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Waiß C, Ströbele B, Graichen U, Klee S, Gartlehner J, Sonntagbauer E, Hirschbichler S, Tinchon A, Kacar E, Wuchty B, Novotna B, Kühn Z, Sellner J, Struhal W, Bancher C, Schnider P, Asenbaum-Nan S, Oberndorfer S. CXCL13 as a biomarker in the diagnostics of European lyme Neuroborreliosis - A prospective multicentre study in Austria. J Cent Nerv Syst Dis 2024; 16:11795735241247026. [PMID: 38706882 PMCID: PMC11067428 DOI: 10.1177/11795735241247026] [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: 10/27/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
Background 'Definite Neuroborreliosis (NB)' is diagnosed with the presence of NB-specific symptoms, cerebrospinal fluid (CSF) pleocytosis and an elevated Borrelia Burgdorferi antibody index. However, some diagnostic uncertainties exist. The B-cell chemokine CXCL13 represents an emerging biomarker for the diagnosis and treatment of NB because its intrathecal concentration rises prior to the Borrelia antibody index and drops rapidly after antibiotic therapy. Nevertheless, due to lacking prospective data, a definite CXCL13 cut-off for the diagnosis of NB is still pending. Objective Definition of a CSF CXCL13 cut-off for the diagnosis of acute and untreated NB in a prospective study setting. Design and methods This multicentre prospective study involved 6 neurological departments treating patients in the Lower Austria district (1.7 million inhabitants). The controls were patients scheduled for a spinal tap but not clinically diagnosed with NB. Demographic data, clinical characteristics and blood counts, as well as inflammatory CSF values and CSF CXCL13-concentration were analysed. Results We recruited 440 adult patients, of whom 42 have been diagnosed as having an acute and untreated 'definite NB'. Three hundred ninety-eight patients were assigned to the control group. The median intrathecal CXCL13 concentration was 2384 pg/ml for patients with NB and 0 pg/ml for controls. The difference was highly statistically significant (P ≤ .001). A CSF CXCL13 cut-off of 271 pg/ml resulted in a sensitivity of 95.2% and a specificity of 97.2% for the confirmation or exclusion of NB. Conclusion Based on our results, we propose a CSF CXCL13 cut-off of 271 pg/ml with Euroimmun-Elisa for the diagnosis of acute and untreated NB. Due to its high sensitivity and specificity, CXCL13 is a strong candidate biomarker for routine NB assessment, especially in clinically unclear cases.
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Affiliation(s)
- Christoph Waiß
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Barbara Ströbele
- Institute of Hygiene and Microbiology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Uwe Graichen
- Department for Health Sciences, Biostatistics and Data Science, Karl-Landsteiner-Private University of Health Sciences (KLPU), Krems an der Donau, Austria
| | - Sascha Klee
- Department for Health Sciences, Biostatistics and Data Science, Karl-Landsteiner-Private University of Health Sciences (KLPU), Krems an der Donau, Austria
| | - Joshua Gartlehner
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Estelle Sonntagbauer
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Stephanie Hirschbichler
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Alexander Tinchon
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
| | - Emrah Kacar
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital Tulln, Tulln, Austria
| | - Bianca Wuchty
- Department of Neurology, Hospital Mistelbach, Mistelbach, Austria
| | - Bianka Novotna
- Department of Neurology, Hospital Mistelbach, Mistelbach, Austria
| | - Zofia Kühn
- Department of Neurology, Hospital Wr. Neustadt, Wiener Neustadt, Austria
| | - Johann Sellner
- Department of Neurology, Hospital Mistelbach, Mistelbach, Austria
| | - Walter Struhal
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital Tulln, Tulln, Austria
| | | | - Peter Schnider
- Department of Neurology, Hospital Wr. Neustadt, Wiener Neustadt, Austria
| | | | - Stefan Oberndorfer
- Department of Neurology, Karl-Landsteiner-Private University of Health Sciences (KLPU), University Hospital St. Poelten, St Polten, Austria
- Karl Landsteiner Institute for Neurology and Neuropsychology St. Poelten, Krems an der Donau, Austria
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Cavallieri F, Sellner J, Akhvlediani T, Bassetti CL, Bereczki D, Fanciulli A, Filipović SR, Guekht A, Helbok R, Hochmeister S, Martinelli Boneschi F, von Oertzen TJ, Özturk S, Priori A, Ramankulov D, Willekens B, Rakusa M, Moro E. The European Academy of Neurology NeuroCOVID-19 Task Force: A lesson for the future. Eur J Neurol 2024:e16321. [PMID: 38676302 DOI: 10.1111/ene.16321] [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: 03/19/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The COVID-19 pandemic has made its mark on world history forever causing millions of deaths, and straining health systems, economies, and societies worldwide. The European Academy of Neurology (EAN) reacted promptly. A special NeuroCOVID-19 Task Force was set up at the beginning of the pandemic to promote knowledge, research, international collaborations, and raise awareness about the prevention and treatment of COVID-19-related neurological issues. METHODS Activities carried out during and after the pandemic by the EAN NeuroCOVID-19 Task Force are described. The main aim was to review all these initiatives in detail as an overarching lesson from the past to improve the present and be better prepared in case of future pandemics. RESULTS During the pandemic, the Task Force was engaged in several initiatives: the creation of the EAN NEuro-covid ReGistrY (ENERGY); the launch of several surveys (neurological manifestations of COVID-19 infection; the pandemic's impact on patients with chronic neurological diseases; the pandemic's impact of restrictions for clinical practice, curricular training, and health economics); the publication of position papers regarding the management of patients with neurological diseases during the pandemic, and vaccination hesitancy among people with chronic neurological disorders; and the creation of a dedicated "COVID-19 Breaking News" section in EANpages. CONCLUSIONS The EAN NeuroCOVID-19 Task Force was immediately engaged in various activities to participate in the fight against COVID-19. The Task Force's concerted strategy may serve as a foundation for upcoming global neurological emergencies.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | | | - Claudio L Bassetti
- Department of Neurology, University Hospital and University of Bern, Bern, Switzerland
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | | | - Saša R Filipović
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Raimund Helbok
- Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | | | - Filippo Martinelli Boneschi
- Neurology Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Tim J von Oertzen
- Medical Directorate, University Hospital Würzburg, Würzburg, Germany
| | - Serefnur Özturk
- Department of Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Alberto Priori
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
- Clinical Neurology Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo and Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, University of Antwerp, Wilrijk, Belgium
| | - Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble, France
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Rakusa M, Moro E, Akhvlediani T, Bereczki D, Bodini B, Cavallieri F, Fanciulli A, Filipović SR, Guekht A, Helbok R, Hochmeister S, Martinelli Boneschi F, Özturk S, Priori A, Romoli M, Willekens B, Zedde M, Sellner J. The COVID-19 pandemic and neurology: A survey on previous and continued restrictions for clinical practice, curricular training, and health economics. Eur J Neurol 2024; 31:e16168. [PMID: 38038262 DOI: 10.1111/ene.16168] [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: 10/01/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023. METHODS An online 18-item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID-19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects. RESULTS We collected 430 responses from 79 countries. Most health care professionals were aged 35-44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID-19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in- and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues. CONCLUSIONS Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID-19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale.
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Affiliation(s)
- Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, INSERM U1216, Grenoble Alpes University, Grenoble, France
| | | | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Benedetta Bodini
- Neurology Department, St. Antoine Hospital, APHP, Paris, France
- Paris Brain Institute, ICM, CNRS, INSERM, Sorbonne Université, Paris, France
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Saša R Filipović
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Raimund Helbok
- Department of Neurology, Johannes Kepler University, Linz, Austria
| | | | - Filippo Martinelli Boneschi
- Neurology Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Serefnur Özturk
- Department of Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Alberto Priori
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
- Clinical Neurology Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo and Department of Health Sciences, University of Milan, Milan, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, University of Antwerp, Wilrijk, Belgium
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinkum Mistelbach-Gänserndorf, Mistelbach, Austria
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Mitsikostas DDD, Caronna E, De Tommaso M, Deligianni CI, Ekizoglu E, Bolay H, Göbel CH, Kristoffersen ES, Lampl C, Moro E, Pozo-Rosich P, Sellner J, Terwindt G, Irimia-Sieira P. Headaches and facial pain attributed to SARS-CoV-2 infection and vaccination: a systematic review. Eur J Neurol 2024:e16251. [PMID: 38415282 DOI: 10.1111/ene.16251] [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: 09/12/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND PURPOSE The aim was to provide insights to the characteristics of headache in the context of COVID-19 on behalf of the Headache Scientific Panel and the Neuro-COVID-19 Task Force of the European Academy of Neurology (EAN) and the European Headache Federation (EHF). METHODS Following the Delphi method the Task Force identified six relevant questions and then conducted a systematic literature review to provide evidence-based answers and suggest specific diagnostic criteria. RESULTS No data for facial pain were identified in the literature search. (1) Headache incidence during acute COVID-19 varies considerably, with higher prevalence rates in prospective compared to retrospective studies (28.9%-74.6% vs. 6.5%-34.0%). (2) Acute COVID-19 headache is usually bilateral or holocranial and often moderate to severe with throbbing pain quality lasting 2-14 days after first signs of COVID-19; photo-phonophobia, nausea, anosmia and ageusia are common associated features; persistent headache shares similar clinical characteristics. (3) Acute COVID-19 headache is presumably caused by immune-mediated mechanisms that activate the trigeminovascular system. (4) Headache occurs in 13.3%-76.9% following SARS-CoV-2 vaccination and occurs more often amongst women with a pre-existing primary headache; the risk of developing headache is higher with the adenoviral-vector-type vaccines than with other preparations. (5) Headache related to SARS-CoV-2 vaccination is mostly bilateral, and throbbing, pressing, jolting or stabbing. (6) No studies have been conducted investigating the underlying mechanism of headache attributed to SARS-CoV-2 vaccines. CONCLUSION The results of this joint EAN/EHF initiative provide a framework for a better understanding of headache in the context of SARS-CoV-2 infection and vaccination.
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Affiliation(s)
- Dimos-Dimtirios D Mitsikostas
- Neurology Department, Aeginition Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marina De Tommaso
- Neurophysiopathology Unit, DiBrain Department, Aldo Moro University, Bari, Italy
| | | | - Esme Ekizoglu
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Hayrunnisa Bolay
- Department of Neurology and Algology, NÖROM, Gazi University Ankara, Ankara, Turkey
| | - Carl H Göbel
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- NorHEAD, Norwegian Centre for Headache Research, Akershus University Hospital, Lørenskog, Norway
- Department of General Practice, HELSAM, University of Oslo, Oslo, Norway
| | - Christian Lampl
- Department of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria
- Headache Medical Center Linz, Linz, Austria
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, Grenoble Alpes University, Grenoble, France
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Gisela Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Feige J, Moser T, Akgün K, Schwenker K, Hitzl W, Haschke‐Becher E, Ziemssen T, Sellner J. Repeated iv anti-CD20 treatment in multiple sclerosis: Long-term effects on peripheral immune cell subsets. Ann Clin Transl Neurol 2024; 11:450-465. [PMID: 38204286 PMCID: PMC10863910 DOI: 10.1002/acn3.51965] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Repeated intravenous administration of anti-CD20 depleting monoclonal antibodies 6 months apart is among the highly effective treatment options in multiple sclerosis (MS). Here, we aimed to investigate peripheral immune cell subset depletion kinetics following either rituximab (RTX) or ocrelizumab (OCR) infusions in people with MS (pwMS). METHODS We studied pwMS treated de-novo with either RTX (n = 7) or OCR (n = 8). The examinations were scheduled before the initiation of anti-CD20 therapy and every 12 weeks for up to 15 months. Immunophenotyping of immune cell subsets in peripheral blood was performed by multiparametric fluorescence cytometry. RESULTS A significant, persistent decrease of CD19+ B cells was observed already with the first anti-CD20 infusion (p < 0.0001). A significant proportional reduction of memory B cells within the B-cell pool was achieved only after two treatment cycles (p = 0.005). We observed a proportional increase of immature (p = 0.04) and naive B cells (p = 0.004), again only after the second treatment cycle. As for the peripheral T-cell pool, we observed a continuous proportional increase of memory T helper (TH) cells/central memory TH cells (p = 0.02/p = 0.008), while the number of regulatory T cells (Treg) decreased (p = 0.007). The percentage of B-cell dependent TH17.1 central memory cells dropped after the second treatment cycle (p = 0.02). No significant differences in the depletion kinetics between RTX and OCR were found. INTERPRETATION Peripheral immune cell profiling revealed more differentiated insights into the prompt and delayed immunological effects of repeated intravenous anti-CD20 treatment. The observation of proportional changes of some pathogenetically relevant immune cell subsets only after two infusion cycles deserves further attention.
