1
|
Meca-Lallana JE, Martínez Yélamos S, Eichau S, Llaneza MÁ, Martín Martínez J, Peña Martínez J, Meca Lallana V, Alonso Torres AM, Moral Torres E, Río J, Calles C, Ares Luque A, Ramió-Torrentà L, Marzo Sola ME, Prieto JM, Martínez Ginés ML, Arroyo R, Otano Martínez MÁ, Brieva Ruiz L, Gómez Gutiérrez M, Rodríguez-Antigüedad Zarranz A, Sánchez-Seco VG, Costa-Frossard L, Hernández Pérez MÁ, Landete Pascual L, González Platas M, Oreja-Guevara C. Consensus statement of the Spanish Society of Neurology on the treatment of multiple sclerosis and holistic patient management in 2023. Neurologia 2024; 39:196-208. [PMID: 38237804 DOI: 10.1016/j.nrleng.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 01/25/2024] Open
Abstract
The last consensus statement of the Spanish Society of Neurology's Demyelinating Diseases Study Group on the treatment of multiple sclerosis (MS) was issued in 2016. Although many of the positions taken remain valid, there have been significant changes in the management and treatment of MS, both due to the approval of new drugs with different action mechanisms and due to the evolution of previously fixed concepts. This has enabled new approaches to specific situations such as pregnancy and vaccination, and the inclusion of new variables in clinical decision-making, such as the early use of high-efficacy disease-modifying therapies (DMT), consideration of the patient's perspective, and the use of such novel technologies as remote monitoring. In the light of these changes, this updated consensus statement, developed according to the Delphi method, seeks to reflect the new paradigm in the management of patients with MS, based on the available scientific evidence and the clinical expertise of the participants. The most significant recommendations are that immunomodulatory DMT be started in patients with radiologically isolated syndrome with persistent radiological activity, that patient perspectives be considered, and that the term "lines of therapy" no longer be used in the classification of DMTs (> 90% consensus). Following diagnosis of MS, the first DMT should be selected according to the presence/absence of factors of poor prognosis (whether epidemiological, clinical, radiological, or biomarkers) for the occurrence of new relapses or progression of disability; high-efficacy DMTs may be considered from disease onset.
Collapse
Affiliation(s)
- J E Meca-Lallana
- Unidad de Neuroinmunología Clínica y CSUR Esclerosis Múltiple, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca)/Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, Universidad Católica San Antonio (UCAM), Murcia, Spain.
| | - S Martínez Yélamos
- Unidad de Esclerosis Múltiple «EMxarxa», Servicio de Neurología. H.U. de Bellvitge, IDIBELL, Departament de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain
| | - S Eichau
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M Á Llaneza
- Servicio de Neurología, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - J Martín Martínez
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - V Meca Lallana
- Servicio de Neurología, Hospital Universitario La Princesa, Madrid, Spain
| | - A M Alonso Torres
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - E Moral Torres
- Servicio de Neurología, Complejo Hospitalario y Universitario Moisès Broggi, Barcelona, Spain
| | - J Río
- Servicio de Neurología, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - C Calles
- Servicio de Neurología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - A Ares Luque
- Servicio de Neurología, Complejo Asistencial Universitario de León, León, Spain
| | - L Ramió-Torrentà
- Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial de Girona (UNIEMTG), Hospital Universitari Dr. Josep Trueta y Hospital Santa Caterina. Grupo Neurodegeneració i Neuroinflamació, IDIBGI. Departamento de Ciencias Médicas, Universidad de Girona, Girona, Spain
| | - M E Marzo Sola
- Servicio de Neurología, Hospital San Pedro, Logroño, Spain
| | - J M Prieto
- Servicio de Neurología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M L Martínez Ginés
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Arroyo
- Servicio de Neurología, Hospital Universitario Quirón Salud Madrid, Madrid, Spain
| | - M Á Otano Martínez
- Servicio de Neurología, Hospital Universitario de Navarra, Navarra, Spain
| | - L Brieva Ruiz
- Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida, Spain
| | - M Gómez Gutiérrez
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | - V G Sánchez-Seco
- Servicio de Neurología, Hospital Universitario de Toledo, Toledo, Spain
| | - L Costa-Frossard
- CSUR de Esclerosis Múltiple, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Á Hernández Pérez
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - L Landete Pascual
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - M González Platas
- Servicio de Neurología, Hospital Universitario de Canarias, La Laguna, Spain
| | - C Oreja-Guevara
- Departamento de Neurología, Hospital Clínico San Carlos, IdISSC, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| |
Collapse
|
2
|
