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Costa-Frossard França L, Meca Lallana V, Labiano-Fontcuberta A, Blasco R, Monreal E, Martínez Ginés ML, Aguirre C, Sabin Muñoz J, Sainz de la Maza S, Cuello JP, Díaz-Pérez C, Chico García JL, Lozano Ros A, Rodríguez Jorge F, Martínez Martínez S, García Domínguez JM. Real-World Retrospective Analysis of Alemtuzumab Outcomes in Relapsing-Remitting Multiple Sclerosis: The LEMCAM Study. CNS Drugs 2024; 38:231-238. [PMID: 38418770 PMCID: PMC10920415 DOI: 10.1007/s40263-024-01066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Alemtuzumab is a high-efficacy treatment approved for relapsing-remitting multiple sclerosis (RRMS). Although clinical trials and observational studies are consistent in showing its efficacy and manageable safety profile, further studies under clinical practice conditions are needed to further support its clinical use. OBJECTIVE The aim of this observational retrospective study was to evaluate the effectiveness and safety of alemtuzumab to add to the current real-world evidence on the drug. METHODS A cohort of 115 adult patients with RRMS treated with alemtuzumab between 2014 and 2020 was retrospectively followed up in five centers in Spain. Analysis included annualized relapse rate (ARR), 6-month confirmed disability worsening (CDW), 6-month confirmed disability improvement (CDI), radiological activity, no evidence of disease activity (NEDA-3), and safety signals. Given the different follow-up periods among participants, ARR was calculated using the person-years method. CDI was defined as a ≥ 1.0-point decrease in Expanded Disability Status Scale (EDSS) score assessed in patients with a baseline EDSS score ≥ 2.0 confirmed 6 months apart. CDW was defined as a ≥ 1.0-point increase in EDSS score assessed in patients with a baseline EDSS score ≥ 1.0 (≥ 1.5 if baseline EDSS = 0), confirmed 6 months apart. RESULTS ARR decreased from 1.9 (95% confidence interval 1.60-2.33) in the year prior to alemtuzumab initiation to 0.28 (0.17-0.37) after 1 year of treatment (87% reduction), and to 0.22 (0.13-0.35) after the second year. Over the entire follow-up period, ARR was 0.24 (0.18-0.30). At year 1, 75% of patients showed no signs of magnetic resonance imaging (MRI) activity and 70% at year 5. One percent of patients experienced 6-month CDW at year 1, 2.6% at year 2, 7.4% at year 3, and no patients over years 4 and 5. A total of 7.7% of patients achieved 6-month CDI in year 1, 3.6% in year 2, and maintained it at years 3 and 4. Most patients achieved annual NEDA-3: year 1, 72%; year 2, 79%; year 3, 80%; year 4, 89%; year 5, 75%. Infusion-related reactions were observed in 95% of patients and infections in 74%. Thyroid disorders occurred in 30% of patients, and only three patients developed immune thrombocytopenia. No cases of progressive multifocal leukoencephalopathy were reported. CONCLUSIONS This study shows that alemtuzumab reduced the relapse rate and disability worsening in real-world clinical practice, with many patients achieving and sustaining NEDA-3 over time. The safety profile of alemtuzumab was consistent with previous findings, and no new or unexpected safety signals were observed. As this was an observational and retrospective study, the main limitation of not having all variables comprehensively available for all patients should be considered when interpreting results.