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Affiliation(s)
- Julia Feige
- Department of NeurologyChristian Doppler University Hospital, Paracelsus Medical UniversitySalzburgAustria
| | - Tobias Moser
- Department of NeurologyChristian Doppler University Hospital, Paracelsus Medical UniversitySalzburgAustria
| | - Katja Akgün
- Department of NeurologyMultiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technical University DresdenDresdenGermany
| | - Kerstin Schwenker
- Department of NeurologyChristian Doppler University Hospital, Paracelsus Medical UniversitySalzburgAustria
| | - Wolfgang Hitzl
- Research Management (RM): Biostatistics and Publication of Clinical Studies TeamParacelsus Medical UniversitySalzburgAustria
- Department of Ophthalmology and OptometryParacelsus Medical UniversitySalzburgAustria
- Research Program Experimental Ophthalmology and Glaucoma ResearchParacelsus Medical UniversitySalzburgAustria
| | | | - Tjalf Ziemssen
- Department of NeurologyMultiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technical University DresdenDresdenGermany
| | - Johann Sellner
- Department of NeurologyChristian Doppler University Hospital, Paracelsus Medical UniversitySalzburgAustria
- Department of Neurology, School of Medicine, Klinikum rechts der IsarTechnische Universität MünchenMünchenGermany
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
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Zinganell A, Göbel G, Berek K, Hofer B, Asenbaum-Nan S, Barang M, Böck K, Bsteh C, Bsteh G, Eger S, Eggers C, Fertl E, Joldic D, Khalil M, Langenscheidt D, Komposch M, Kornek B, Kraus J, Krendl R, Rauschka H, Sellner J, Auer M, Hegen H, Pauli FD, Deisenhammer F. Multiple sclerosis in the elderly: a retrospective cohort study. J Neurol 2024; 271:674-687. [PMID: 37855871 DOI: 10.1007/s00415-023-12041-1] [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: 07/07/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There is a lack of knowledge of disease course, prognosis, comorbidities and potential treatments of elderly MS patients. OBJECTIVE To characterize the disease course including disability progression and relapses, to quantify the use of DMTs and to identify comorbidities and risk factors for progression in elderly multiple sclerosis (MS) patients. METHODS This is a retrospective study of 1200 Austrian MS patients older than 55 years as of May 1st, 2017 representing roughly one-third of all the MS patients of this age in Austria. Data were collected from 15 MS centers including demographics, first symptom at onset, number of relapses, evolvement of disability, medication, and comorbidities. RESULTS Median observation time was 17.1 years with 957 (80%) relapsing and 243 (20%) progressive onsets. Average age at diagnosis was 45 years with a female predominance of 71%. Three-hundred and twenty-six (27%) patients were never treated with a DMT, while most treated patients received interferons (496; 41%) at some point. At last follow-up, 420 (35%) patients were still treated with a DMT. No difference was found between treated and never-treated patients in terms of clinical outcome; however, patients with worse disability progression had significantly more DMT switches. Pyramidal onset, number of comorbidities, dementia, epilepsy, and psychiatric conditions as well as a higher number of relapses were associated with worse outcome. The risk of reaching EDSS 6 rose with every additional comorbidity by 22%. In late and very-late-onset MS (LOMS, VLOMS) time to diagnosis took nearly twice the time compared to adult and early onset (AEOMS). The overall annualized relapse rate (ARR) decreased over time and patients with AEOMS had significantly higher ARR compared to LOMS and VLOMS. Four percent of MS patients had five medications or more fulfilling criteria of polypharmacy and 20% of psychiatric drugs were administered without a matching diagnosis. CONCLUSIONS In this study, we identified number of comorbidities, pyramidal and cerebellar signs, and a higher number of relapses as unfavorable prognostic factors in elderly MS patients filling gaps of knowledge in patients usually underrepresented in clinical trials and may guide future therapeutic studies.
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Affiliation(s)
- Anne Zinganell
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Barbara Hofer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Matin Barang
- Department of Neurology, Hospital of St. Pölten, St. Pölten, Austria
| | - Klaus Böck
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | | | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stephan Eger
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | - Christian Eggers
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | - Elisabeth Fertl
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Damir Joldic
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Martina Komposch
- Department of Neurology, Hospital of Klagenfurt, Klagenfurt, Austria
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jörg Kraus
- Neurologist, Zell Am See, Austria
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Reinhard Krendl
- Department of Neurology, Hospital of Villach, Villach, Austria
| | - Helmut Rauschka
- Department of Neurology, Klinik Donaustadt, Vienna, Austria
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Department of Neurology, Klinik Donaustadt, Vienna, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach, Mistelbach, Austria
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Sellner J. Autoimmune neurology-a rapidly evolving field. Wien Med Wochenschr 2024; 174:1-3. [PMID: 37921999 DOI: 10.1007/s10354-023-01023-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 11/05/2023]
Affiliation(s)
- Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, 2130, Mistelbach, Austria.
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8
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Moser T, Zimmermann G, Baumgartner A, Berger T, Bsteh G, Di Pauli F, Enzinger C, Fertl E, Heller T, Koppi S, Rommer PS, Safoschnik G, Seifert-Held T, Stepansky R, Sellner J. Long-term outcome of natalizumab-associated progressive multifocal leukoencephalopathy in Austria: a nationwide retrospective study. J Neurol 2024; 271:374-385. [PMID: 37728757 PMCID: PMC10770206 DOI: 10.1007/s00415-023-11924-7] [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: 05/26/2023] [Revised: 07/28/2023] [Accepted: 08/06/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND/OBJECTIVE The use of natalizumab (NAT) in multiple sclerosis (MS) may be complicated by progressive multifocal leukoencephalopathy (PML), a rare and life-threatening opportunistic brain infection. We aimed to analyze the course of MS after PML recovery together with the long-term outcome of NAT-associated PML (NAT-PML) in Austria. METHODS Retrospective study based on identification of cases in the nationwide Austrian MS treatment registry (AMSTR) and MS centers with review of patient records. The expanded disability status scale (EDSS) was used to measure neurological disability and outcome. RESULTS As of December 2022, we identified 15 NAT-PML cases in Austria; only 20% occurred after 2016, when increased vigilance commenced. Two patients did not survive acute PML, and an additional patient died five years later, yielding a mortality rate of 20%. Seizures occurred exclusively in patients with pronounced EDSS increase. Gadolinium (Gd)-enhancement on brain magnetic resonance imaging (MRI) on PML suspicion was associated with minor changes of post-PML neurological disability. Long-term follow-up of up to 132 months (median 76 months) was available in 11/15. The overall median EDSS increased from 3.5 at pre-PML to 6.5 at the last assessment. Regarding inflammatory MS-related disease activity during the observation period, one single individual experienced an MS relapse and another patient had two Gd-enhancing brain lesions. Three patients converted to progressive MS within three years from PML and the EDSS further increased in 6/11. CONCLUSIONS The number of NAT-PML cases is decreasing over time. While many patients accumulated severe persistent neurological deficits compared to pre-PML, inflammatory MS-related disease activity after PML recovery was rare.
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Affiliation(s)
- Tobias Moser
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Anna Baumgartner
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elisabeth Fertl
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Thomas Heller
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Stefan Koppi
- Rehabilitation Clinic Montafon, Schruns, Austria
| | - Paulus S Rommer
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Johann Sellner
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrasse 67, 2130, Mistelbach, Austria.
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9
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Akhvlediani T, Bernard-Valnet R, Dias SP, Eikeland R, Pfausler B, Sellner J. Neurological side effects and drug interactions of antiviral compounds against SARS-CoV-2. Eur J Neurol 2023; 30:3904-3912. [PMID: 37526048 DOI: 10.1111/ene.16017] [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: 06/13/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), rapidly spread across the globe. Tremendous efforts have been mobilized to create effective antiviral treatment options to reduce the burden of the disease. This article summarizes the available knowledge about the antiviral drugs against SARS-CoV-2 from a neurologist's perspective. METHODS We summarize neurological aspects of antiviral compounds against SARS-CoV-2 with full, conditional, or previous marketing authorization by the European Medicines Agency (EMA). RESULTS Nirmatrelvir/ritonavir targets the SARS-CoV-2 3c-like protease using combinatorial chemistry. Nirmatrelvir/ritonavir levels are affected by medications metabolized by or inducing CYP3A4, including those used in neurological diseases. Dysgeusia with a bitter or metallic taste is a common side effect of nirmatrelvir/ritonavir. Molnupiravir is a nucleotide analog developed to inhibit the replication of viruses. No clinically significant interactions with other drugs have been identified, and no specific considerations for people with neurological comorbidity are required. In the meantime, inconsistent results from clinical trials regarding efficacy have led to the withdrawal of marketing authorization by the EMA. Remdesivir is a viral RNA polymerase inhibitor and interferes with the production of viral RNA. The most common side effect in patients with COVID-19 is nausea. Remdesivir is a substrate for CYP3A4. CONCLUSIONS Neurological side effects and drug interactions must be considered for antiviral compounds against SARS-CoV-2. Further studies are required to better evaluate their efficacy and adverse events in patients with concomitant neurological diseases. Moreover, evidence from real-world studies will complement the current knowledge.
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Affiliation(s)
| | - Raphael Bernard-Valnet
- Neurology Service, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
| | - Sara P Dias
- Department of Neurology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Randi Eikeland
- Department of Health and Nursing Sciences, University of Agder, Grimstad, Norway
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
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10
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Fanciulli A, Skorić MK, Leys F, Carneiro DR, Campese N, Calandra-Buonaura G, Camaradou J, Chiaro G, Cortelli P, Falup-Pecurariu C, Granata R, Guaraldi P, Helbok R, Hilz MJ, Iodice V, Jordan J, Kaal ECA, Kamondi A, Le Traon AP, Rocha I, Sellner J, Senard JM, Terkelsen A, Wenning GK, Moro E, Berger T, Thijs RD, Struhal W, Habek M. EFAS/EAN survey on the influence of the COVID-19 pandemic on European clinical autonomic education and research. Clin Auton Res 2023; 33:777-790. [PMID: 37792127 PMCID: PMC10751256 DOI: 10.1007/s10286-023-00985-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE To understand the influence of the coronavirus disease 2019 (COVID-19) pandemic on clinical autonomic education and research in Europe. METHODS We invited 84 European autonomic centers to complete an online survey, recorded the pre-pandemic-to-pandemic percentage of junior participants in the annual congresses of the European Federation of Autonomic Societies (EFAS) and European Academy of Neurology (EAN) and the pre-pandemic-to-pandemic number of PubMed publications on neurological disorders. RESULTS Forty-six centers answered the survey (55%). Twenty-nine centers were involved in clinical autonomic education and experienced pandemic-related didactic interruptions for 9 (5; 9) months. Ninety percent (n = 26/29) of autonomic educational centers reported a negative impact of the COVID-19 pandemic on education quality, and 93% (n = 27/29) established e-learning models. Both the 2020 joint EAN-EFAS virtual congress and the 2021 (virtual) and 2022 (hybrid) EFAS and EAN congresses marked higher percentages of junior participants than in 2019. Forty-one respondents (89%) were autonomic researchers, and 29 of them reported pandemic-related trial interruptions for 5 (2; 9) months. Since the pandemic begin, almost half of the respondents had less time for scientific writing. Likewise, the number of PubMed publications on autonomic topics showed the smallest increase compared with other neurological fields in 2020-2021 and the highest drop in 2022. Autonomic research centers that amended their trial protocols for telemedicine (38%, n = 16/41) maintained higher clinical caseloads during the first pandemic year. CONCLUSIONS The COVID-19 pandemic had a substantial negative impact on European clinical autonomic education and research. At the same time, it promoted digitalization, favoring more equitable access to autonomic education and improved trial design.
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Affiliation(s)
- Alessandra Fanciulli
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Magdalena Krbot Skorić
- Department of Neurology, University Hospital Centre, Zagreb, Croatia
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Fabian Leys
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Diogo Reis Carneiro
- Department of Neurology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Nicole Campese
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Giovanna Calandra-Buonaura
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Jennifer Camaradou
- Patient Partner of the EAN Scientific Panel for Autonomic Nervous System Disorders, London, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Giacomo Chiaro
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Roberta Granata
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University, Linz, Austria
| | - Max J Hilz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Jens Jordan
- German Aerospace Center, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Evert C A Kaal
- Department of Neurology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Anita Kamondi
- Department of Neurology, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Anne Pavy Le Traon
- Department of Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Isabel Rocha
- Cardiovascular Autonomic Function Lab, Faculty of Medicine and CCUL, University of Lisbon, Lisbon, Portugal
| | - Johann Sellner
- Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jean Michel Senard
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U 1297, Toulouse, France
| | - Astrid Terkelsen
- Department of Neurology, Aarhus University Hospital and Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Elena Moro
- Division of Neurology, Grenoble Institute of Neuroscience, Grenoble Alpes University, CHU of Grenoble, Grenoble, France
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Walter Struhal
- Department of Neurology, University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Mario Habek
- Department of Neurology, University Hospital Centre, Zagreb, Croatia
- Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia
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11
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Abdelhak A, Barba L, Romoli M, Benkert P, Conversi F, D'Anna L, Masvekar RR, Bielekova B, Prudencio M, Petrucelli L, Meschia JF, Erben Y, Furlan R, De Lorenzo R, Mandelli A, Sutter R, Hert L, Epple V, Marastoni D, Sellner J, Steinacker P, Aamodt AH, Heggelund L, Dyrhol-Riise AM, Virhammar J, Fällmar D, Rostami E, Kumlien E, Blennow K, Zetterberg H, Tumani H, Sacco S, Green AJ, Otto M, Kuhle J, Ornello R, Foschi M, Abu-Rumeileh S. Prognostic performance of blood neurofilament light chain protein in hospitalized COVID-19 patients without major central nervous system manifestations: an individual participant data meta-analysis. J Neurol 2023:10.1007/s00415-023-11768-1. [PMID: 37184659 PMCID: PMC10183689 DOI: 10.1007/s00415-023-11768-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND AIMS To investigate the prognostic value of blood neurofilament light chain protein (NfL) levels in the acute phase of coronavirus disease 2019 (COVID-19). METHODS We conducted an individual participant data (IPD) meta-analysis after screening on MEDLINE and Scopus to May 23rd 2022. We included studies with hospitalized adult COVID-19 patients without major COVID-19-associated central nervous system (CNS) manifestations and with a measurement of blood NfL in the acute phase as well as data regarding at least one clinical outcome including intensive care unit (ICU) admission, need of mechanical ventilation (MV) and death. We derived the age-adjusted measures NfL Z scores and conducted mixed-effects modelling to test associations between NfL Z scores and other variables, encompassing clinical outcomes. Summary receiver operating characteristic curves (SROCs) were used to calculate the area under the curve (AUC) for blood NfL. RESULTS We identified 382 records, of which 7 studies were included with a total of 669 hospitalized COVID-19 cases (mean age 66.2 ± 15.0 years, 68.1% males). Median NfL Z score at admission was elevated compared to the age-corrected reference population (2.37, IQR: 1.13-3.06, referring to 99th percentile in healthy controls). NfL Z scores were significantly associated with disease duration and severity. Higher NfL Z scores were associated with a higher likelihood of ICU admission, need of MV, and death. SROCs revealed AUCs of 0.74, 0.80 and 0.71 for mortality, need of MV and ICU admission, respectively. CONCLUSIONS Blood NfL levels were elevated in the acute phase of COVID-19 patients without major CNS manifestations and associated with clinical severity and poor outcome. The marker might ameliorate the performance of prognostic multivariable algorithms in COVID-19.