Puig-Casadevall M, Álvarez-Bravo G, Varela AQ, Robles-Cedeño R, Sànchez Cirera L, Miguela A, Laguillo G, Montalban X, Hauser SL, Ramió-Torrentà L. Progressive multifocal leukoencephalopathy in a patient with relapsing multiple sclerosis treated with ocrelizumab: A case report. Eur J Neurol 2023; 30:3357-3361. [PMID: 37485841 DOI: 10.1111/ene.15988] [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: 04/25/2023] [Revised: 06/03/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy is a rare but often fatal complication of some multiple sclerosis treatments. Although it has mainly been associated with natalizumab treatment, its appearance with other immunosuppressive therapies has also been reported. AIMS The aim of this case report is to describe the development of progressive multifocal encephalopathy in a patient with relapsing-remitting multiple sclerosis treated with ocrelizumab without previous use of natalizumab. CONCLUSIONS A summary of the presentation and disease course is provided, presented in the context of the current literature and likely pathophysiology.
Collapse
Affiliation(s)
- Marc Puig-Casadevall
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Salt, Spain
| | - Gary Álvarez-Bravo
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Salt, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Ana Quiroga Varela
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Instituto de Salud Carlos III, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Madrid, Spain
| | - René Robles-Cedeño
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Salt, Spain
- Instituto de Salud Carlos III, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Madrid, Spain
- Medical Sciences Department, University of Girona, Girona, Spain
| | | | - Albert Miguela
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Instituto de Salud Carlos III, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Madrid, Spain
| | - Gemma Laguillo
- Radiology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco, California, USA
| | - Lluis Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Salt, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Instituto de Salud Carlos III, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Madrid, Spain
- Medical Sciences Department, University of Girona, Girona, Spain
- Neurology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| |
Collapse
|
3
|
Martín-Aguilar L, Presas-Rodriguez S, Rovira À, Capellades J, Massuet-Vilamajó A, Ramió-Torrentà L, Tintoré M, Brieva-Ruiz L, Moral E, Cano-Orgaz A, Blanco Y, Batlle-Nadal J, Carmona O, Gea M, Hervás-García J, Ramo-Tello C. Gadolinium-enhanced brain lesions in multiple sclerosis relapse. Neurología (English Edition) 2022; 37:557-563. [DOI: 10.1016/j.nrleng.2021.10.005] [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] [Received: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 10/14/2022] Open
|
4
|
Contreras-Rodriguez O, Arnoriaga-Rodríguez M, Miranda-Olivos R, Blasco G, Biarnés C, Puig J, Rivera-Pinto J, Calle ML, Pérez-Brocal V, Moya A, Coll C, Ramió-Torrentà L, Soriano-Mas C, Fernandez-Real JM. Obesity status and obesity-associated gut dysbiosis effects on hypothalamic structural covariance. Int J Obes (Lond) 2022; 46:30-38. [PMID: 34471225 PMCID: PMC8748191 DOI: 10.1038/s41366-021-00953-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional connectivity alterations in the lateral and medial hypothalamic networks have been associated with the development and maintenance of obesity, but the possible impact on the structural properties of these networks remains largely unexplored. Also, obesity-related gut dysbiosis may delineate specific hypothalamic alterations within obese conditions. We aim to assess the effects of obesity, and obesity and gut-dysbiosis on the structural covariance differences in hypothalamic networks, executive functioning, and depressive symptoms. METHODS Medial (MH) and lateral (LH) hypothalamic structural covariance alterations were identified in 57 subjects with obesity compared to 47 subjects without obesity. Gut dysbiosis in the subjects with obesity was defined by the presence of high (n = 28) and low (n = 29) values in a BMI-associated microbial signature, and posthoc comparisons between these groups were used as a proxy to explore the role of obesity-related gut dysbiosis on the hypothalamic measurements, executive function, and depressive symptoms. RESULTS Structural covariance alterations between the MH and the striatum, lateral prefrontal, cingulate, insula, and temporal cortices are congruent with previously functional connectivity disruptions in obesity conditions. MH structural covariance decreases encompassed postcentral parietal cortices in the subjects with obesity and gut-dysbiosis, but increases with subcortical nuclei involved in the coding food-related hedonic information in the subjects with obesity without gut-dysbiosis. Alterations for the structural covariance of the LH in the subjects with obesity and gut-dysbiosis encompassed increases with frontolimbic networks, but decreases with the lateral orbitofrontal cortex in the subjects with obesity without gut-dysbiosis. Subjects with obesity and gut dysbiosis showed higher executive dysfunction and depressive symptoms. CONCLUSIONS Obesity-related gut dysbiosis is linked to specific structural covariance alterations in hypothalamic networks relevant to the integration of somatic-visceral information, and emotion regulation.