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Affiliation(s)
| | - Virginia Meca Lallana
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Rosario Blasco
- Neuroimmunology Unit, Neurology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- IRYCIS (Ramón y Cajal Institute for Health Research), Madrid, Spain
- REEM (Spanish Network of Multiple Sclerosis), Universidad de Alcalá, Madrid, Spain
| | | | - Clara Aguirre
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | - Julia Sabin Muñoz
- Neuroimmunology Unit, Neurology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- IRYCIS (Ramón y Cajal Institute for Health Research), Madrid, Spain
- REEM (Spanish Network of Multiple Sclerosis), Universidad de Alcalá, Madrid, Spain
| | - Juan Pablo Cuello
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carolina Díaz-Pérez
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Alberto Lozano Ros
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Goicochea Briceño H, Higueras Y, Ruiz Pérez I, García Domínguez JM, Cuello JP, Meldaña Rivera A, Martínez Ginés ML. Spasticity-Plus syndrome in multiple sclerosis patients in a tertiary hospital in Spain. Front Neurol 2024; 15:1360032. [PMID: 38469589 PMCID: PMC10926473 DOI: 10.3389/fneur.2024.1360032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Spasticity is a common symptom in multiple sclerosis (MS) and it is often associated with other symptoms such as spasms/cramps and pain. The concept of Spasticity-Plus syndrome takes into account that spasticity is accompanied by one or more symptoms (spasms/cramps, pain, bladder dysfunction, sleep disorders, fatigue and/or tremor). As these symptoms share a common cannabinoid control, therapy acting on cannabinoid receptors may be useful. The main study objectives were to determine the number of MS patients who met Spasticity-Plus syndrome criteria and to identify the most common symptoms. Methods Clinical records of MS patients treated with nabiximols in a tertiary hospital from 2002 to 2022 were reviewed retrospectively. Results Of the 73 patients included in the study, 53.4% were women, and most had secondary progressive MS (64.4%). All patients met the criteria for Spasticity-Plus syndrome: 100% had spasticity and at least another symptom. Pain was the second most common symptom (91.8%), followed by spasms/cramps (79.4%), and fatigue (76.7%). Sleep disturbances (p < 0.0001) and tremor (p < 0.027) were more frequent in patients with relapsing-remitting MS than in patients with progressive MS. No statistically significant differences were found for spasticity, pain, spasms/cramps, and fatigue between MS phenotypes. Regarding symptoms clusters, 94.4% of the patients had three or more symptoms. Spasticity was more frequently associated with pain (91.8%) and spasms/cramps (79.4%). Conclusion Spasticity-Plus syndrome was present in all the study population of patients with different MS phenotypes, and treated with nabiximols.
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Affiliation(s)
| | - Yolanda Higueras
- Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Irene Ruiz Pérez
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Juan Pablo Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ariana Meldaña Rivera
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Cuello JP, Meldaña Rivera A, Monreal E, Gómez Lozano A, García Cano AM, García Domínguez JM, Fernández Velasco JI, Costa-Frossard França L, Goicochea H, Higueras Y, De León-Luis JA, Sainz De La Maza S, Villarrubia N, Arribas Gómez I, Ruiz Perez I, Martinez Ginés ML, Villar LM. Emerging biomarkers for improving pregnancy planning in multiple sclerosis. Front Neurol 2024; 15:1292296. [PMID: 38426179 PMCID: PMC10902912 DOI: 10.3389/fneur.2024.1292296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
Background Patient disability, relapse rate, and age are used for family planning in multiple sclerosis (MS). However, the need for more accurate biomarkers is widely recognized. We aimed to explore the influence of age on neurofilament light chain (sNfL), which reflects acute inflammation; glial fibrillary acidic protein (GFAP), associated with disability progression independent of relapses; and anti-Müllerian hormone (AMH), reflecting ovarian reserve, to provide a tailored family planning strategy. Methods This case-control study included 95 MS patients and 61 healthy control women (HCW). sNfL and GFAP levels were measured using a sensitive single-molecule array assay. AMH levels were measured by the automated Elecsys® Anti-Müllerian Hormone Assay. Results We observed no significant differences in AMH values between MS patients and the control group within any of the age-matched categories. Age exhibited a negative correlation with AMH values in both groups, as expected. Nevertheless, our findings suggest a slight tendency toward reduced ovarian reserve in MS patients (rho MS patients = -0.67, p < 0.0001; rho HCW = -0.43, p = 0.0006). Interestingly, among the 76 MS participants under 40 years old, we identified ten individuals (13.1%) with AMH levels below 0.7 ng/ml, indicative of a low ovarian reserve, and an additional six individuals (7.8%) with AMH levels between 0.7 ng/ml and 0.9 ng/ml, suggesting a potential risk of premature ovarian failure. Conversely, sNfL and GFAP levels in the MS group exhibited high variability but showed no significant association with age intervals. Conclusion We found no significant differences in AMH, sNfL or GFAP values between MS patients and the control group within any of the age-matched categories. The assessment of AMH, sNFL and GFAP levels at MS onset facilitates personalized therapeutic and family planning strategies for childbearing-age women.