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Affiliation(s)
- Ahmed Abdelhak
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
| | - Lorenzo Barba
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Michele Romoli
- Department of Neuroscience, Neurology Unit, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Pascal Benkert
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Francesco Conversi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
- Department of Brain Sciences, Imperial College London, London SW7 2AZ, UK
| | - Ruturaj R Masvekar
- Neuroimmunological Diseases Section, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Bibiana Bielekova
- Neuroimmunological Diseases Section, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, 32224, USA
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL, 32224, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Roberto Furlan
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Institute of Experimental Neurology, Division of Neuroscience, Vita e Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandra Mandelli
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raoul Sutter
- Department of Acute Medical Care, Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Lisa Hert
- Department of Acute Medical Care, Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Varenka Epple
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Petra Steinacker
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anne Margarita Dyrhol-Riise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Johan Virhammar
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Elham Rostami
- Department of Medical Sciences, Uppsala University, Neurosurgery,, Sweden
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eva Kumlien
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ari J Green
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
| | - Markus Otto
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Kuhle
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Centre, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- Department of Neuroscience, Neurology Unit, S.Maria Delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, Italy.
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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12
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Fanciulli A, Leys F, Krbot Skorić M, Carneiro DR, Calandra-Buonaura G, Camaradou J, Chiaro G, Cortelli P, Falup-Pecurariu C, Granata R, Guaraldi P, Helbok R, Hilz MJ, Iodice V, Jordan J, Kaal ECA, Kamondi A, Pavy Le Traon A, Rocha I, Sellner J, Senard JM, Terkelsen A, Wenning GK, Moro E, Berger T, Thijs RD, Struhal W, Habek M. Impact of the COVID-19 pandemic on clinical autonomic practice in Europe A survey of the European Academy of Neurology (EAN) and the European Federation of Autonomic Societies (EFAS). Eur J Neurol 2023. [PMID: 36920252 DOI: 10.1111/ene.15787] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To investigate the impact of the coronavirus-disease-2019 (COVID-19) pandemic on European clinical autonomic practice. METHODS Eighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021. RESULTS Forty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every-third center reported major adverse events due to postponed examinations or visits. The most frequent newly-diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and recurrent vasovagal syncope, deemed likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new-onset of orthostatic intolerance, but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases. By contrast, low frequencies of newly-diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently POTS and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50-100% recovery rates at follow-up. CONCLUSIONS Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, while the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints.
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Affiliation(s)
| | - Fabian Leys
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Krbot Skorić
- Department of Neurology, University Hospital Centre, Zagreb, Croatia.,Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Diogo Reis Carneiro
- Department of Neurology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Giovanna Calandra-Buonaura
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Jennifer Camaradou
- Patient partner of the EAN Scientific Panel for Autonomic Nervous System Disorders, London, UK.,UCL Social Research Institute, University College London, London, UK
| | - Giacomo Chiaro
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Roberta Granata
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neurology, Kepler University Linz, Austria
| | - Max J Hilz
- Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Neurology, University Erlangen-, Nuremberg, Germany
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Jens Jordan
- German Aerospace Center, Cologne, Germany.,Medical Faculty, University of Cologne, Germany
| | - Evert C A Kaal
- Department of Neurology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Anita Kamondi
- Department of Neurology, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.,Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Anne Pavy Le Traon
- Department of Neurology, Centre, Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Isabel Rocha
- Cardiovascular Autonomic Function Lab, Faculty of Medicine and CCUL, University of Lisbon, Lisbon, Portugal
| | - Johann Sellner
- Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Jean Michel Senard
- Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U 1297, Toulouse, France
| | - Astrid Terkelsen
- Department of Neurology, Aarhus University, Hospital and Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble Institut of Neuroscience, Grenoble, France
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Walter Struhal
- Karl Landsteiner University of Health Sciences, Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - Mario Habek
- Department of Neurology, University Hospital Centre, Zagreb, Croatia.,Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia
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Reis Carneiro D, Rocha I, Habek M, Helbok R, Sellner J, Struhal W, Wenning G, Fanciulli A. Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID-19 infection - A systematic review. Eur J Neurol 2023; 30:1528-1539. [PMID: 36694382 DOI: 10.1111/ene.15714] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function. METHODS We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection or post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared. RESULTS We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred and thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history) and 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post-COVID-19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002). CONCLUSIONS There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.
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Affiliation(s)
- Diogo Reis Carneiro
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Rocha
- Cardiovascular Autonomic Function Lab, Institute of Physiology, CCUL, Faculty of Medicine of University of Lisbon, Lisbon, Portugal
| | - Mario Habek
- Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia.,Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johann Sellner
- Landesklinikum Mistlbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Walter Struhal
- Karl Landsteiner University of Health Sciences, Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - Gregor Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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14
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Adamec I, Brecl Jakob G, Drulović J, Sellner J, Bilić E, Sitaš B, Bilić H, Tamaš O, Budimkić M, Veselinović N, Horvat Ledinek A, Jerše J, Gomezelj S, Hauer L, Krbot Skorić M, Habek M. Transverse myelitis following COVID-19: Insights from a multi-center study and systematic literature review. J Neurol Sci 2022; 443:120463. [PMID: 36334503 DOI: 10.1016/j.jns.2022.120463] [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: 08/17/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION We aimed to provide insights into transverse myelitis (TM) following COVID-19 by analyzing cases treated at tertiary care neurology centers and a systemic review of the literature. METHODS The retrospective observational multi-center study was conducted at the four university neurology departments in Croatia, Slovenia, Serbia, and Austria. We searched for acute myelitis cases that occurred during or after COVID-19. A systemic review of the literature on COVID-19 and transverse myelitis was performed. RESULTS We identified 76 persons with TM associated with COVID-19, 13 from the multi-center study and 63 from the literature review. Most of the participants (55.6%) had an intermediate latency, 25.4% had short and 19% long latency from COVID-19 symptoms to TM. The clinical presentation consisted of the typical TM signs. More than half of the participants had inflammatory changes in the CSF, with rare patients having intrathecal OCB synthesis and positive serology for anti-MOG or anti-AQP4 antibodies. Persons with autonomic symptoms and CSF pleocytosis were significantly more common to have an intermediate latency of 8 to 21 days from COVID-19 to TM (p = 0.005 and p = 0.003; respectively). According to logistic regression analysis, only participants with lesions evident on spinal cord MRI compared to normal spinal cord MRI had reduced risks for poor recovery. >80% of participants were treated with a combination of corticosteroids and intravenous immunoglobulins or plasma exchange with 73% having incomplete recovery. CONCLUSION Our study further characterizes clinical, laboratory, and MRI features, as well as treatment of TM associated with COVID-19.
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Affiliation(s)
- Ivan Adamec
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Gregor Brecl Jakob
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia.
| | - Jelena Drulović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; University Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia.
| | - Johann Sellner
- Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.
| | - Ervina Bilić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Barbara Sitaš
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.
| | - Hrvoje Bilić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.
| | - Olivera Tamaš
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; University Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia.
| | - Maja Budimkić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; University Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia.
| | - Nikola Veselinović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; University Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia.
| | | | - Jana Jerše
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia.
| | - Sarah Gomezelj
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia.
| | - Larissa Hauer
- Christian Doppler Medical Center, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia.
| | - Mario Habek
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
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15
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Habek M, Leys F, Krbot Skorić M, Reis Carneiro D, Calandra‐Buonaura G, Camaradou J, Chiaro G, Cortelli P, Falup‐Pecurariu C, Granata R, Guaraldi P, Helbok R, Hilz MJ, Iodice V, Jordan J, Kaal ECA, Kamondi A, Pavy Le Traon A, Rocha I, Sellner J, Senard JM, Terkelsen A, Wenning GK, Berger T, Thijs RD, Struhal W, Fanciulli A. Clinical autonomic nervous system laboratories in Europe: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies. Eur J Neurol 2022; 29:3633-3646. [PMID: 36056590 PMCID: PMC9826284 DOI: 10.1111/ene.15538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/21/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. METHODS We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. RESULTS We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021). CONCLUSIONS This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.
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Affiliation(s)
- Mario Habek
- Department of NeurologyUniversity Hospital Centre ZagrebZagrebCroatia,Department of NeurologyUniversity of Zagreb, School of MedicineZagrebCroatia
| | - Fabian Leys
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Magdalena Krbot Skorić
- Department of NeurologyUniversity Hospital Centre ZagrebZagrebCroatia,Faculty of Electrical Engineering and ComputingUniversity of ZagrebZagrebCroatia
| | - Diogo Reis Carneiro
- Neurology DepartmentCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Giovanna Calandra‐Buonaura
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly,Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Jennifer Camaradou
- Patient Partner of the EAN Scientific Panel for Autonomic Nervous System DisordersLondonUK,UCL Social Research InstituteUniversity College LondonLondonUK
| | - Giacomo Chiaro
- Autonomic UnitNational Hospital for Neurology and Neurosurgery, Queen SquareLondonUK,UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly,Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | | | - Roberta Granata
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly,Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Raimund Helbok
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Max J. Hilz
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of NeurologyUniversity Erlangen‐NurembergErlangen‐NurembergGermany
| | - Valeria Iodice
- Autonomic UnitNational Hospital for Neurology and Neurosurgery, Queen SquareLondonUK,UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Jens Jordan
- Institute of Aerospace MedicineGerman Aerospace Center (DLR) and Medical FacultyUniversity of CologneCologneGermany
| | - Evert C. A. Kaal
- Department of Neurology, Maasstad ZiekenhuisRotterdamThe Netherlands
| | - Anita Kamondi
- Department of NeurologyNational Institute of Mental Health, Neurology and NeurosurgeryBudapestHungary
| | - Anne Pavy Le Traon
- Department of NeurologyCentre Hospitalier Universitaire de Toulouse and INSERM U 1297ToulouseFrance
| | - Isabel Rocha
- Institute of Physiology, Faculty of MedicineUniversity of LisbonLisbonPortugal
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach‐GänserndorfMistelbachAustria,Department of Neurology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Jean Michel Senard
- Department of Cardiolog, Toulouse University HospitalInstitute des Maladies Métaboliques et Cardiovasculaires, INSERM U 1297ToulouseFrance
| | - Astrid Terkelsen
- Department of NeurologyAarhus University Hospital and Danish Pain Research CenterAarhus UniversityAarhusDenmark
| | - Gregor K. Wenning
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Thomas Berger
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Roland D. Thijs
- Department of NeurologyLeiden University Medical CentreLeidenThe Netherlands,Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | - Walter Struhal
- Department of Neurology, University Hospital TullnKarl Landsteiner University of Health SciencesTullnAustria
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Sellner J. Multiple sclerosis at the crossroads of scientific evidence and clinical translation. Wien Med Wochenschr 2022; 172:327-328. [PMID: 36287338 PMCID: PMC9607687 DOI: 10.1007/s10354-022-00936-z] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, 2130, Mistelbach, Austria.
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17
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Hauer L, Sellner J. Diroximel Fumarate as a Novel Oral Immunomodulating Therapy for Relapsing Forms of Multiple Sclerosis: A Review on the Emerging Data. Drug Des Devel Ther 2022; 16:3915-3927. [PMID: 36388086 PMCID: PMC9663167 DOI: 10.2147/dddt.s236926] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disorder of the central nervous system. Disease-modifying drugs (DMDs) and subsequent adherence are crucial for preventing reversible episodes of neurological dysfunction and delayed onset of progressive accumulation of irreversible deficits. Yet, side effects may limit their usage in clinical practice. Gastrointestinal (GI) side effects are a significant limitation of the use of dimethyl fumarate (DMF), the most frequently prescribed oral DMD in MS worldwide. Diroximel fumarate (DRF) is a second-generation oral fumaric acid ester (FAE) that was developed as a formulation with better GI tolerability. The improved tolerability is assumed to be related to a lower synthesis of gut-irritating methanol. Other explanations for DRF’s lower extent of GI irritation include a more modest off-target activity due to its chemical structure. The superior GI tolerability of DRF compared to DMF could be proven in clinical trials and lead to approval of DRF for the treatment of relapsing forms of MS/relapsing-remitting MS (United States Food and Drug Administration and European Medicines Agency, respectively). Here, we summarize the mode of action of oral FAE and compare the chemical and physiological characteristics of DMF and DRF. Moreover, we discuss the adverse effects of FAE and introduce the emerging preclinical and trial data leading to the approval of DRF in MS. This article additionally reviews our current understanding of coronavirus disease 2019 (COVID-19) and the efficacy of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination in people treated with FAE.
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Affiliation(s)
- Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
- Correspondence: Johann Sellner, Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, Mistelbach, 2130, Austria, Tel +2572/9004-12850, Fax +2572/9004-49281, Email
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18
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Perncezky J, Sellner J. Natalizumab extended-interval dosing in multiple sclerosis to mitigate progressive multifocal leukoencephalopathy risk: initial study evidence and real-world experience. J Cent Nerv Syst Dis 2022; 14:11795735221135485. [PMID: 36277271 PMCID: PMC9580073 DOI: 10.1177/11795735221135485] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The high efficacy of natalizumab in the treatment of relapsing-remitting multiple sclerosis (MS) is without controversy. Indeed, effective disease control was not only demonstrated in the pivotal trials but has been corroborated impressively in real-world observations. This monoclonal IgG4 antibody blocks the α4β1 integrin-mediated leukocyte-endothelial interaction and thereby inhibits the migration of immune cells to the brain parenchyma. However, treatment with natalizumab carries the risk of progressive multifocal leukoencephalopathy (PML). This potentially lethal side effect is a significant limitation for treatment initiation and long-term therapy. Natalizumab is given intravenously or subcutaneously in the standard dose of 300 mg every 4 weeks, allowing drug concentrations at levels that ensure continuous α4β1 integrin receptor saturation on the surface of immune cells. Extended-interval dosing (EID) is an emerging treatment approach that aims to mitigate the natalizumab-related PML risk by prolonging the standard infusion intervals to 6 weeks or even more. This treatment approach may abrogate the PML risk due to improved immune surveillance within the central nervous system while maintaining clinical efficacy. Moreover, even an individual interval dosing can be envisioned based on the availability of a biomarker that is capable of monitoring both safety and efficacy aspects. This review summarizes the early and encouraging evidence for EID from observational and randomized-controlled trials and discusses current limitations and upcoming challenges for introducing a tailored treatment approach.