Collapse
Affiliation(s)
- O Contreras-Rodriguez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, and CIBERSam-17 and CIBERObn (CB06/03/0034), Barcelona, Spain.
- Department of Radiology-Medical Imaging (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain.
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Health Institute Carlos III (ISCIII), Barcelona, Spain.
| | - M Arnoriaga-Rodríguez
- Health Institute Carlos III (ISCIII), Barcelona, Spain
- Department of Diabetes, Endocrinology and Nutrition-UDEN, and CIBERObn (CB06/03/0010), Girona, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - R Miranda-Olivos
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, and CIBERSam-17 and CIBERObn (CB06/03/0034), Barcelona, Spain
| | - G Blasco
- Department of Radiology-Medical Imaging (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - C Biarnés
- Department of Radiology-Medical Imaging (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - J Puig
- Department of Radiology-Medical Imaging (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - J Rivera-Pinto
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- Biosciences Department, Faculty of Sciences and Technology, University of Vic-Central University of Catalonia, VIC, Badalona, Spain
| | - M L Calle
- Biosciences Department, Faculty of Sciences and Technology, University of Vic-Central University of Catalonia, VIC, Badalona, Spain
| | - V Pérez-Brocal
- Department of Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain, and CIBEResp- CB06/02/0050, Madrid, Spain
| | - A Moya
- Department of Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO-Public Health), Valencia, Spain, and CIBEResp- CB06/02/0050, Madrid, Spain
- Institute for Integrative Systems Biology (I2SysBio), The University of Valencia and The Spanish National Research Council (CSIC-UVEG), Valencia, Spain
| | - C Coll
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Girona Biomedical Research Institute (IdIBGi), Dr. Josep Trueta University Hospital, Girona, Spain
| | - L Ramió-Torrentà
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Girona Biomedical Research Institute (IdIBGi), Dr. Josep Trueta University Hospital, Girona, Spain
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, and CIBERSam-17 and CIBERObn (CB06/03/0034), Barcelona, Spain
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Fernandez-Real
- Health Institute Carlos III (ISCIII), Barcelona, Spain.
- Department of Diabetes, Endocrinology and Nutrition-UDEN, and CIBERObn (CB06/03/0010), Girona, Spain.
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.
| |
Collapse
|
5
|
Aliaga-Gaspar P, Hurtado-Guerrero I, Ciano-Petersen NL, Urbaneja P, Brichette-Mieg I, Reyes V, Rodriguez-Bada JL, Alvarez-Lafuente R, Arroyo R, Quintana E, Ramió-Torrentà L, Alonso A, Leyva L, Fernández O, Oliver-Martos B. Soluble Receptor Isoform of IFN-Beta (sIFNAR2) in Multiple Sclerosis Patients and Their Association With the Clinical Response to IFN-Beta Treatment. Front Immunol 2021; 12:778204. [PMID: 34975865 PMCID: PMC8716373 DOI: 10.3389/fimmu.2021.778204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Interferon beta receptor 2 subunit (IFNAR2) can be produced as a transmembrane protein, but also as a soluble form (sIFNAR2) generated by alternative splicing or proteolytic cleavage, which has both agonist and antagonist activities for IFN-β. However, its role regarding the clinical response to IFN-β for relapsing-remitting multiple sclerosis (RRMS) is unknown. We aim to evaluate the in vitro short-term effects and after 6 and 12 months of IFN-β therapy on sIFNAR2 production and their association with the clinical response in MS patients. Methods Ninety-four RRMS patients were included and evaluated at baseline, 6 and 12 months from treatment onset. A subset of 41 patients were classified as responders and non-responders to IFN-β therapy. sIFNAR2 serum levels were measured by ELISA. mRNA expression for IFNAR1, IFNAR2 splice variants, MxA and proteases were assessed by RT-PCR. The short-term effect was evaluated in PBMC from RRMS patients after IFN-β stimulation in vitro. Results Protein and mRNA levels of sIFNAR2 increased after IFN-β treatment. According to the clinical response, only non-responders increased sIFNAR2 significantly at both protein and mRNA levels. sIFNAR2 gene expression correlated with the transmembrane isoform expression and was 2.3-fold higher. While MxA gene expression increased significantly after treatment, IFNAR1 and IFNAR2 only slightly increased. After short-term IFN-β in vitro induction of PBMC, 6/7 patients increased the sIFNAR2 expression. Conclusions IFN-β administration induces the production of sIFNAR2 in RRMS and higher levels might be associated to the reduction of therapeutic response. Thus, levels of sIFNAR2 could be monitored to optimize an effective response to IFN-β therapy.