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Affiliation(s)
- Juan Pablo Cuello
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Ana Gómez Lozano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Maria García Cano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - José Ignacio Fernández Velasco
- Department of Immunology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Lucienne Costa-Frossard França
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Haydee Goicochea
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Juan Antonio De León-Luis
- Health Research Institute Gregorio Marañón, Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Susana Sainz De La Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Noelia Villarrubia
- Department of Immunology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Ignacio Arribas Gómez
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Irene Ruiz Perez
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Luisa María Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
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Lafuente-Gómez G, Anaya-Fernández Lomana F, Gómez-Roldós A, García-Domínguez JM, Lozano-Ros A, Cuello JP, Higueras-Hernández Y, Meldaña-Rivera A, Goicochea-Briceño H, Leal-Hidalgo R, De Miguel-Sánchez de Puerta CJ, Martínez-Ginés ML. [Periodic plasmapheresis as maintenance treatment in relapsing-remitting multiple sclerosis, a new therapeutic line? A case report]. Rev Neurol 2022; 74:340-342. [PMID: 35548915 DOI: 10.33588/rn.7410.2021184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Relapsing-remitting multiple sclerosis (RRMS) treatment has significantly changed in recent years because of the discovery of new molecules that have shown efficacy as maintenance treatment. However, the classical treatment for acute attacks is based on corticosteroids administration, being the periodical plasmapheresis the alternative treatment in the case of refractory patients. We introduce a case of relapsing-remitting multiple sclerosis treated with a classical acute attacks therapy: plasmapheresis. CASE REPORT The case of a 39-year-old patient who was diagnosed with relapsing-remitting multiple sclerosis, postpartum debut and aggresive course, who, after suboptimal response to disease modifying therapies (alemtuzumab and ocrelizumab), receives combination treatment with outpatient periodic plasmapheresis every 3 weeks as maintenance therapy. Good tolerance and response. Clinical stability with this treatment. She has not required new hospital admissions for acute attacks of multiple sclerosis from February 2020 to March 2021. CONCLUSION Although more specific studies are needed, this case provides information on a potential new maintenance treatment for patients with relapsing-remitting multiple sclerosis refractory to disease-modifying drug therapies.
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Affiliation(s)
| | | | - A Gómez-Roldós
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - A Lozano-Ros
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J P Cuello
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | | | - R Leal-Hidalgo
- Hospital General Universitario Gregorio Marañón, Madrid, España
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Sánchez-Soblechero A, Cuello JP, Martínez Ginés ML, Lozano Ros A, Romero Delgado F, De Andrés C, Goicochea Briceño H, García Domínguez JM. Recurrent intracranial hemorrhage in a patient with relapsing multiple sclerosis under interferon-β therapy. Neurologia 2022; 37:77-79. [PMID: 33722454 DOI: 10.1016/j.nrl.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/12/2021] [Accepted: 02/07/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- A Sánchez-Soblechero
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - J P Cuello
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M L Martínez Ginés
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Lozano Ros
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Romero Delgado
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C De Andrés
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - H Goicochea Briceño
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J M García Domínguez