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Affiliation(s)
- Julian Perncezky
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria,Johann Sellner, Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr 67, Mistelbach 2130, Austria.
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19
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Sellner J, Hauer L, Rinaldi F, Covi M, Brigo F, Pikija S, Nardone R. Embolic Stroke Following Ingestion of Liquid Nicotine Refill Solution. Neurohospitalist 2022; 12:693-696. [PMID: 36147756 PMCID: PMC9485683 DOI: 10.1177/19418744221115523] [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] [Indexed: 10/03/2023] Open
Abstract
The use of e-cigarettes is gaining popularity despite knowing about cardiovascular health risks. Cases of intentional or accidental intoxication following ingestion of the refill solution are also a growing concern. Most of these cases were fatal and related to cardiac arrest and hypoxic brain injury. We report the case of a 54-year-old woman who developed bilateral acute ischemic stroke in the anterior and posterior cerebral circulation following intentional oral intake of e-liquid nicotine refill solution. The diagnostic work-up concluded an etiology of embolic stroke of undetermined source, most likely of cardiac origin. We assume that sympathetic overactivation lead to temporary cardiac arrhythmia and subsequent thrombi formation. Moreover, we discuss several additional pathogenic aspects of oral intake of e-liquid refill solution for the development of central nervous system pathology. This case expands the clinical spectrum of health hazards associated with the introduction of e-cigarettes and raises awareness of the need for preventive measures.
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Affiliation(s)
- Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Fabrizio Rinaldi
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Markus Covi
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Slaven Pikija
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
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20
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Fox RJ, Wiendl H, Wolf C, De Stefano N, Sellner J, Gryb V, Rejdak K, Bozhinov PS, Tomakh N, Skrypchenko I, Muehler AR. A double-blind, randomized, placebo-controlled phase 2 trial evaluating the selective dihydroorotate dehydrogenase inhibitor vidofludimus calcium in relapsing-remitting multiple sclerosis. Ann Clin Transl Neurol 2022; 9:977-987. [PMID: 35698927 PMCID: PMC9268865 DOI: 10.1002/acn3.51574] [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: 01/28/2022] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Inhibition of dihydroorotate dehydrogenase suppresses magnetic resonance imaging brain lesions and disease activity in multiple sclerosis but has limiting tolerability. We assessed the safety and efficacy of vidofludimus calcium, a novel, selective dihydroorotate dehydrogenase inhibitor, in patients with relapsing-remitting multiple sclerosis. METHODS This double-blind, 24 weeks, placebo-controlled, phase 2 trial (EMPhASIS) enrolled patients 18-55 years with relapsing-remitting multiple sclerosis. Eligible patients were randomly assigned (1:1:1) to once-daily vidofludimus calcium (30 mg or 45 mg) or placebo. The primary endpoint was the cumulative number of combined unique active lesions to week 24 between vidofludimus calcium 45 mg and placebo (clinicalTrials.gov number NCT03846219; EudraCT 2018-001896-19). RESULTS After 24 weeks, the mean cumulative number of combined unique active lesions was 6.4 (95% CI: 2.8-13.9) with placebo compared to 2.4 (95% CI: 1.1-4.9) with vidofludimus calcium 45 mg (rate ratio 0.38, 95% CI: 0.22-0.64; p = 0.0002); the rate ratio between vidofludimus calcium 30 mg and placebo was 0.30 (95% CI: 0.17-0.53; p < 0.0001). Treatment-emergent adverse events occurred in 30 (44%) of patients assigned placebo and 60 (43%) of patients assigned vidofludimus calcium. Serious adverse events occurred in one (1%) assigned placebo and two (1%) assigned vidofludimus calcium. No increased incidence of infectious, hepatic, or renal treatment-emergent adverse events or serious adverse events was observed. INTERPRETATION Treatment with vidofludimus calcium led to a reduction in new magnetic resonance imaging lesions in patients with relapsing-remitting multiple sclerosis and was well tolerated with a favorable safety profile. Assessment in longer, larger trials is justified.
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Affiliation(s)
- Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio, USA
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | | | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, 2130, Mistelbach, Austria
| | - Viktoriia Gryb
- Regional Clinical Hospital Department of Vascular Neurology, Ivano-Frankivsk, Ukraine
| | - Konrad Rejdak
- Medical University of Lublin, Department of Neurology, Jaczewskiego 8, 20-954, Lublin, Poland
| | | | - Nataliya Tomakh
- LLC "INET-09" 32, Zhabotinskogo Leonida Street, Zaporozhye, Ukraine
| | - Iryna Skrypchenko
- Kharkiv Regional Clinical Hospital Department of Neurology, Kharkiv, Ukraine
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21
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Rakusa M, Öztürk S, Moro E, Helbok R, Bassetti CL, Beghi E, Bereczki D, Bodini B, Di Liberto G, Jenkins TM, Macerollo A, Maia LF, Martinelli-Boneschi F, Pisani A, Priori A, Sauerbier A, Soffietti R, Taba P, von Oertzen TJ, Zedde M, Crean M, Burlica A, Cavallieri F, Sellner J. COVID-19 vaccination hesitancy among people with chronic neurological disorders: a position paper. Eur J Neurol 2022; 29:2163-2172. [PMID: 35460319 PMCID: PMC9111566 DOI: 10.1111/ene.15368] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Health risks associated with SARS‐CoV‐2 infection are undisputed. Moreover, the capability of vaccination to prevent symptomatic, severe, and fatal COVID‐19 is recognized. There is also early evidence that vaccination can reduce the chance for long COVID‐19. Nonetheless, the willingness to get vaccinated and receive booster shots remains subpar among people with neurologic disorders. Vaccine scepticism not only jeopardizes collective efforts to end the COVID‐19 pandemic but puts individual lives at risk, as some chronic neurologic diseases are associated with a higher risk for an unfavorable COVID‐19 course. Methods In this position paper, the NeuroCOVID‐19 Task Force of the European Academy of Neurology (EAN) summarizes the current knowledge on the prognosis of COVID‐19 among patients with neurologic disease, elucidates potential barriers to vaccination coverage, and formulates strategies to overcome vaccination hesitancy. A survey among the Task Force members on the phenomenon of vaccination hesitancy among people with neurologic disease supports the lines of argumentation. Results The study revealed that people with multiple sclerosis and other nervous system autoimmune disorders are most skeptical of SARS‐CoV‐2 vaccination. The prevailing concerns included the chance of worsening the pre‐existing neurological condition, vaccination‐related adverse events, and drug interaction. Conclusions The EAN NeuroCOVID‐19 Task Force reinforces the key role of neurologists as advocates of COVID‐19 vaccination. Neurologists need to argue in the interest of their patients about the overwhelming individual and global benefits of COVID‐19 vaccination. Moreover, they need to keep on eye on this vulnerable patient group, its concerns, and the emergence of potential safety signals.
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Affiliation(s)
- Martin Rakusa
- Department of Neurologic Diseases, University Medical Centre Maribor, Maribor, Slovenia
| | - Serefnur Öztürk
- Department of Neurology and Neurointensive Care, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, Grenoble, France
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudio L Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Benedetta Bodini
- Department of Neurology, Saint-Antoine Hospital, APHP, Paris, France.,Paris Brain Institute, Sorbonne University, Paris, France
| | - Giovanni Di Liberto
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Thomas M Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonella Macerollo
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK
| | - Luis F Maia
- Department of Neurology, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde Universidade do Porto, Porto, Portugal
| | - Filippo Martinelli-Boneschi
- Neurology Unit and MS Centre, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, Milan
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Alberto Priori
- Division of Neurology, Department of Neurology, 'Aldo Ravelli' Research Center, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Tartu, Estonia.,Tartu University Hospital, Tartu, Estonia
| | - Tim J von Oertzen
- Department of Neurology, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michael Crean
- European Academy of Neurology (EAN) Head Office, Vienna, Austria
| | - Anja Burlica
- European Academy of Neurology (EAN) Head Office, Vienna, Austria
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
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22
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Moser T, Ziemssen T, Sellner J. Real-world evidence for cladribine tablets in multiple sclerosis: further insights into efficacy and safety. Wien Med Wochenschr 2022; 172:365-372. [PMID: 35451662 PMCID: PMC9026047 DOI: 10.1007/s10354-022-00931-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/14/2022] [Indexed: 01/31/2023]
Abstract
Cladribine (CLAD) is a purine nucleoside analog approved in tablet form to treat highly active multiple sclerosis (MS). CLAD tablets are the first oral therapy with an infrequent dosing schedule, administered in two annual treatment courses, each divided into two treatment cycles comprising 4–5 days of treatment. The efficacy and safety of CLAD tablets have been verified in randomized controlled clinical trials. Clinical observational studies are performed in more representative populations and over more extended periods, and thus provide valuable complementary insights. Here, we summarize the available evidence for CLAD tablets from post-marketing trials, including two observational, four long-term extensions, and two comparative studies. The patients in the post-marketing setting differed from the cohort recruited in the pivotal phase III trials regarding demographics and MS-related disability. The limited number of studies with small cohorts corroborate the disease-modifying capacity of oral CLAD and report on a durable benefit after active treatment periods. Skin-related adverse events were common in the studies focusing on safety aspects. In addition, single cases of CLAD-associated autoimmune events have been reported. Lastly, CLAD tablets appear safe regarding COVID-19 concerns, and patients mount a robust humoral immune response to SARS-CoV‑2 vaccination. We conclude that the current real-world evidence for CLAD tablets as immune reconstitution therapy for treatment of MS is based on a small number of studies and a population distinct from the cohorts randomized in the pivotal phase III trials. Further research should advance the understanding of long-term disease control after active treatment periods and the mitigation of adverse events.
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Affiliation(s)
- Tobias Moser
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Tjalf Ziemssen
- Department of Neurology, Multiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstraße 67, 2130, Mistelbach, Austria.
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23
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Aleksovska K, Kobulashvili T, Costa J, Zimmermann G, Ritchie K, Reinhard C, Vignatelli L, Fanciulli A, Damian M, Pavlakova L, Burgunder JM, Kopishinskaya S, Rakusa M, Kovacs N, Erdogan FF, Linton LR, Copetti M, Lamperti C, Servidei S, Evangelista T, Ayme S, Pareyson D, Sellner J, Krarup C, de Visser M, van den Bergh P, Toscano A, Graessner H, Berger T, Bassetti C, Vidailhet M, Trinka E, Deuschl G, Federico A, Leone MA. European Academy of Neurology guidance for developing and reporting clinical practice guidelines on rare neurological diseases. Eur J Neurol 2022; 29:1571-1586. [PMID: 35318776 DOI: 10.1111/ene.15267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Rare diseases affect up to 29 million people in the European Union, and almost 50% of them affect the nervous system or muscles. Delays in diagnosis and treatment onset and insufficient treatment choices are common. Clinical practice guidelines (CPGs) may improve the diagnosis and treatment of patients and optimize care pathways, delivering the best scientific evidence to all clinicians treating these patients. Recommendations are set for developing and reporting high-quality CPGs on rare neurological diseases (RNDs) within the European Academy of Neurology (EAN), through a consensus procedure. METHODS A group of 27 experts generated an initial list of items that were evaluated through a two-step Delphi consensus procedure and a face-to-face meeting. The final list of items was reviewed by an external review group of 58 members. RESULTS The consensus procedure yielded 63 final items. Items are listed according to the domains of the AGREE instruments and concern scope and purpose, stakeholder involvement, rigour of development, and applicability. Additional items consider reporting and ethical issues. Recommendations are supported by practical examples derived from published guidelines and are presented in two tables: (1) items specific to RND CPGs, and general guideline items of special importance for RNDs, or often neglected; (2) items for guideline development within the EAN. CONCLUSIONS This guidance aims to provide solutions to the issues specific to RNDs. This consensus document, produced by many experts in various fields, is considered to serve as a starting point for further harmonization and for increasing the quality of CPGs in the field of RNDs.
