significant differences were
found in frequencies of IgA and IgM concentrations under LLN
[n (MS patients/controls): IgA 203/30, IgM 224/24].
Independently of age, secondary progressive MS patients had lower IgG
concentrations than relapsing–remitting and primary progressive patients
(both: p ⩽ 0.01). After adjusting for sex, age, and disease
course, IgG concentrations were lower in patients treated with rituximab
(p = 0.001; n = 42/327), intravenous
corticosteroids (p < 0.001;
n = 16/327), natalizumab (p < 0.001;
n = 48/327), and fingolimod
(p = 0.003; n = 6/327). Conclusion: Our study demonstrated high prevalence rates of reduced serum IgG
concentrations in MS patients with and without disease-modifying treatments.
The significance of lower IgG concentrations at the levels noted is unclear
considering that infections or interference with antibody production
generally occur when IgG levels are much lower, at or below 400 mg/dl.
However, the information is useful to monitor IgG levels especially with
anti-B-cell therapies and consider IgG substitution when levels drop below
400 mg/dl.
Collapse
Affiliation(s)
- Greta Zoehner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrei Miclea
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern. Freiburgstrasse, Bern, CH-3010, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maud Bagnoud
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Farhad Ahmadi
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Myriam Briner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nazanin Sédille-Mostafaie
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Constantinos Kilidireas
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | |
Collapse
|
22
|
Friedrichs-Maeder C, Friedli C, Kuchen S, Wiest R, Hewer E, Rovó A, Chan A. Langerhans cell histiocytosis with initial central nervous system presentation as a mimic of neurosarcoidosis. Clinical and Translational Neuroscience 2019. [DOI: 10.1177/2514183x19875064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 58-year-old Caucasian woman who presented with a subacute cerebellar syndrome accompanied by disturbance of the hypothalamic–pituitary axis and was diagnosed with isolated neurosarcoidosis based on radiological findings including typically located cerebral lesions (infratentorial and pituitary stalk). Due to persistent clinical and radiological disease activity during several years despite escalation of immunosuppressive treatment, the diagnosis was reevaluated, and a transsphenoidal biopsy of a lesion at the pituitary stalk was performed revealing Langerhans cell histiocytosis. In this case, we discuss the different steps leading to the diagnostic error, as well as the presence of red flags, which should have led to an earlier diagnostic reevaluation.
Collapse
Affiliation(s)
| | - Christoph Friedli
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Kuchen
- Department of Rheumatology, Immunology and Allergology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Neuroradiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Alicia Rovó
- Department of Hematology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
23
|
Briner M, Bagnoud M, Miclea A, Friedli C, Diem L, Chan A, Hoepner R, Salmen A. Time course of lymphocyte repopulation after dimethyl fumarate-induced grade 3 lymphopenia: contribution of patient age. Ther Adv Neurol Disord 2019. [PMID: 31105768 DOI: 10.1177/1756286419843450.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Dimethyl fumarate (DMF) is licensed for treatment of relapsing-remitting multiple sclerosis (RRMS). DMF can induce lymphopenia, which is assumed to increase the risk for opportunistic infections like progressive multifocal leukoencephalopathy. Our goal for this work was to estimate the frequency of grade 3 lymphopenia in DMF-treated patients with RRMS and to characterize patient-sided factors influencing the time course of lymphocyte repopulation after DMF withdrawal. Material and methods A single-center retrospective data analysis was performed at University Hospital Bern, Switzerland. Patients with DMF treatment were analyzed for lymphocyte counts. Demographic factors were statistically analyzed in grade 3 lymphopenic patients. Results We estimated a grade 3 lymphopenia frequency of 11/246 (4.5%), corroborating previous studies. In all patients, lymphocytes recovered to values ⩾800/µl within 0.5 years. Multivariate linear regression analysis unmasked older age as being associated with a longer duration of repopulation. Conclusion Considering the aging population, our findings warrant further investigations of DMF-induced lymphopenia.