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Cuello JP, Martínez Ginés ML, García Domínguez JM, Tejeda-Velarde A, Lozano Ros A, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, Garcia-Tizon S, de León-Luis J, Medina Heras S, Fernández Velasco JI, Pérez-Pérez S, García-Martínez MÁ, Pardo-Rodríguez B, Domínguez-Mozo MI, García-Calvo E, Estévez H, Luque-García JL, Villar LM, Alvarez-Lafuente R. Short-chain fatty acids during pregnancy in multiple sclerosis: A prospective cohort study. Eur J Neurol 2021; 29:895-900. [PMID: 34662474 DOI: 10.1111/ene.15150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/07/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Short-chain fatty acids (SCFAs) can have pro- or anti-inflammatory properties, but their relationship with multiple sclerosis (MS) relapses during pregnancy remains unknown. This study aimed to explore SCFA profiles in MS patients during pregnancy and to assess their association with the appearance of relapses during pregnancy and postpartum. METHODS We prospectively included 53 pregnant MS patients and 21 healthy control women. Patients were evaluated during pregnancy and puerperium. SCFAs were measured by liquid chromatography-mass spectrometry. RESULTS Sixteen patients (32%) had relapses during pregnancy or puerperium, and 37 (68%) did not. All MS patients showed significant increases in acetate levels during pregnancy and the postpartum period compared to non-MS women. However, propionate and butyrate values were associated with disease activity. Their values were higher in nonrelapsing patients and remained similar to the control group in relapsing patients. The variable that best identified active patients was the propionate/acetate ratio. Ratios of <0.36 during the first trimester were associated with higher inflammatory activity (odds ratio = 165, 95% confidence interval = 10.2-239.4, p < 0.01). Most nonrelapsing patients showed values of >0.36, which were similar to those in healthy pregnant women. CONCLUSIONS Low propionate/acetate ratio values during the first trimester of gestation identified MS patients at risk of relapses during pregnancy and the postpartum period.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Silvia Pérez-Pérez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - María Ángel García-Martínez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - Beatriz Pardo-Rodríguez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - María Inmaculada Domínguez-Mozo
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - Estefanía García-Calvo
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | - Héctor Estévez
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | - Jose Luis Luque-García
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | | | - Roberto Alvarez-Lafuente
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
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Moreno-Torres I, Meca Lallana V, Costa-Frossard L, Oreja-Guevara C, Aguirre C, Alba Suárez EM, Gómez Moreno M, Borrega Canelo L, Sabín Muñoz J, Aladro Y, Cárcamo A, Rodríguez García E, Cuello JP, Monreal E, Sainz de la Maza S, Pérez Parra F, Valenzuela Rojas F, López de Silanes de Miguel C, Casanova I, Martínez Gines ML, Blasco R, Orviz García A, Villar-Guimerans LM, Fernández-Dono G, Elvira V, Santiuste C, Espiño M, García Domínguez JM. Risk and outcomes of COVID-19 in patients with multiple sclerosis. Eur J Neurol 2021; 28:3712-3721. [PMID: 34152073 PMCID: PMC8444942 DOI: 10.1111/ene.14990] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/30/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Background and purpose Limited information is available on incidence and outcomes of COVID‐19 in patients with multiple sclerosis (MS). This study investigated the risks of SARS‐CoV‐2 infection and COVID‐19‐related outcomes in patients with MS, and compared these with the general population. Methods A regional registry was created to collect data on incidence, hospitalization rates, intensive care unit admission, and death in patients with MS and COVID‐19. National government outcomes and seroprevalence data were used for comparison. The study was conducted at 14 specialist MS treatment centers in Madrid, Spain, between February and May 2020. Results Two‐hundred nineteen patients were included in the registry, 51 of whom were hospitalized with COVID‐19. The mean age ± standard deviation was 45.3 ± 12.4 years, and the mean duration of MS was 11.9 ± 8.9 years. The infection incidence rate was lower in patients with MS than the general population (adjusted incidence rate ratio = 0.78, 95% confidence interval [CI] = 0.70–0.80), but hospitalization rates were higher (relative risk = 5.03, 95% CI = 3.76–6.62). Disease severity was generally low, with only one admission to an intensive care unit and five deaths. Males with MS had higher incidence rates and risk of hospitalization than females. No association was found between the use of any disease‐modifying treatment and hospitalization risk. Conclusions Patients with MS do not appear to have greater risks of SARS‐CoV‐2 infection or severe COVID‐19 outcomes compared with the general population. The decision to start or continue disease‐modifying treatment should be based on a careful risk–benefit assessment.