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Affiliation(s)
- Katina Aleksovska
- European Academy of Neurology, Vienna, Austria.,SC Neurology, Department of Emergency and Critical Care, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy.,Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, N. Macedonia
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated Partner of the ERN EpiCARE, Salzburg, Austria
| | - Joao Costa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated Partner of the ERN EpiCARE, Salzburg, Austria.,Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria.,Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | | | - Carola Reinhard
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Maxwel Damian
- Neurology and Neurointensive Care, Cambridge University Hospitals and Ipswich Hospital, Cambridge, UK
| | | | - Jean-Marc Burgunder
- Swiss Huntington Center, Neurozentrum Siloah AG, Gümligen, Switzerland.,Department of Neurology, University of Bern, Bern, Switzerland
| | | | - Martin Rakusa
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Norbert Kovacs
- Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, N. Macedonia.,Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
| | | | - Lori Renna Linton
- EuroHSP, Federation of National Groups Related With Hereditary Spastic Paraplegia, Paris, France
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
| | - Costanza Lamperti
- Division of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Serenella Servidei
- Fondazione Policlinico Universitario IRCCS Roma, Università Cattolica del Sacro Cuore, Italy
| | - Theresina Evangelista
- Neuromuscular Morphology Unit, Myology Institute, Groupe Hospitalier Universitaire La Pitié-Salpêtrière, Paris, France.,AP-HP, Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile de France, Sorbonne Université - Inserm UMRS 974, Paris, France
| | - Segolene Ayme
- Paris Brain Institute-ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Universite, Paris, France
| | - Davide Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Christian Krarup
- Clinical Neurophysiology, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine and Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centre, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter van den Bergh
- Neuromuscular Reference Centre UCL St-Luc, University Hospital St-Luc, Brussels, Belgium
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, Neurology and Neuromuscular Disorders Unit, AOU Policlinico di Messina, Messina, Italy
| | - Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Claudio Bassetti
- Neurology Department, Medical Faculty, University Hospital, Bern, Switzerland
| | - Marie Vidailhet
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Department de Neurologie, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Hospital Salpetriere, Sorbonne Université, Paris, France
| | - Eugene Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated Partner of the ERN EpiCARE, Salzburg, Austria.,Neuroscience Institute, Centre for Cognitive Neuroscience, Christian Doppler University Hospital, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Guenther Deuschl
- Department of Neurology, Christian Albrecht's University, Kiel, Germany
| | - Antonio Federico
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Department Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Maurizio A Leone
- SC Neurology, Department of Emergency and Critical Care, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
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24
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Pikija S, Kunz AB, Nardone R, Enzinger C, Pfaff JA, Trinka E, Seifert-Held T, Sellner J. Spontaneous spinal cord infarction in Austria: a two-center comparative study. Ther Adv Neurol Disord 2022; 15:17562864221076321. [PMID: 35299778 PMCID: PMC8921761 DOI: 10.1177/17562864221076321] [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: 11/11/2021] [Accepted: 01/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Spinal cord infarction (SCI) is a neurological emergency associated with high rates of persistent neurological deficits. Knowledge about this rare but potentially treatable condition needs to be expanded. Objective: To describe the characteristics of spontaneous SCI in a large retrospective series of patients treated at two tertiary care centers in Austria. Methods: We performed a descriptive and comparative analysis of spontaneous SCI treated at the University Hospitals of Salzburg and Graz between the years 2000 and 2020. The analysis included pre- and in-hospital procedures, clinical presentation, etiology, diagnostic certainty, reperfusion therapy, and functional outcome at discharge. Results: We identified 88 cases, 61% were ascertained in the second half of the study period. The median age was 65.5 years [interquartile range (IQR) = 56–74], 51.1% were women. Anterior spinal artery infarction was the predominant syndrome (82.9%). Demographics, vascular comorbidities, and clinical presentation did not differ between the centers. The most frequent etiology and level of diagnostic certainty were distinct, with atherosclerosis (50%) and definite SCI (42%), and unknown (52.5%) and probable SCI (60%) as front runners in Salzburg and Graz, respectively. Patients arrived after a median of 258.5 min (IQR = 110–528) at the emergency room. The first magnetic resonance imaging (MRI) of the spinal cord was performed after a median of 148 min (IQR = 90–312) from admission and was diagnostic for SCI in 45%. Two patients received intravenous thrombolysis (2.2%). The outcome was poor in 37/77 (48%). Conclusion: Demographics, clinical syndromes, and quality benchmarks for spontaneous SCI were consistent at two Austrian tertiary care centers. Our findings provide the foundation for establishing standards for pre- and in-hospital care to improve outcomes.
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Affiliation(s)
- Slaven Pikija
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Alexander B. Kunz
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Raffaele Nardone
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Johannes A.R. Pfaff
- University Institute for Neuroradiology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria Neuroscience Institute, Christian Doppler Medical Center and Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | | | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, 2130 Mistelbach, Austria
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany
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25
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Beghi E, Helbok R, Oztturk S, Karadas O, Lisnic V, Grosu O, Kovács T, Dobronyi L, Bereczki D, Cotelli MS, Turla M, Davidescu EI, Popescu BO, Valzania F, Cavallieri F, Ulmer H, Maia LF, Amodt AH, Armon C, Brola W, Gryb V, Riahi A, Krehan I, von Oertzen T, Azab MA, Crean M, Lolich M, Lima MJ, Sellner J, Perneczky J, Jenkins T, Meoni S, Bianchi E, Moro E, Bassetti CLA. Short- and long-term outcome and predictors in an international cohort of patients with neuro COVID-19. Eur J Neurol 2022; 29:1663-1684. [PMID: 35194889 PMCID: PMC9111799 DOI: 10.1111/ene.15293] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Despite the increasing number of reports on the spectrum of neurological manifestations of COVID‐19 (neuro‐COVID), few studies have assessed short‐ and long‐term outcome of the disease. Methods This is a cohort study enrolling adult patients with neuro‐COVID seen in neurological consultation. Data were collected prospectively or retrospectively in the European Academy of Neurology NEuro‐covid ReGistrY ((ENERGY). The outcome at discharge was measured using the modified Rankin Scale and defined as ‘stable/improved’ if the modified Rankin Scale score was equal to or lower than the pre‐morbid score, ‘worse’ if the score was higher than the pre‐morbid score. Status at 6 months was also recorded. Demographic and clinical variables were assessed as predictors of outcome at discharge and 6 months. Results From July 2020 to March 2021, 971 patients from 19 countries were included. 810 (83.4%) were hospitalized. 432 (53.3%) were discharged with worse functional status. Older age, stupor/coma, stroke and intensive care unit (ICU) admission were predictors of worse outcome at discharge. 132 (16.3%) died in hospital. Older age, cancer, cardiovascular complications, refractory shock, stupor/coma and ICU admission were associated with death. 262 were followed for 6 months. Acute stroke or ataxia, ICU admission and degree of functional impairment at discharge were predictors of worse outcome. 65/221 hospitalized patients (29.4%) and 10/32 non‐hospitalized patients (24.4%) experienced persisting neurological symptoms/signs. 10/262 patients (3.8%) developed new neurological complaints during the 6 months of follow‐up. Conclusions Neuro‐COVID is a severe disease associated with worse functional status at discharge, particularly in older subjects and those with comorbidities and acute complications of infection.
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Affiliation(s)
- Ettore Beghi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Neuroscience
| | - Raimund Helbok
- Medical University of Innsbruck, Department of Neurology, Neurological Intensive Care Unit
| | | | - Omer Karadas
- University of Health Science, Gulhane School of Medicine, Neurology Department, Ankara, Turkey
| | - Vitalie Lisnic
- Nicolae Testemiceanu State Medical and Pharmaceutical University, Neurology
| | - Oxana Grosu
- Academy of Sciences of Moldova, Neurology, Nicolae Testemiceanu State Medical and Pharmaceutical University, Neurology
| | | | | | | | | | | | | | | | - Franco Valzania
- Azienda USL-IRCCS di Reggio Emilia, Neurology Unit, Neuromotor & Rehabilitation Department
| | | | - Hanno Ulmer
- Innsbruck Medical University, Department of Medical Statistics, Informatics and Health Economics
| | - Luis F Maia
- Centro Hospitalar Universitario do Porto EPE, Neurology
| | | | - Carmel Armon
- Tel Aviv University School of Medicine, Department of Neurology
| | - Waldemer Brola
- Specialist Hospital Konskie, Collegium Medicum, Jan Kochanowski University, Department of Neurology, Kielce
| | - Victoria Gryb
- Ivano-Frankivsk Medical University, Vascular Neurology
| | - Anis Riahi
- Military hospital of Tunis, Tunis El Manar University, Department of Neurology
| | | | - Tim von Oertzen
- Kepler Universitatsklinikum GmbH, Dpet of Neurology 1, Johannes Kepler Universitat Linz, Medical Faculty
| | - Mohammed A Azab
- Idaho State University Boise, Department of Biochemistry and Molecular Biology
| | - Michael Crean
- European Academy of Neurology, department of neurology
| | | | | | - Johann Sellner
- Landesklinikum Mistelbach-Gänserndorf Abteilung für Urologie, Department of Neurology
| | | | - Tom Jenkins
- The University of Sheffield Institute for Translational Neuroscience, Department of neurology
| | - Sara Meoni
- Pole de Psychiatrie et Neurologie, CHUGA, Pole de Psychiatrie et Neurologie
| | | | - Elena Moro
- Division of Neurology, Centre Hospitalier Universitaire of Grenoble, Grenoble Alpes University, Neurology, CHUGA, Neuroscience
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26
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Abstract
In humans, several respiratory viruses can have neurologic implications affecting both central and peripheral nervous system. Neurologic manifestations can be linked to viral neurotropism and/or indirect effects of the infection due to endothelitis with vascular damage and ischemia, hypercoagulation state with thrombosis and hemorrhages, systemic inflammatory response, autoimmune reactions, and other damages. Among these respiratory viruses, recent and huge attention has been given to the coronaviruses, especially the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic started in 2020. Besides the common respiratory symptoms and the lung tropism of SARS-CoV-2 (COVID-19), neurologic manifestations are not rare and often present in the severe forms of the infection. The most common acute and subacute symptoms and signs include headache, fatigue, myalgia, anosmia, ageusia, sleep disturbances, whereas clinical syndromes include mainly encephalopathy, ischemic stroke, seizures, and autoimmune peripheral neuropathies. Although the pathogenetic mechanisms of COVID-19 in the various acute neurologic manifestations are partially understood, little is known about long-term consequences of the infection. These consequences concern both the so-called long-COVID (characterized by the persistence of neurological manifestations after the resolution of the acute viral phase), and the onset of new neurological symptoms that may be linked to the previous infection.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble Institute of Neurosciences, Grenoble, France,Correspondence to: Elena Moro, Service de neurologie, CHU de Grenoble (Hôpital Nord), Boulevard de la Chantourne, 38043 La Tronche, France. Tel: + 33-4-76-76-94-52, Fax: +33-4-76-76-56-31
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27
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Abstract
Der Prävention von Infektionskrankheiten kommt bei der Multiplen Sklerose (MS) eine besondere Bedeutung zu, da diese den Krankheitsverlauf ungünstig beeinflussen können. Dies wird uns im Rahmen der COVID-19-Pandemie verdeutlicht, wo die SARS-CoV-2-Infektion als Auslöser von besonders schweren und prolongierten Schüben und klinischer Verschlechterung identifiziert werden konnte. Umso wichtiger ist es daher, den Einfluss der für die MS zugelassenen Immuntherapien auf eine etwaige Suszeptibilität für eine SARS-CoV-2-Infektion, den COVID-19-Krankheitsverlauf und das Impfansprechen zu verstehen. In dieser Übersichtsarbeit werden diese Punkte unter besonderer Berücksichtigung von Cladribin-Tabletten, einer für den hochaktiven MS-Verlauf zugelassenen Immunrekonstitutionstherapie, beleuchtet.
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Affiliation(s)
- Johann Sellner
- Abteilung für Neurologie, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, 2130 Mistelbach, Österreich
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28
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Bsteh G, Sellner J. T cells as the hoped-for savior for SARS-CoV-2 vaccination during CD20-depleting antibody therapy?: Commentary for: "Discordant humoral and T cell immune responses to SARS-CoV-2 vaccination in people with multiple sclerosis on anti-CD20 therapy.". EBioMedicine 2021; 74:103692. [PMID: 34773893 PMCID: PMC8579751 DOI: 10.1016/j.ebiom.2021.103692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical Center, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Moser T, Hoepner L, Schwenker K, Seiberl M, Feige J, Akgün K, Haschke-Becher E, Ziemssen T, Sellner J. Cladribine Alters Immune Cell Surface Molecules for Adhesion and Costimulation: Further Insights to the Mode of Action in Multiple Sclerosis. Cells 2021; 10:cells10113116. [PMID: 34831335 PMCID: PMC8618022 DOI: 10.3390/cells10113116] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/28/2022] Open
Abstract
Cladribine (CLAD) is a deoxyadenosine analogue prodrug which is given in multiple sclerosis (MS) as two short oral treatment courses 12 months apart. Reconstitution of adaptive immune function following selective immune cell depletion is the presumed mode of action. In this exploratory study, we investigated the impact of CLAD tablets on immune cell surface molecules for adhesion (CAMs) and costimulation (CoSs) in people with MS (pwMS). We studied 18 pwMS who started treatment with CLAD and 10 healthy controls (HCs). Peripheral blood mononuclear cells were collected at baseline and every 3 months throughout a 24-month period. We analysed ICAM-1, LFA-1, CD28, HLADR, CD154, CD44, VLA-4 (CD49d/CD29), PSGL-1 and PD-1 with regard to their expression on B and T cells (T helper (Th) and cytotoxic T cells (cT)) and surface density (mean fluorescence intensity, MFI) by flow cytometry. The targeted analysis of CAM and CoS on the surface of immune cells in pwMS revealed a higher percentage of ICAM-1 (B cells, Th, cT), LFA-1 (B cells, cT), HLADR (B cells, cT), CD28 (cT) and CD154 (Th). In pwMS, we found lower frequencies of Th and cT cells expressing PSGL-1 and B cells for the inhibitory signal PD-1, whereas the surface expression of LFA-1 on cT and of HLADR on B cells was denser. Twenty-four months after the first CLAD cycle, the frequencies of B cells expressing CD44, CD29 and CD49d were lower compared with the baseline, together with decreased densities of ICAM-1, CD44 and HLADR. The rate of CD154 expressing Th cells dropped at 12 months. For cT, no changes were seen for frequency or density. Immune reconstitution by oral CLAD was associated with modification of the pro-migratory and -inflammatory surface patterns of CAMs and CoSs in immune cell subsets. This observation pertains primarily to B cells, which are key cells underlying MS pathogenesis.
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Affiliation(s)
- Tobias Moser
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (K.S.); (M.S.); (J.F.)
- Department of Neurology, Multiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technical University Dresden, 01307 Dresden, Germany; (L.H.); (K.A.); (T.Z.)
| | - Lena Hoepner
- Department of Neurology, Multiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technical University Dresden, 01307 Dresden, Germany; (L.H.); (K.A.); (T.Z.)
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (K.S.); (M.S.); (J.F.)
| | - Michael Seiberl
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (K.S.); (M.S.); (J.F.)
| | - Julia Feige
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (K.S.); (M.S.); (J.F.)
| | - Katja Akgün
- Department of Neurology, Multiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technical University Dresden, 01307 Dresden, Germany; (L.H.); (K.A.); (T.Z.)
| | | | - Tjalf Ziemssen
- Department of Neurology, Multiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technical University Dresden, 01307 Dresden, Germany; (L.H.); (K.A.); (T.Z.)
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (K.S.); (M.S.); (J.F.)