Collapse
Affiliation(s)
- Pablo Aliaga-Gaspar
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
- Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Isaac Hurtado-Guerrero
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
- Neuroinflammation Unit, Biotech Research and Innovation Centre (BRIC), Faculty of Health and Medical Sciences, Copenhagen Biocentre, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Lundahl Ciano-Petersen
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-Reca), Málaga, Spain
| | - Patricia Urbaneja
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-Reca), Málaga, Spain
| | - Isabel Brichette-Mieg
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Virginia Reyes
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-Reca), Málaga, Spain
| | - Jose Luis Rodriguez-Bada
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Roberto Alvarez-Lafuente
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Rafael Arroyo
- Servicio de Neurología, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Ester Quintana
- Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
- Servicio de Neurología, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Lluis Ramió-Torrentà
- Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
- Servicio de Neurología, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Medical Sciences Department, University of Girona, Girona, Spain
| | - Ana Alonso
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-Reca), Málaga, Spain
| | - Laura Leyva
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Oscar Fernández
- Departmento de Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
- *Correspondence: Begoña Oliver-Martos, ; Oscar Fernández,
| | - Begoña Oliver-Martos
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Gestión Clínica (UGC) Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-Reca), Málaga, Spain
- Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
- Departamento de Biología Celular, Genética y Fisiología, Área de Fisiología, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- *Correspondence: Begoña Oliver-Martos, ; Oscar Fernández,
| |
Collapse
|
6
|
Walo-Delgado PE, Monreal E, Medina S, Quintana E, Sainz de la Maza S, Fernández-Velasco JI, Lapuente P, Comabella M, Ramió-Torrentà L, Montalban X, Midaglia L, Villarrubia N, Carrasco-Sayalero A, Rodríguez-Martín E, Roldán E, Meca-Lallana J, Alvarez-Lafuente R, Masjuan J, Costa-Frossard L, Villar LM. Role of B Cell Profile for Predicting Secondary Autoimmunity in Patients Treated With Alemtuzumab. Front Immunol 2021; 12:760546. [PMID: 34691084 PMCID: PMC8531491 DOI: 10.3389/fimmu.2021.760546] [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: 08/18/2021] [Accepted: 09/21/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To explore if baseline blood lymphocyte profile could identify relapsing remitting multiple sclerosis (RRMS) patients at higher risk of developing secondary autoimmune adverse events (AIAEs) after alemtuzumab treatment. Methods Multicenter prospective study including 57 RRMS patients treated with alemtuzumab followed for 3.25 [3.5-4.21] years, (median [interquartile range]). Blood samples were collected at baseline, and leukocyte subsets determined by flow cytometry. We had additional samples one year after the first cycle of alemtuzumab treatment in 39 cases. Results Twenty-two patients (38.6%) developed AIAEs during follow-up. They had higher B-cell percentages at baseline (p=0.0014), being differences mainly due to plasmablasts/plasma cells (PB/PC, p=0.0011). Those with no AIAEs had higher percentages of CD4+ T cells (p=0.013), mainly due to terminally differentiated (TD) (p=0.034) and effector memory (EM) (p=0.031) phenotypes. AIAEs- patients also showed higher values of TNF-alpha-producing CD8+ T cells (p=0.029). The percentage of PB/PC was the best variable to differentiate both groups of patients. Baseline values >0.10% closely associated with higher AIAE risk (Odds ratio [OR]: 5.91, 95% CI: 1.83-19.10, p=0.004). When excluding the 12 patients with natalizumab, which decreases blood PB/PC percentages, being the last treatment before alemtuzumab, baseline PB/PC >0.1% even predicted more accurately the risk of AIAEs (OR: 11.67, 95% CI: 2.62-51.89, p=0.0007). The AIAEs+ group continued having high percentages of PB/PC after a year of alemtuzumab treatment (p=0.0058). Conclusions A PB/PC percentage <0.1% at baseline identifies MS patients at low risk of secondary autoimmunity during alemtuzumab treatment.