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Affiliation(s)
- Irene Moreno-Torres
- Demyelinating Diseases Unit, Jiménez Diaz Foundation University Hospital, Madrid, Spain
| | | | | | - Celia Oreja-Guevara
- Department of Neurology, Department of Medicine, Faculty of Medicine, San Carlos Clinical Hospital, Complutense University of Madrid and San Carlos Institute for Health Research, Madrid, Spain
| | - Clara Aguirre
- Demyelinating Diseases Unit, La Princesa University Hospital, Madrid, Spain
| | | | | | | | - Julia Sabín Muñoz
- Neuroimmunology Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Yolanda Aladro
- Demyelinating Diseases Unit, University Hospital of Getafe, Madrid, Spain
| | - Alba Cárcamo
- Demyelinating Diseases Unit, University Hospital of Getafe, Madrid, Spain
| | | | - Juan Pablo Cuello
- Demyelinating Diseases Unit, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Enric Monreal
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - Rosario Blasco
- Neuroimmunology Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Aida Orviz García
- Demyelinating Diseases Unit, Jiménez Diaz Foundation University Hospital, Madrid, Spain
| | | | | | | | - Carmen Santiuste
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Mercedes Espiño
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
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Cuello JP, Martínez Ginés ML, Tejeda-Velarde A, Medina Heras S, García Domínguez JM, Fernández Velasco JI, Lozano Ros A, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, Garcia-Tizon Larroca S, De León-Luis J, de Andrés C, Álvarez Lafuente R, Villar LM. Cytokine profile during pregnancy predicts relapses during pregnancy and postpartum in multiple sclerosis. J Neurol Sci 2020; 414:116811. [DOI: 10.1016/j.jns.2020.116811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022]
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Vales Montero M, Mateo Sierra O, Romero Martínez J, Fortea Gil F, Fernández Carballal C, Cuello JP. Spinal epidural abscess caused by Streptococcus agalactiae in an immunocompetent patient. Med Clin (Barc) 2019; 153:290-292. [PMID: 31492449 DOI: 10.1016/j.medcli.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Streptococcus agalactiae is an uncommon microorganism that causes spinal epidural abscess (SEA) and usually affects individuals with a predisposing condition or potential source of infection. CASE DESCRIPTION We present the case of an immunocompetent 53-year-old patient with an unremarkable past medical history who developed progressive low extremity weakness, bowel and bladder dysfunction and genital sensory impairment. A neurological exam on admission revealed flaccid proximal paraparesis, T10 sensory level, atonic anal sphincter and normal myotatic reflexes. Urgent neuroimaging showed a large thoracic epidural spinal abscess. Laminectomy and abscess drainage were immediately performed and systemic antibiotic treatment was initiated. Abscess cultures revealed Streptococcus agalactiae. After an exhaustive workup no predisposing factors or local or systemic source for the infection were found. CONCLUSIONS We report a singular case of spinal epidural abscess caused by Streptococcus agalactiae in a healthy patient with no predisposing factors. This case also highlights the importance of an early diagnosis and treatment to obtain a better neurological outcome.
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Affiliation(s)
- Marta Vales Montero
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Olga Mateo Sierra
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Julia Romero Martínez
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Fernando Fortea Gil
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Juan Pablo Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Cuello JP, Salgado Cámara P, García Domínguez JM, Lozano Ros A, Mas Serrano M, Martínez Ginés ML. Pregnancy exposure to disease-modifying drugs in multiple sclerosis: a prospective study. Med Clin (Barc) 2019; 154:214-217. [PMID: 31420082 DOI: 10.1016/j.medcli.2019.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In multiple sclerosis (MS), foetal exposure to disease-modifying drugs (DMDs) carries varying degrees of risk. We sought to analyse the clinical and obstetric outcomes of MS patients (MSp) exposed to DMDs during pregnancy. PATIENTS AND METHODS Observational study. We analysed the clinical-obstetric data of a cohort MSp, who became pregnant between 2007-2017. They were prospectively followed up during pregnancy and postpartum. CONTROL GROUP healthy pregnant women (HPW) and MSp unexposed to DMDs. RESULTS Sixty-eight pregnancies in MSp. Fifty-six HPW. Thirteen MSp were exposed to DMDs during pregnancy. Obstetric outcome: 2 (15%) infants had low birth weight, no preterm deliveries. Fifty-five MSp were not exposed to DMDs: 22 (40%) discontinued DMD before pregnancy, 33(60%) naïve. Five infants (9%) had low birth weight and 7 (12%) were preterm. HPW: 56. Low birth weight 6 (11%), preterm delivery 6 (11%). There were no differences in relapse incidence during pregnancy-puerperium between MSp groups. There were no differences in birth weight, gestation time, delivery-caesarean section. We found no special obstetric morbidity in women exposed to DMDs. CONCLUSIONS There were no significant differences in the clinical and obstetric variables analysed between pregnant women exposed to DMDs, unexposed, and HPW.