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, 80333 München, Germany
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, 2130 Mistelbach, Austria
- Correspondence: ; Tel.: +43-2572-9004-12850; Fax: +43-2572-9004-49281
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Sellner J, Jenkins TM, von Oertzen TJ, Bassetti CL, Beghi E, Bereczki D, Bodini B, Cavallieri F, Di Liberto G, Helbok R, Macerollo A, Maia LF, Oreja‐Guevara C, Özturk S, Rakusa M, Pisani A, Priori A, Sauerbier A, Soffietti R, Taba P, Zedde M, Crean M, Burlica A, Twardzik A, Moro E. A plea for equitable global access to COVID-19 diagnostics, vaccination and therapy: The NeuroCOVID-19 Task Force of the European Academy of Neurology. Eur J Neurol 2021; 28:3849-3855. [PMID: 33460486 PMCID: PMC8014664 DOI: 10.1111/ene.14741] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
Coronavirus disease 2019 (COVID-19), a multi-organ disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to challenge health and care systems around the globe. The pandemic has disrupted acute neurology services and routine patient care and has impacted the clinical course in patients with chronic neurological disease. COVID-19 appears to have exposed inequalities of societies and healthcare systems and had a disproportionate impact on already vulnerable communities. The next challenge will be to set up initiatives to stop disparities in all aspects related to COVID-19. From the medical perspective, there is a need to consider inequalities in prevention, treatment and long-term consequences. Some of the issues of direct relevance to neurologists are summarised. With this appraisal, the European Academy of Neurology NeuroCOVID-19 Task Force intends to raise awareness of the potential impact of COVID-19 on inequalities in healthcare and calls for action to prevent disparity at individual, national and supranational levels.
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Affiliation(s)
- Johann Sellner
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
- Department of NeurologyChristian Doppler Medical CenterParacelsus Medical UniversitySalzburgAustria
- Department of NeurologyKlinikum rechts der IsarTechnische Universität MünchenMünchenGermany
| | - Thomas M. Jenkins
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Tim J. von Oertzen
- Faculty of MedicineJohannes‐Kepler UniversitätLinzAustria
- Department of Neurology 1Kepler UniversitätsklinikumLinzAustria
| | | | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario NegriIRCCSMilanItaly
| | | | - Benedetta Bodini
- Department of NeurologySaint‐Antoine HospitalAPHPSorbonne UniversityParisFrance
| | - Francesco Cavallieri
- Neurology UnitNeuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly
| | - Giovanni Di Liberto
- Department of Clinical NeurosciencesCentre Hospitalier Universitaire Vaudois and University of LausanneLausanneSwitzerland
| | - Raimund Helbok
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Antonella Macerollo
- Walton Centre NHS Foundation TrustLiverpoolUK
- School of PsychologyFaculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - Luis F. Maia
- Department of NeurologyHospital Santo AntónioCentro Hospitalar Universitário do PortoPortoPortugal
- i3S ‐ Instituto de Investigação e Inovação em Saúde Universidade do PortoPortoPortugal
| | - Celia Oreja‐Guevara
- Department of NeurologyHospital Clinico San CarlosMadridSpain
- Departamento de MedicinaFacultad de MedicinaUniversidad Complutense de Madrid (UCMMadridSpain
- IdISSCMadridSpain
| | - Serefnur Özturk
- Department of NeurologyFaculty of MedicineSelcuk UniversityKonyaTurkey
| | - Martin Rakusa
- Department of NeurologyUniversity Medical Centre MariborMariborSlovenia
| | - Antonio Pisani
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Alberto Priori
- Division of NeurologyDepartment of Neurology‘Aldo Ravelli’ Research CenterUniversity of Milan and ASST Santi Paolo e CarloMilanItaly
| | - Anna Sauerbier
- Department of NeurologyUniversity Hospital CologneCologneGermany
- King's College HospitalNational Parkinson Foundation International Centre of ExcellenceLondonUK
| | - Riccardo Soffietti
- Division of Neuro‐OncologyDepartment of NeuroscienceUniversity of TurinTurinItaly
| | - Pille Taba
- Department of Neurology and NeurosurgeryInstitute of Clinical MedicineUniversity of TartuTartuEstonia
| | - Marialuisa Zedde
- Neurology UnitNeuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly
| | - Michael Crean
- European Academy of Neurology (EAN) Head OfficeViennaAustria
| | - Anja Burlica
- European Academy of Neurology (EAN) Head OfficeViennaAustria
| | - Alex Twardzik
- European Academy of Neurology (EAN) Head OfficeViennaAustria
| | - Elena Moro
- Division of NeurologyCHU of GrenobleGrenoble Institute of NeurosciencesGrenoble Alpes UniversityGrenobleFrance
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Uccelli A, Laroni A, Ali R, Battaglia MA, Blinkenberg M, Brundin L, Clanet M, Fernandez O, Marriot J, Muraro P, Nabavi SM, Oliveri RS, Radue E, Ramo Tello C, Schiavetti I, Sellner J, Sorensen PS, Sormani MP, Wuerfel JT, Freedman MS. Safety, tolerability, and activity of mesenchymal stem cells versus placebo in multiple sclerosis (MESEMS): a phase 2, randomised, double-blind crossover trial. Lancet Neurol 2021; 20:917-929. [PMID: 34687636 DOI: 10.1016/s1474-4422(21)00301-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mesenchymal stem cells (MSCs), also known as mesenchymal stromal cells, have been proposed as a promising therapeutic option for people with multiple sclerosis on the basis of their immunomodulatory and neuroprotective properties. The MEsenchymal StEm cells for Multiple Sclerosis (MESEMS) study was devised to evaluate the safety, tolerability, and activity of autologous MSCs derived from bone marrow and infused intravenously in patients with active multiple sclerosis. METHODS MESEMS is a randomised phase 2 trial done at 15 sites in nine countries. Patients (aged 18-50 years) with active relapsing-remitting or progressive multiple sclerosis were included if they had a disease duration of 2-15 years since onset of multiple sclerosis and an Expanded Disability Status Scale score of 2·5-6·5. Patients were randomly assigned (1:1), according to a crossover design, to receive a single intravenous dose of autologous bone marrow-derived MSCs followed by placebo at week 24, or to receive placebo followed by autologous MSCs at week 24, with a follow-up visit at week 48. Primary objectives were to test safety and activity of MSC treatment. The primary safety endpoint was to assess the number and severity of adverse events within each treatment arm. The primary efficacy endpoint was the number of gadolinium-enhancing lesions (GELs) counted over week 4, 12, and 24 compared between treatment groups. The primary efficacy endpoint was assessed in the full analyis set, after all participants completed the week 24 visit. Efficacy endpoints were evaluated using a predefined statistical testing procedure. Safety was monitored throughout the study by recording vital signs and adverse events at each visit. FINDINGS From July 16, 2012, until July 31, 2019, 144 patients were randomly assigned to first receive early intravenous infusion of autologous bone marrow-derived MSCs (n=69) or placebo (n=75). MSC treatment did not meet the primary endpoint of efficacy on the total number of GELs accumulated from baseline to week 24 (rate ratio [RR] 0·94, 95% CI 0·58-1·50; p=0·78). 213 adverse events were recorded, similarly distributed between groups (93 cases recorded in 35 [51%] of 69 patients treated first with MSCs vs 120 cases in 42 [56%] of 75 patients infused first with placebo). The most frequent adverse events reported were infection and infestations, with a total of 54 (25%) of 213 adverse events (18 [19%] of 93 in the early-MSC group and 36 [30%] of 120 in the delayed-MSC group). Nine serious adverse events were reported in seven patients treated with placebo versus none in the MSC group. All serious adverse events were considered to be unrelated to the treatment infusion. No deaths were reported during the study. INTERPRETATION Bone marrow-derived MSC treatment was safe and well tolerated but did not show an effect on GELs, an MRI surrogate marker of acute inflammation, in patients with active forms of multiple sclerosis, at week 24. Thus, this study does not support the use of bone marrow-derived MSCs to treat active multiple sclerosis. Further studies should address the effect of MSCs on parameters related to tissue repair. FUNDING Fondazione Italiana Sclerosi Multipla (FISM), the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), and the Multiple Sclerosis International Federation (MSIF) for centralised activities. Individual trials participating in the MESEMS network are funded by the following agencies: FISM and Compagnia di San Paolo (Italy); The Danish Multiple Sclerosis Society, The Toyota Foundation, and Danish Blood Donors' Research Foundation (Denmark); the Spanish Health Research Institute Carlos 3 and the Andalusian Public Foundation Progreso y Salud (Spain); the Royan Institute for Stem Cell Biology and Technology (Iran); the Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, and Salzburg (Austria); the Fondation pour l'aide à la recherche sur la sclérose en plaques (ARSEP), French Muscular Dystrophy Association (AFM)-Telethon (France); the UK Multiple Sclerosis Society and the UK Stem Cell Foundation (UK); and the Multiple Sclerosis Society of Canada and The Multiple Sclerosis Scientific Research Foundation and Research Manitoba (Canada).
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Affiliation(s)
- Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rehiana Ali
- Department of Brain Sciences, Imperial College London, London, UK
| | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Italy; Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Centre, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Lou Brundin
- Department of Clinical Neuroscience, Karolinska Institutet, and Division of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Michel Clanet
- Department of Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Oscar Fernandez
- Department of Neurology, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario, Málaga, Spain
| | - James Marriot
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Paolo Muraro
- Department of Brain Sciences, Imperial College London, London, UK
| | - Seyed Massood Nabavi
- Department of Brain and Cognitive Sciences, Cell Science Research Centre and Regenerative Medicine Department, Royan Institute for Stem Cell Biology and Technology, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Roberto S Oliveri
- Cell Therapy Unit, Department of Clinical Immunology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Ernst Radue
- Medical Image Analysis Centre and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Cristina Ramo Tello
- Multiple Sclerosis Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Per Soelberg Sorensen
- Danish Multiple Sclerosis Centre, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Jens Thomas Wuerfel
- Medical Image Analysis Centre and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Schulte EC, Sellner J. SARS-CoV-2 vaccination in multiple sclerosis: A clearer picture for the time point during CD20 depleting therapy. EBioMedicine 2021; 73:103635. [PMID: 34656879 PMCID: PMC8515038 DOI: 10.1016/j.ebiom.2021.103635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Eva C Schulte
- Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany; Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig-Maximilians-University, Munich, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Aleksovska K, Kobulashvili T, Costa J, Zimmermann G, Ritchie K, Reinhard C, Vignatelli L, Fanciulli A, Damian M, Pavlakova L, Burgunder JM, Rakusa M, Kovacs N, Erdogan F, Linton L, Copetti M, Lamperti C, Servidei S, Evangelista T, Ayme S, Pareyson D, Sellner J, Kopishinskaya S, Krarup C, De Visser M, Van Den Bergh P, Toscano A, Graessner H, Berger T, Bassetti C, Vidailhet M, Trinka E, Deuschl G, Federico A, Leone M. EAN guidance for developing and reporting clinical practice guidelines on rare neurological diseases. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Perneczky J, Wuchty B, Sellner J. Iatrogene Liquorfistel als Folge eines SARS-CoV-2-Nasopharyngealabstrichs. psychopraxis neuropraxis 2021. [PMCID: PMC8047594 DOI: 10.1007/s00739-021-00720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In Österreich wurden seit Beginn der COVID-19(„coronavirus disease 2019“)-Pandemie über 16 Mio. Abstriche durchgeführt, wobei hier bevorzugt Nasen-Rachen-Abstriche zum Einsatz kommen. Neben Blutungen und lokalen Abszessen gibt es wenige Daten hinsichtlich möglicher schwerwiegenderer Komplikationen. Anhand von 4 Kasuistiken wird eine iatrogene Liquorfistel als mögliche Folge eines Nasen-Rachen-Abstriches aufgezeigt. Bei entsprechenden Symptomen sollte an diese seltene, jedoch potenziell lebensgefährliche Komplikation gedacht werden.
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Wuchty B, Perneczky J, Sellner J. Methanolintoxikation: ein Kollateralschaden der COVID-19-Pandemie. psychopraxis neuropraxis 2021. [PMCID: PMC8053034 DOI: 10.1007/s00739-021-00721-4] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bianca Wuchty
- Abteilung für Neurologie, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, 2130 Mistelbach, Österreich
| | - Julian Perneczky
- Abteilung für Neurologie, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, 2130 Mistelbach, Österreich
| | - Johann Sellner
- Abteilung für Neurologie, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, 2130 Mistelbach, Österreich
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Bodini B, Moro E, Jaarsma J, Cunningham E, Sellner J, Walsh D. Lessons learned from people with neurological diseases at the time of COVID-19: The EFNA-EAN survey. Eur J Neurol 2021; 29:318-323. [PMID: 34463009 PMCID: PMC8652681 DOI: 10.1111/ene.15087] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The European Federation of Neurological Associations (EFNA), in partnership with the NeuroCOVID-19 taskforce of the European Academy of Neurology (EAN), has investigated the impact of the first wave of the COVID-19 pandemic on individuals with neurological diseases, as well as the hopes and fears of these patients about the post-pandemic phase. METHODS An EFNA-EAN survey was available online to any person living with a neurological disorder in Europe. It consisted of 18 items concerning the impact of the first wave of the COVID-19 pandemic on the medical care of people with neurological disorders, and the hopes and fears of these individuals regarding the post-pandemic phase. RESULTS For 44.4% of the 443 survey participants, the overall care of their neurological disease during the pandemic was inappropriate. This perception was mainly due to significant delays in accessing medical care (25.7%), insufficiently reliable information received about the potential impact of COVID-19 on their neurological disease (49.6%), and a substantial lack of involvement in their disease management decisions (54.3%). Participants indicated that their major concerns for the post-pandemic phase were experiencing longer waiting times to see a specialist (24.1%), suffering from social isolation and deteriorating mental well-being (23.1%), and facing delays in clinical trials with disinvestment in neuroscience research (13.1%). CONCLUSIONS Despite the great efforts of health services to cope with the first wave of the COVID-19 pandemic, individuals with neurological conditions feel they have been left behind. These findings provide invaluable insights for improving the care of patients with neurological disorders in the further course of the COVID-19 pandemic.