Collapse
Affiliation(s)
- Myriam Briner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Maud Bagnoud
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrei Miclea
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
24
|
Briner M, Bagnoud M, Miclea A, Friedli C, Diem L, Chan A, Hoepner R, Salmen A. Time course of lymphocyte repopulation after dimethyl fumarate-induced grade 3 lymphopenia: contribution of patient age. Ther Adv Neurol Disord 2019; 12:1756286419843450. [PMID: 31105768 PMCID: PMC6506915 DOI: 10.1177/1756286419843450] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/14/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Dimethyl fumarate (DMF) is licensed for treatment of relapsing–remitting
multiple sclerosis (RRMS). DMF can induce lymphopenia, which is assumed to
increase the risk for opportunistic infections like progressive multifocal
leukoencephalopathy. Our goal for this work was to estimate the frequency of
grade 3 lymphopenia in DMF-treated patients with RRMS and to characterize
patient-sided factors influencing the time course of lymphocyte repopulation
after DMF withdrawal. Material and methods: A single-center retrospective data analysis was performed at University
Hospital Bern, Switzerland. Patients with DMF treatment were analyzed for
lymphocyte counts. Demographic factors were statistically analyzed in grade
3 lymphopenic patients. Results: We estimated a grade 3 lymphopenia frequency of 11/246 (4.5%), corroborating
previous studies. In all patients, lymphocytes recovered to values ⩾800/µl
within 0.5 years. Multivariate linear regression analysis unmasked older age
as being associated with a longer duration of repopulation. Conclusion: Considering the aging population, our findings warrant further investigations
of DMF-induced lymphopenia.
Collapse
Affiliation(s)
- Myriam Briner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Maud Bagnoud
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrei Miclea
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
25
|
Schoenhoff F, Friedli C, Pavlovic M, Pfammatter JP, Casaulta C, Carrel T, Kadner A. Surgical correction of tracheo-esophageal obstructions provides excellent freedom-from-re-intervention during long-term follow-up. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297691] [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: 10/14/2022]
|
26
|
|
27
|
Affiliation(s)
- C. Friedli
- Institut d'Electrochimie et de Radiochimie, Swiss Federal Institute of Technology, CH-1015 Lausanne, Switzerland
| | - J. J. Geering
- Institut d'Electrochimie et de Radiochimie, Swiss Federal Institute of Technology, CH-1015 Lausanne, Switzerland
| | - P. Lerch
- Institut d'Electrochimie et de Radiochimie, Swiss Federal Institute of Technology, CH-1015 Lausanne, Switzerland
| |
Collapse
|
28
|
|
29
|
Friedli C, Schweikert EA, Lerch P. Studies in heavy ion activation analysis trace determination possibilities with9Be bombardment. J Radioanal Nucl Chem 1987. [DOI: 10.1007/bf02035784] [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: 10/25/2022]
|
30
|
|
31
|
|
32
|
|
33
|
Fauquex P, Flaschel E, Renken A, Do H, Friedli C, Lerch P. 24Na and 99mTc tracers applied to the characterization of liquid-solid fluidized bed and hydraulic transport reactors. ACTA ACUST UNITED AC 1983. [DOI: 10.1016/0020-708x(83)90048-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
|
35
|
|
36
|
Friedli C, Chinet A, Girardier L. Comparative measurements of in vitro thermogenesis of brown adipose tissue from control and cold adapted rats. Experientia Suppl 1978; 32:259-66. [PMID: 274311 DOI: 10.1007/978-3-0348-5559-4_29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Heat output and oxygen uptake rates as well as caloric equivalents of O2 were measured in brown fat fragments from cold-adapted and control rats. Resting metabolic rate per unit wet weight was the same in both groups. Submaximal responses to noradrenaline were significantly lower in the cold-adapted than in the control group. Apparent maximal responses were the same for both groups. Caloric equivalents of O2 gave no evidence for anaerobic glycolysis even under conditions of oxygen limitation.
Collapse
|
37
|
Chinet A, Friedli C, Seydoux J, Girardier L. Does cytoplasmic alkalinization trigger mitochondrial energy dissipation in the brown adipocyte? Experientia Suppl 1978; 32:25-32. [PMID: 25782 DOI: 10.1007/978-3-0348-5559-4_2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Indirect calorimetry measurements showed that brown fat thermogenesis was very sensitive to modifications of intra-cellular pH induced by extracellular acid-base perturbations. Specific blockage of active Na-K transport by ouabain inhibited the thermogenic response only in acidosis and more efficiently when the glycoside was administered before the catecholamine stimulus than when it was added after the full calorigenic response had developed. It is suggested that the catecholamine stimulus might initiate a positive feed-back alkalinization of the cytoplasm, concomitant with activation of Na-K transport.
Collapse
|
38
|
|