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Affiliation(s)
- Juan Pablo Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Paula Salgado Cámara
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Alberto Lozano Ros
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Miguel Mas Serrano
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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11
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Cuello JP, Martínez Ginés ML, Kuhle J, García Domínguez JM, Lozano Ros A, Romero Delgado F, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, García-Tizon Larroca S, De León-Luis J, Michalak Z, Barro C, Álvarez Lafuente R, Medina Heras S, Fernández Velasco JI, Tejeda-Velarde A, Domínguez-Mozo MI, Muriel A, de Andrés C, Villar LM. Neurofilament light chain levels in pregnant multiple sclerosis patients: a prospective cohort study. Eur J Neurol 2019; 26:1200-1204. [PMID: 30977955 DOI: 10.1111/ene.13965] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Neurofilament light chain is a cytoskeletal protein of neurons. Its levels are increasingly recognized as measures of neuroaxonal damage. The aim of this study was to explore serum neurofilament light chain (sNfL) levels in multiple sclerosis (MS) patients and healthy controls during pregnancy and puerperium. METHODS This was a prospective, longitudinal, single-center study. sNfL concentration was assessed using a highly sensitive single-molecule array during pregnancy and in puerperium, in a cohort of 39 pregnant patients with relapsing multiple sclerosis (P-MS). Twenty-one healthy pregnant women (HPW) served as a control group. Eight P-MS suffered relapses during pregnancy (P-MS-R) in the first or second trimesters. RESULTS No differences in pregnancy and delivery data were observed between P-MS and HPW. P-MS showed higher sNfL values than HPW in the first trimester, independently of the presence (P = 0.002) or not (P = 0.02) of relapses during pregnancy. However, in the third trimester, only P-MS-R showed higher sNfL values than HPW (P = 0.001). These differences extended to the puerperium, where P-MS-R showed higher sNfL values than those with no relapses during gestation (P = 0.02). CONCLUSION These data strongly suggest that sNfL levels reflect MS activity during pregnancy. Additionally, the absence of relapses during pregnancy may have a beneficial effect on neurodegeneration during puerperium.
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Affiliation(s)
- J P Cuello
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | | | - J Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - A Lozano Ros
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - F Romero Delgado
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - Y Higueras
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - A Meldaña Rivera
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | | | | | - J De León-Luis
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - Z Michalak
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - C Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - R Álvarez Lafuente
- Grupo de Investigación de Esclerosis Múltiple, Instituto de investigación Sanitaria San Carlos (IdISSC)/Hospital Clínico San Carlos, Madrid, España
| | | | | | | | - M I Domínguez-Mozo
- Grupo de Investigación de Esclerosis Múltiple, Instituto de investigación Sanitaria San Carlos (IdISSC)/Hospital Clínico San Carlos, Madrid, España
| | - A Muriel
- Hospital Universitario Ramón y Cajal, Madrid, España
| | - C de Andrés
- Hospital General Universitario Gregrorio Marañón, Madrid, España
| | - L M Villar
- Hospital Universitario Ramón y Cajal, Madrid, España
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12
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Villarrubia N, Rodríguez-Martín E, Alari-Pahissa E, Aragón L, Castillo-Triviño T, Eixarch H, Ferrer JM, Martínez-Rodríguez JE, Massot M, Pinto-Medel MJ, Prada Á, Rodríguez-Acevedo B, Urbaneja P, Gascón-Gimenez F, Herrera G, Hernández-Clares R, Salgado MG, Oterino A, San Segundo D, Cuello JP, Gil-Herrera J, Cámara C, Gómez-Gutiérrez M, Martínez-Hernández E, Meca-Lallana V, Moga E, Muñoz-Calleja C, Querol L, Presas-Rodríguez S, Teniente-Serra A, Vlagea A, Muriel A, Roldán E, Villar LM. Multi-centre validation of a flow cytometry method to identify optimal responders to interferon-beta in multiple sclerosis. Clin Chim Acta 2018; 488:135-142. [PMID: 30408481 DOI: 10.1016/j.cca.2018.11.008] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/23/2018] [Accepted: 11/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Percentages of blood CD19+CD5+ B cells and CD8+perforin+ T lymphocytes can predict response to Interferon (IFN)-beta treatment in relapsing-remitting multiple sclerosis (RRMS) patients. We aimed to standardize their detection in a multicenter study, prior to their implementation in clinical practice. METHODS Fourteen hospitals participated in the study. A reference centre was established for comparison studies. Peripheral blood cells of 105 untreated RRMS patients were studied. Every sample was analyzed in duplicate in the participating centre and in the reference one by flow cytometry. When needed, participating centres corrected fluorescence compensations and negative cut-off position following reference centre suggestions. Concordance between results obtained by participating centres and by reference one was evaluated by intraclass correlation coefficients (ICC) and Spearman correlation test. Centre performance was measured by using z-scores values. RESULTS After results review and corrective actions implementation, overall ICC was 0.86 (CI: 0.81-0.91) for CD19+CD5+ B cell and 0.89 (CI: 0.85-0.93) for CD8+ perforin+ T cell quantification; Spearman r was 0.92 (0.89-0.95; p <0.0001) and 0.92 (0.88-0.95; p <0.0001) respectively. All centres obtained z-scores≤0.5 for both biomarkers. CONCLUSION Homogenous percentages of CD19+CD5+ B cells and CD8 perforin+ T lymphocytes can be obtained if suitable compensation values and negative cut-off are pre-established.