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Affiliation(s)
- Benedetta Bodini
- Paris Brain Institute, Sorbonne University, Paris, France.,Department of Neurology, Saint-Antoine Hospital, APHP, Paris, France
| | - Elena Moro
- Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble Alpes University, Grenoble, France
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | | | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Donna Walsh
- European Federation of Neurological Associations, Brussels, Belgium
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Affiliation(s)
- Lukas Dearing
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Felix Müller
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
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Steinmaurer A, Wimmer I, Berger T, Rommer PS, Sellner J. Bruton's tyrosine kinase inhibition in the treatment of preclinical models and multiple sclerosis. Curr Pharm Des 2021; 28:437-444. [PMID: 34218776 DOI: 10.2174/1381612827666210701152934] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
Significant progress has been made in understanding the immunopathogenesis of multiple sclerosis (MS) over recent years. Successful clinical trials with CD20-depleting monoclonal antibodies have corroborated the fundamental role of B cells in the pathogenesis of MS and reinforced the notion that cells of the B cell lineage are an attractive treatment target. Therapeutic inhibition of Bruton's tyrosine kinase (BTK), an enzyme involved in B cell and myeloid cell activation and function, is regarded as a next-generation approach that aims to attenuate both errant innate and adaptive immune functions. Moreover, brain-penetrant BTK inhibitors may impact compartmentalized inflammation and neurodegeneration within the central nervous system by targeting brain-resident B cells and microglia, respectively. Preclinical studies in animal models of MS corroborated an impact of BTK inhibition on meningeal inflammation and cortical demyelination. Notably, BTK inhibition attenuated the antigen-presenting capacity of B cells and the generation of encephalitogenic T cells. Evobrutinib, a selective oral BTK inhibitor, has been tested recently in a phase 2 study of patients with relapsing-remitting MS. The study met the primary endpoint of a significantly reduced cumulative number of Gadolinium-enhancing lesions under treatment with evobrutinib compared to placebo treatment. Thus, the results of ongoing phase 2 and 3 studies with evobrutinib, fenobrutinib, and tolebrutinib in relapsing-remitting and progressive MS are eagerly awaited. This review article introduces the physiological role of BTK, summarizes the pre-clinical and trial evidence, and addresses the potential beneficial effects of BTK inhibition in MS.
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Affiliation(s)
- Anja Steinmaurer
- Department of Neurology, Medical University of Vienna, Vienna. Austria
| | - Isabella Wimmer
- Department of Neurology, Medical University of Vienna, Vienna. Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna. Austria
| | | | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach. Austria
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Schulte EC, Hauer L, Kunz AB, Sellner J. Systematic review of cases of acute myelitis in individuals with COVID-19. Eur J Neurol 2021; 28:3230-3244. [PMID: 34060708 PMCID: PMC8239542 DOI: 10.1111/ene.14952] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 02/17/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022]
Abstract
Background and purpose An incremental number of cases of acute transverse myelitis (ATM) in individuals with ongoing or recent coronavirus disease 2019 (COVID‐19) have been reported. Methods A systematic review was performed of cases of ATM described in the context of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection by screening both articles published and in preprint. Results Twenty cases were identified. There was a slight male predominance (60.0%) and the median age was 56 years. Neurological symptoms first manifested after a mean of 10.3 days from the first onset of classical, mostly respiratory symptoms of COVID‐19. Overall, COVID‐19 severity was relatively mild. Polymerase chain reaction of cerebrospinal fluid for SARS‐CoV‐2 was negative in all 14 cases examined. Cerebrospinal fluid findings reflected an inflammatory process in most instances (77.8%). Aquaporin‐4 and myelin oligodendrocyte protein antibodies in serum (tested in 10 and nine cases, respectively) were negative. On magnetic resonance imaging, the spinal cord lesions spanned a mean of 9.8 vertebral segments, necrotic‐hemorrhagic transformation was present in three cases and two individuals had additional acute motor axonal neuropathy. More than half of the patients received a second immunotherapy regimen. Over a limited follow‐up period of several weeks, 90% of individuals recovered either partially or near fully. Conclusion Although causality cannot readily be inferred, it is possible that cases of ATM occur para‐ or post‐infectiously in COVID‐19. All identified reports are anecdotal and case descriptions are heterogeneous. Whether the condition and the observed radiological characteristics are specific to SARS‐CoV‐2 infection needs to be clarified.
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Affiliation(s)
- Eva C Schulte
- Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Alexander B Kunz
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Gunther Ladurner Nursing Home, Salzburg, Austria
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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40
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Seifert-Held T, Eberhard K, Lechner C, Macher S, Hegen H, Moser T, Jacob GB, Puttinger G, Topakian R, Guger M, Kacar E, Zoche L, De Simoni D, Seiser A, Oberndorfer S, Baumgartner C, Struhal W, Zimprich F, Sellner J, Deisenhammer F, Enzinger C, Reindl M, Rauschka H, Berger T, Höftberger R. Functional Recovery in Autoimmune Encephalitis: A Prospective Observational Study. Front Immunol 2021; 12:641106. [PMID: 34093529 PMCID: PMC8175889 DOI: 10.3389/fimmu.2021.641106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background Prospective observations of functional recovery are lacking in patients with autoimmune encephalitis defined by antibodies against synaptic proteins and neuronal cell surface receptors. Methods Adult patients with a diagnosis of autoimmune encephalitis were included into a prospective registry. At 3, 6 and 12 months of follow-up, the patients’ modified Rankin Scale (mRS) was obtained. Results Patients were stratified into three groups according to their antibody (Ab) status: anti-NMDAR-Ab (n=12; group I), anti-LGI1/CASPR2-Ab (n=35; group II), and other antibodies (n=24; group III). A comparably higher proportion of patients in group I received plasma exchange/immunoadsorption and second line immunosuppressive treatments at baseline. A higher proportion of patients in group II presented with seizures. Group III mainly included patients with anti-GABABR-, anti-GAD65- and anti-GlyR-Ab. At baseline, one third of them had cancer. Patients in groups I and III had much higher median mRS scores at 3 months compared to patients in group II. A median mRS of 1 was found at all follow-up time points in group II. Conclusions The different dynamics in the recovery of patients with certain autoimmune encephalitides have important implications for clinical trials. The high proportion of patients with significant disability at 3 months after diagnosis in groups I and III points to the need for improving treatment options. More distinct scores rather than the mRS are necessary to differentiate potential neurological improvements in patients with anti-LGI1-/CASPR2-encephalitis.
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Affiliation(s)
| | - Katharina Eberhard
- Core Facility Computational Bioanalytics, Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Christian Lechner
- Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tobias Moser
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Brecl Jacob
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gertraud Puttinger
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Michael Guger
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Emrah Kacar
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Lea Zoche
- Department of Neurology, Hospital Hietzing, Vienna, Austria
| | - Desiree De Simoni
- Department of Neurology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Andreas Seiser
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Christoph Baumgartner
- Department of Neurology, Hospital Hietzing, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Walter Struhal
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | | | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | | | | | - Markus Reindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Rauschka
- Department of Neurology, Hospital Donaustadt, Vienna, Austria.,Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Diseases, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
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Perneczky J, Neuchrist C, Sellner J. Rhinorrhea following SARS-CoV-2 nasopharyngeal swab: A case for β2-transferrin testing. Eur J Neurol 2021; 28:3552-3553. [PMID: 33900682 PMCID: PMC8239899 DOI: 10.1111/ene.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Julian Perneczky
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Csilla Neuchrist
- Department of Otorhinolaryngology, Head and Neck Surgery, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
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Sellner J, Sitte HH, Rommer PS. Targeting interleukin-6 to treat neuromyelitis optica spectrum disorders: Implications from immunology, the FcRn pathway and clinical experience. Drug Discov Today 2021; 26:1591-1601. [PMID: 33781948 DOI: 10.1016/j.drudis.2021.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/24/2021] [Accepted: 03/19/2021] [Indexed: 12/22/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare disease of the central nervous system (CNS) that is associated with poor outcomes for patients. Until recently, when complement inhibitors were approved, there was no approved therapy. Most recently, clinical trials of interleukin-6 (IL-6) blockade showed a therapeutic benefit for NMOSD. In this review, we introduce the immunological basis of IL-6 blockade in NMOSD and summarize current knowledge about the clinical use of the IL-6 receptor inhibitors tocilizumab and satralizumab. The aim of extending the half-life of monoclonal antibodies (mAbs) has been actualized by successful clinical translation for Satralizumab, achieved via the neonatal Fc receptor (FcRn) pathway. The basic principles of FcRn are highlighted in this review together with the potential therapeutic benefits of this emerging technology.
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Affiliation(s)
- Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Harald H Sitte
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University Vienna, Vienna, Austria
| | - Paulus S Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria; Neuroimmunological Section, Department of Neurology, University of Rostock, Rostock, Germany.
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43
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Gubanova K, Lang J, Latzko J, Novotna B, Perneczky J, Pingitzer S, Purer P, Wuchty B, Waiß C, Sellner J. Peripheral neuropathy due to neuroborreliosis: Insensitivity for CXCL13 as early diagnostic marker. Int J Infect Dis 2021; 105:460-462. [PMID: 33684563 DOI: 10.1016/j.ijid.2021.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/14/2021] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 11/19/2022] Open
Abstract
The case of a 69-year-old woman with peripheral neuropathy caused by Lyme neuroborreliosis (LNB) in an endemic region in Eastern Austria is reported. The patient had noticed transient numbness of her left leg. On initial examination, she had patchy sensory disturbances of the left lower leg, but ancillary examinations of nerve conduction and cerebrospinal fluid (CSF), including the B-cell chemokine CXCL13, were normal. A re-tap performed 54 days later, following clinical progression with foot drop, widespread lower leg paresthesia, and pain, revealed an increased cell count, autochthonous IgM production, synthesis of Borrelia-specific IgM, and elevated CXCL13. Neurophysiological examinations disclosed an incomplete conduction block, mixed axonal and demyelinating sensorimotor neuropathy, and subacute neurogenic damage of muscles innervated by the peroneal nerve. This case study presents rare evidence of very early diagnostic findings in peripheral neuropathy caused by LNB. These are characterized by insensitivity of CXCL13 in CSF to aid earlier diagnosis and the development of an intrathecal immune response against Borrelia at a later stage. These findings reinforce the need for a re-tap to confirm the diagnosis and facilitate appropriate treatment in this rare manifestation of LNB.
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Affiliation(s)
- Kristina Gubanova
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Julia Lang
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Juliane Latzko
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Bianka Novotna
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Julian Perneczky
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Stefan Pingitzer
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Petra Purer
- Institute for Hygiene and Microbiology, University Hospital of St Pölten, Karl Landsteiner University of Health Sciences, St Pölten, Austria
| | - Bianca Wuchty
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Christoph Waiß
- Department of Neurology, University Hospital of St Pölten, Karl Landsteiner University of Health Sciences, St Pölten, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria; Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, München, Germany; Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria.
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Sellner J, Rommer PS. Multiple Sclerosis and SARS-CoV-2 Vaccination: Considerations for Immune-Depleting Therapies. Vaccines (Basel) 2021; 9:vaccines9020099. [PMID: 33525459 PMCID: PMC7911298 DOI: 10.3390/vaccines9020099] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 01/06/2021] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/19/2022] Open
Abstract
Several concerns have been raised about the use of immunodepleting agents including alemtuzumab, cladribine and CD20-depleting antibodies in people with multiple sclerosis (pwMS) during the coronavirus disease (COVID) 2019 pandemic. As the end of the pandemic is not yet in sight, vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) may be an elegant strategy to overcome the potential hazards associated with initiating and continuing treatment with immune-depleting agents. In this review, we summarize the immunological effects of immune-depleting therapy and underlying considerations for the hitherto existing recommendations that suggest a restricted use of immune-deleting therapies during the pandemic. Moreover, we critically discuss open questions regarding vaccination in general and against SARS-CoV-2 in pwMS.
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Affiliation(s)
- Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, 2130 Mistelbach, Austria
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-2572-9004-12850; Fax: +43-2572-9004-49281
| | - Paulus S. Rommer
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
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45
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Baldini T, Asioli GM, Romoli M, Carvalho Dias M, Schulte EC, Hauer L, Aguiar De Sousa D, Sellner J, Zini A. Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis. Eur J Neurol 2021; 28:3478-3490. [PMID: 33426733 PMCID: PMC8014715 DOI: 10.1111/ene.14727] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [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: 11/13/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection predisposes patients to arterial and venous thrombosis. This study aimed to systematically review the available evidence in the literature for cerebral venous thrombosis (CVT) in association with coronavirus disease-2019 (COVID-19). METHODS We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases to identify cases of COVID-19-associated CVT. The search period spanned 1 January 2020 to 1 December 2020, and the review protocol (PROSPERO-CRD42020214327) followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Identified studies were evaluated for bias using the Newcastle-Ottawa scale. A proportion meta-analysis was performed to estimate the frequency of CVT among hospitalized COVID-19 patients. RESULTS We identified 57 cases from 28 reports. Study quality was mostly classified as low. CVT symptoms developed after respiratory disease in 90%, and the mean interval was 13 days. CVT involved multiple sites in 67% of individuals, the deep venous system was affected in 37%, and parenchymal hemorrhage was found in 42%. Predisposing factors for CVT beyond SARS-CoV-2 infection were present in 31%. In-hospital mortality was 40%. Using data from 34,331 patients, the estimated frequency of CVT among patients hospitalized for SARS-CoV-2 infection was 0.08% (95% confidence interval [CI]: 0.01-0.5). In an inpatient setting, CVT accounted for 4.2% of cerebrovascular disorders in individuals with COVID-19 (cohort of 406 patients, 95% CI: 1.47-11.39). CONCLUSIONS Cerebral venous thrombosis in the context of SARS-CoV-2 infection is a rare, although there seems to be an increased relative risk. High suspicion is necessary, because the diagnosis of this potentially life-threatening condition in COVID-19 patients can be challenging. Evidence is still scarce on the pathophysiology and potential prevention of COVID-19-associated CVT.