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Affiliation(s)
- Noelia Villarrubia
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Eulalia Rodríguez-Martín
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Elisenda Alari-Pahissa
- Immunology and Neurology Dpt., Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Carrer del Dr. Aiguader 88, 08003 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Larraitz Aragón
- Immunology and Neurology Dpt., Hospital Universitario de Donostia, Biodonostia, P° Dr. Beguiristain 107-111, 20014 San Sebastián, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Tamara Castillo-Triviño
- Immunology and Neurology Dpt., Hospital Universitario de Donostia, Biodonostia, P° Dr. Beguiristain 107-111, 20014 San Sebastián, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Herena Eixarch
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Joana María Ferrer
- Immunology and Neurology Dpt., Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears, IdISBa, Ctra. Valldemossa 79, Palma 07010, Spain
| | - José Enrique Martínez-Rodríguez
- Immunology and Neurology Dpt., Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Carrer del Dr. Aiguader 88, 08003 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Margarita Massot
- Immunology and Neurology Dpt., Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears, IdISBa, Ctra. Valldemossa 79, Palma 07010, Spain.
| | - María Jesús Pinto-Medel
- Clinical Management Unit of Neurosciences, Instituto de Biomedicina de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Plaza del Hospital Civil s/n., Málaga, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Álvaro Prada
- Immunology and Neurology Dpt., Hospital Universitario de Donostia, Biodonostia, P° Dr. Beguiristain 107-111, 20014 San Sebastián, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Patricia Urbaneja
- Clinical Management Unit of Neurosciences, Instituto de Biomedicina de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Plaza del Hospital Civil s/n., Málaga, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - Francisco Gascón-Gimenez
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Av. de Blasco Ibáñez 17, 46010 València, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - Guadalupe Herrera
- Flow Cytometry Unit, UCIM, INCLIVA-Universidad de Valencia, Avda Blasco Ibañez 13, 46010 València, Spain
| | - Rocío Hernández-Clares
- Immunology and Neurology Dpt., Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - María Gema Salgado
- Immunology and Neurology Dpt., Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Agustín Oterino
- Immunology and Neurology Dpt., IDIVAL, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla 25, 39008 Santander, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - David San Segundo
- Immunology and Neurology Dpt., IDIVAL, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla 25, 39008 Santander, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Juan Pablo Cuello
- Immunology and Neurology Dpt., Hospital General Universitario and Instituto de Investigación Sanitaria "Gregorio Marañón", C/ Dr Esquerdo 46, 28007 Madrid, Spain.
| | - Juana Gil-Herrera
- Immunology and Neurology Dpt., Hospital General Universitario and Instituto de Investigación Sanitaria "Gregorio Marañón", C/ Dr Esquerdo 46, 28007 Madrid, Spain.
| | - Carmen Cámara
- Immunology and Neurology Dpt., Hospital San Pedro de Alcántara, Avda. Pablo Naranjo s/n, 10003 Cáceres, Spain.
| | - Montserrat Gómez-Gutiérrez
- Immunology and Neurology Dpt., Hospital San Pedro de Alcántara, Avda. Pablo Naranjo s/n, 10003 Cáceres, Spain
| | - Eugenia Martínez-Hernández
- Immunology and Neurology Dpt., Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Virginia Meca-Lallana
- Immunology and Neurology Dpt., Instituto de Investigación Sanitaria La Princesa, IIS-IP, Demyelinating Diseases Unit, Hospital Universitario de La Princesa, C/ Diego de León 62, 28006 Madrid, Spain
| | - Esther Moga
- Immunology and Neurology Dpt., Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Sant Antoni Maria Claret 167, 08025 Barcelona, Ciberer, Madrid, Spain.
| | - Cecilia Muñoz-Calleja
- Immunology and Neurology Dpt., Instituto de Investigación Sanitaria La Princesa, IIS-IP, Demyelinating Diseases Unit, Hospital Universitario de La Princesa, C/ Diego de León 62, 28006 Madrid, Spain.
| | - Luis Querol
- Immunology and Neurology Dpt., Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Sant Antoni Maria Claret 167, 08025 Barcelona, Ciberer, Madrid, Spain.
| | - Silvia Presas-Rodríguez
- Immunology and Neurology Dpt., Multiple Sclerosis Unit, Hospital Universitario e Instituto de Investigación Germans Trias i Pujol, Campus Can Ruti, 08916 Badalona, Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - Aina Teniente-Serra
- Immunology and Neurology Dpt., Multiple Sclerosis Unit, Hospital Universitario e Instituto de Investigación Germans Trias i Pujol, Campus Can Ruti, 08916 Badalona, Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Alexandru Vlagea
- Immunology and Neurology Dpt., Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.
| | - Alfonso Muriel
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain.
| | - Ernesto Roldán
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Luisa María Villar
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
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Pastor AG, Otero FD, Navarro SG, Cuello JP, García PS, Arratibel AG, Mohedano AMI, Alen PV, Bullido YF, Osorio JAV, Nuñez AG. Vascular Imaging Before Intravenous Thrombolysis: Consequences of In-Hospital Delay in Applying Two Diagnostic Procedures. J Neuroimaging 2014; 25:397-402. [DOI: 10.1111/jon.12148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/14/2014] [Accepted: 04/26/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Andrés García Pastor
- Stroke Unit, Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - Fernando Díaz Otero
- Stroke Unit, Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - Silvia Gil Navarro
- Stroke Unit, Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - Juan Pablo Cuello
- Stroke Unit, Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - Pilar Sobrino García
- Stroke Unit, Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - Amaia García Arratibel
- Stroke Unit, Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | - Pilar Vázquez Alen
- Stroke Unit, Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | | | - Antonio Gil Nuñez
- Stroke Unit, Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
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14
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Muñoz González A, Cuello JP, Rodríguez Cruz PM, Iglesias Mohedano AM, Domínguez Rubio R, Romero Delgado F, García Pastor A, Guzmán de Villoria Lebiedziejswki J, Fernández García P, Romero Martínez J, Ezpeleta Echevarri D, Díaz Otero F, Vázquez Alen P, Villanueva Osorio JA, Gil Núñez A. Spontaneous spinal epidural haematoma: a retrospective study of a series of 13 cases. Neurologia 2014; 30:393-400. [PMID: 24839904 DOI: 10.1016/j.nrl.2014.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/26/2014] [Accepted: 03/10/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset. OBJECTIVE To describe a sample of patients with SSEH and analyse variables related to its functional prognosis. PATIENTS AND METHODS Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital. RESULTS We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset. CONCLUSIONS Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option.
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Affiliation(s)
- A Muñoz González
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - J P Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P M Rodríguez Cruz
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A M Iglesias Mohedano
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Domínguez Rubio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Romero Delgado
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A García Pastor
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - P Fernández García
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Romero Martínez
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - F Díaz Otero
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Vázquez Alen
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J A Villanueva Osorio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Gil Núñez
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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15
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Cuello JP, de Andrés de Frutos C, Villanueva Osorio JA, Guzmán de Villoria JA, Fernández García P, García Pastor A. Risa y llanto patológico autolimitado debido a un hematoma protuberancial en un paciente con enfermedad moyamoya. Rev Neurol 2010. [DOI: 10.33588/rn.5103.2010282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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