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Affiliation(s)
- Tommaso Baldini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
| | - Gian Maria Asioli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
| | - Michele Romoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy.,Neurology Clinic, University of Perugia-S. Maria della Misericordia Hospital, Perugia, Italy
| | - Mariana Carvalho Dias
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria/CHLN, University of Lisbon, Lisbon, Portugal
| | - Eva C Schulte
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Virology, Technical University of Munich, Munich, Germany
| | - Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Diana Aguiar De Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria/CHLN, University of Lisbon, Lisbon, Portugal
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
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Sellner J, M Jenkins T, J von Oertzen T, Bassetti CL, Beghi E, Bereczki D, Bodini B, Cavallieri F, Di Liberto G, Helbok R, Macerollo A, Maia LF, Oreja-Guevara C, Özturk S, Rakusa M, Sauerbier A, Soffietti R, Taba P, Pisani A, Priori A, Zedde M, Crean M, Burlica A, Twardzik A, Moro E. Primary prevention of COVID-19: Advocacy for vaccination from a neurological perspective. Eur J Neurol 2021; 28:3226-3229. [PMID: 33386655 DOI: 10.1111/ene.14713] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas M Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tim J von Oertzen
- Faculty of Medicine, Johannes-Kepler Universität, Linz, Austria.,Department of Neurology 1, Kepler Universitätsklinikum, Linz, Austria
| | - Claudio L Bassetti
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
| | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Benedetta Bodini
- Department of Neurology, Sorbonne University, Saint-Antoine Hospital, APHP, Paris, France
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Di Liberto
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Antonella Macerollo
- Walton Centre NHS Foundation Trust, Liverpool, UK.,School of Psychology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Luis F Maia
- Department of Neurology, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde Universidade do Porto, Porto, Portugal
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.,IdISSC, Madrid, Spain
| | - Serefnur Özturk
- Department of Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Martin Rakusa
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Anna Sauerbier
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Riccardo Soffietti
- Department of Neuroscience, Division of Neuro-Oncology, University of Turin, Turin, Italy
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alberto Priori
- Department of Neurology, Division of Neurology, 'Aldo Ravelli' Research Center, University of Milan and ASST Santi Paolo e Carlo, Milan, Italy
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michael Crean
- European Academy of Neurology (EAN) Headoffice, Vienna, Austria
| | - Anja Burlica
- European Academy of Neurology (EAN) Headoffice, Vienna, Austria
| | - Alex Twardzik
- European Academy of Neurology (EAN) Headoffice, Vienna, Austria
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble Institute of Neurosciences, Grenoble, France
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von Oertzen TJ, Macerollo A, Leone MA, Beghi E, Crean M, Oztuk S, Bassetti C, Twardzik A, Bereczki D, Di Liberto G, Helbok R, Oreja‐ Guevara C, Pisani A, Sauerbier A, Sellner J, Soffietti R, Zedde M, Bianchi E, Bodini B, Cavallieri F, Campiglio L, Maia LF, Priori A, Rakusa M, Taba P, Moro E, Jenkins TM. EAN consensus statement for management of patients with neurological diseases during the COVID-19 pandemic. Eur J Neurol 2021; 28:7-14. [PMID: 33058321 PMCID: PMC7675361 DOI: 10.1111/ene.14521] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE The recent SARS-CoV-2 pandemic has posed multiple challenges to the practice of clinical neurology including recognition of emerging neurological complications and management of coexistent neurological diseases. In a fast-evolving pandemic, evidence-based studies are lacking in many areas. This paper presents European Academy of Neurology (EAN) expert consensus statements to guide neurologists caring for patients with COVID-19. METHODS A refined Delphi methodology was applied. In round 1, statements were provided by EAN scientific panels (SPs). In round 2, these statements were circulated to SP members not involved in writing them, asking for agreement/disagreement. Items with agreement >70% were retained for round 3, in which SP co-chairs rated importance on a five-point Likert scale. Results were graded by importance and reported as consensus statements. RESULTS In round one, 70 statements were provided by 23 SPs. In round two, 259/1061 SP member responses were received. Fifty-nine statements obtained >70% agreement and were retained. In round three, responses were received from 55 co-chairs of 29 SPs. Whilst general recommendations related to prevention of COVID-19 transmission had high levels of agreement and importance, opinion was more varied concerning statements related to therapy. CONCLUSION This is the first structured consensus statement on good clinical practice in patients with neurological disease during the COVID-19 pandemic that provides immediate guidance for neurologists. In this fast-evolving pandemic, a rapid response using refined Delphi methodology is possible, but guidance may be subject to change as further evidence emerges.
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Affiliation(s)
- T. J. von Oertzen
- Faculty of MedicineJohannes‐Kepler UniversitätLinzAustria
- Department of Neurology 1Kepler UniversitätsklinikumLinzAustria
| | - A. Macerollo
- Walton Centre NHS Foundation TrustLiverpoolUK
- Faculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - M. A. Leone
- UO NeurologiaFondazione IRCCS 'Casa Sollievo della Sofferenza'San Giovanni RotondoItaly
| | - E. Beghi
- Department of NeuroscienceIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - M. Crean
- European Academy of NeurologyHead OfficeViennaAustria
| | - S. Oztuk
- Department of NeurologyFaculty of MedicineSelcuk UniversityKonyaTurkey
| | - C. Bassetti
- Department of NeurologyInselspitalUniversity of BernBernSwitzerland
| | - A. Twardzik
- European Academy of NeurologyHead OfficeViennaAustria
| | - D. Bereczki
- Department of NeurologySemmelweis UniversityBudapestHungary
| | - G. Di Liberto
- Department of Pathology and ImmunologyGeneva Faculty of MedicineGenevaSwitzerland
| | - R. Helbok
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - C. Oreja‐ Guevara
- Department of NeurologyHospital Clínico San CarlosMadridSpain
- Departamento de MedicinaFacultad de MedicinaUniversidad Complutense de Madrid (UCM)MadridSpain
- IdISSCMadridSpain
| | - A. Pisani
- NeurologyDepartment of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - A. Sauerbier
- Department of NeurologyUniversity Hospital CologneCologneGermany
| | - J. Sellner
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
- Department of NeurologyChristian Doppler Medical CenterParacelsus Medical UniversitySalzburgAustria
- Department of NeurologyKlinikum rechts der IsarTechnische Universität MünchenMünchenGermany
| | - R. Soffietti
- Division of Neuro‐OncologyDepartment of NeuroscienceUniversity of TurinTurinItaly
| | - M. Zedde
- Neurology UnitNeuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - E. Bianchi
- Department of NeuroscienceIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - B. Bodini
- Department of NeurologySaint‐Antoine HospitalAPHPSorbonne UniversityParisFrance
| | - F. Cavallieri
- Neurology UnitNeuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaReggio EmiliaItaly
| | - L. Campiglio
- Division of Neurology'Aldo Ravelli' Research CenterDepartment of NeurologyUniversity of Milan and ASST Santi Paolo e CarloMilanItaly
| | - L. F. Maia
- Department of NeurologyCentro Hospitalar Universitário do PortoPortoPortugal
| | - A. Priori
- Division of Neurology'Aldo Ravelli' Research CenterDepartment of NeurologyUniversity of Milan and ASST Santi Paolo e CarloMilanItaly
| | - M. Rakusa
- Department of NeurologyUniversity Medical Centre MariborMariborSlovenia
| | - P. Taba
- Department of Neurology and NeurosurgeryInstitute of Clinical MedicineUniversity of TartuTartuEstonia
| | - E. Moro
- Division of NeurologyCHU of GrenobleGrenoble Alpes UniversityGrenoble Institute of NeurosciencesGrenobleFrance
| | - T. M. Jenkins
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
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Berger T, Adamczyk-Sowa M, Csépány T, Fazekas F, Fabjan TH, Horáková D, Ledinek AH, Illes Z, Kobelt G, Jazbec SŠ, Klímová E, Leutmezer F, Rejdak K, Rozsa C, Sellner J, Selmaj K, Štouracˇ P, Szilasiová J, Turcˇáni P, Vachová M, Vanecková M, Vécsei L, Havrdová EK. Factors influencing daily treatment choices in multiple sclerosis: practice guidelines, biomarkers and burden of disease. Ther Adv Neurol Disord 2020; 13:1756286420975223. [PMID: 33335562 PMCID: PMC7724259 DOI: 10.1177/1756286420975223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/23/2020] [Indexed: 12/23/2022] Open
Abstract
At two meetings of a Central European board of multiple sclerosis (MS) experts in
2018 and 2019 factors influencing daily treatment choices in MS, especially
practice guidelines, biomarkers and burden of disease, were discussed. The
heterogeneity of MS and the complexity of the available treatment options call
for informed treatment choices. However, evidence from clinical trials is
generally lacking, particularly regarding sequencing, switches and escalation of
drugs. Also, there is a need to identify patients who require highly efficacious
treatment from the onset of their disease to prevent deterioration. The recently
published European Committee for the Treatment and Research in Multiple
Sclerosis/European Academy of Neurology clinical practice guidelines on
pharmacological management of MS cover aspects such as treatment efficacy,
response criteria, strategies to address suboptimal response and safety concerns
and are based on expert consensus statements. However, the recommendations
constitute an excellent framework that should be adapted to local regulations,
MS center capacities and infrastructure. Further, available and emerging
biomarkers for treatment guidance were discussed. Magnetic resonance imaging
parameters are deemed most reliable at present, even though complex assessment
including clinical evaluation and laboratory parameters besides imaging is
necessary in clinical routine. Neurofilament-light chain levels appear to
represent the current most promising non-imaging biomarker. Other immunological
data, including issues of immunosenescence, will play an increasingly important
role for future treatment algorithms. Cognitive impairment has been recognized
as a major contribution to MS disease burden. Regular evaluation of cognitive
function is recommended in MS patients, although no specific disease-modifying
treatment has been defined to date. Finally, systematic documentation of
real-life data is recognized as a great opportunity to tackle unresolved daily
routine challenges, such as use of sequential therapies, but requires joint
efforts across clinics, governments and pharmaceutical companies.
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Affiliation(s)
- Thomas Berger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Tünde Csépány
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Tanja Hojs Fabjan
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Dana Horáková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Zsolt Illes
- Department of Neurology, University of Southern Denmark, Odense, Denmark
| | | | - Saša Šega Jazbec
- Department of Neurology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Eleonóra Klímová
- Department of Neurology, University of Prešov and Teaching Hospital of J. A. Reiman, Prešov, Slovakia
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Csilla Rozsa
- Department of Neurology, Jahn Ferenc Dél-pesti Hospital, Budapest, Hungary
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria, and Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia-Mazury, Olsztyn, Poland
| | - Pavel Štouracˇ
- Department of Neurology, Masaryk University, Brno, Czech Republic
| | - Jarmila Szilasiová
- Department of Neurology, P. J. Šafárik University Košice and University Hospital of L. Pasteur Košice, Slovakia
| | - Peter Turcˇáni
- Department of Neurology, Comenius University, Bratislava, Slovakia
| | | | - Manuela Vanecková
- Department of Radiology, MRI Unit, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - László Vécsei
- Department of Neurology and MTA-SZTE Neuroscience Research Group, University of Szeged, Szeged, Hungary
| | - Eva Kubala Havrdová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Findling O, Sellner J. Second-generation immunotherapeutics in multiple sclerosis: can we discard their precursors? Drug Discov Today 2020; 26:416-428. [PMID: 33248250 DOI: 10.1016/j.drudis.2020.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/18/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022]
Abstract
Options for disease-modifying therapies in multiple sclerosis have increased over the past two decades. Among these innovations are interferon-β, glatiramer acetate, fumaric acid and dihydroorotate dehydrogenase inhibitors, an antibody targeting the migration of immune cells, a compound that traps immune cells in lymphoid organs by sphingosine 1-phosphate receptor (S1PR) modulation and immune-reconstitution therapies. Second-generation drugs such as pegylated interferon-β, advanced CD20 depleting antibodies, more-specific S1PR modulators and new formulations have been developed to achieve higher efficacy while exhibiting fewer side effects. In this review, we address the shortcomings of the parent drugs, present the pros and cons of the second-generation therapies and summarize upcoming developments in the field of immunotherapy for multiple sclerosis.
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Affiliation(s)
- Oliver Findling
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland; Department of Neurology, University Hospital Tulln, Karl-Landsteiner-University, Tulln, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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50
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Moser T, Schwenker K, Seiberl M, Feige J, Akgün K, Haschke-Becher E, Ziemssen T, Sellner J. Long-term peripheral immune cell profiling reveals further targets of oral cladribine in MS. Ann Clin Transl Neurol 2020; 7:2199-2212. [PMID: 33002321 PMCID: PMC7664268 DOI: 10.1002/acn3.51206] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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: 06/26/2020] [Revised: 08/04/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To expand the knowledge about the immunological consequences of cladribine (CLAD), a pulsed immune reconstitution therapy approved for active multiple sclerosis (MS), beyond the known short-term effects on peripheral immune cell subsets. METHODS In this study, we characterized depletion and restitution kinetics as well as cytokine profiles of peripheral immune cell subsets in 18 patients with MS following treatment with oral CLAD. The methods involved blood collection prior to CLAD and every three months over a period of 24 months, and extensive characterization of various immune cells subsets by multiparametric flow cytometry. RESULTS We found a selectivity of CLAD towards central memory T cells and memory B cells and detected a hyper-repopulation of maturing B cells. Counts of classical (-65%) and various nonclassical TH17 cells (-84% to -87%) were markedly reduced 24 months after treatment start, and were comparable with depletion rates of class-switched memory B-cell phenotypes (-87% to -95%). The nadir of TH cells was more pronounced in the second treatment year. We observed a proportional surge of CD20 T-cell subsets and an expansion of regulatory T, B and NK cells. Natural killer T cells (NKT) were only depleted in year two and did not recover. INTERPRETATION Peripheral immune cell profiling revealed more differentiated insights into the immunological effects of CLAD. While some immune cell subsets expanded, we also observed additive depleting effects after the second treatment course. Further studies are required to elucidate whether these changes are paramount for the consistent and prolonged disease-modifying effect of CLAD.
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Affiliation(s)
- Tobias Moser
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Multiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Michael Seiberl
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Julia Feige
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Katja Akgün
- Department of Neurology, Multiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | | | - Tjalf Ziemssen
- Department of Neurology, Multiple Sclerosis Center, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany.,Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
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