Collapse
Affiliation(s)
- Paulette Esperanza Walo-Delgado
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Enric Monreal
- Department of Neurology, Ramón y Cajal University Hospital, IRYCIS, Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Silvia Medina
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Ester Quintana
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Neurodegeneration and Neuroinflammation Research Group, Biomedical Research Institute (IDIBGI), Red Española de Esclerosis Múltiple (REEM), Girona, Spain
| | - Susana Sainz de la Maza
- Department of Neurology, Ramón y Cajal University Hospital, IRYCIS, Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - José Ignacio Fernández-Velasco
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Paloma Lapuente
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Lluis Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Neurodegeneration and Neuroinflammation Research Group, Biomedical Research Institute (IDIBGI), Red Española de Esclerosis Múltiple (REEM), Girona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Noelia Villarrubia
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Angela Carrasco-Sayalero
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Eulalia Rodríguez-Martín
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Ernesto Roldán
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - José Meca-Lallana
- Department of Neurology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Roberto Alvarez-Lafuente
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Clínico San Carlos, Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Jaime Masjuan
- Department of Neurology, Ramón y Cajal University Hospital, IRYCIS, Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Lucienne Costa-Frossard
- Department of Neurology, Ramón y Cajal University Hospital, IRYCIS, Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Luisa Maria Villar
- Department of Immunology, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| |
Collapse
|
7
|
Meca-Lallana JE, Oreja-Guevara C, Muñoz D, Olascoaga J, Pato A, Ramió-Torrentà L, Meca-Lallana V, Hernández MA, Marzo ME, Álvarez- Cermeño JC, Rodríguez-Antigüedad A, Montalbán X, Fernández O. Four-year safety and effectiveness data from patients with multiple sclerosis treated with fingolimod: The Spanish GILENYA registry. PLoS One 2021; 16:e0258437. [PMID: 34644366 PMCID: PMC8513911 DOI: 10.1371/journal.pone.0258437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To describe the profile of patients with multiple sclerosis (MS) treated with fingolimod in Spain and to assess the effectiveness and safety of fingolimod after 4 years of inclusion in the Spanish Gilenya Registry. Methods An observational, retrospective/prospective, multicenter case registry, including all patients with relapsing-remitting MS (RRMS) starting treatment with fingolimod in 43 centers in Spain. Analyses were performed in the overall population and in subgroups according to prior disease-modifying therapy (DMT): glatiramer acetate/interferon beta-1 (BRACE), natalizumab, other treatment, or naïve. Results Six hundred and sixty-six evaluable patients were included (91.1% previously treated with at least one DMT). The mean annualized relapse rate (ARR) prior to fingolimod was 1.12, and the mean EDSS at fingolimod initiation was 3.03. Fingolimod reduced the ARR by 71.4%, 75%, 75.5%, and 80.3%, after 1, 2, 3 and 4 years, respectively (p<0.001). This significant reduction in the ARR continued to be observed in all subgroups. After 4 years, the EDSS showed a minimal deterioration, with the EDSS scores from year 1 to year 4 remaining mostly stable. The percentage of patients without T1 Gd+ lesions progressively increased from 45.6% during the year prior to fingolimod initiation to 88.2% at year 4. The proportion of patients free from new/enlarged T2 lesions after 4 years of fingolimod treatment was 80.3%. This trend in both radiological measures was also observed in the subgroups. Adverse events (AEs) were experienced by up to 41.6% of patients (most commonly: lymphopenia [12.5%] and urinary tract infection [3.7%]). Most AEs were mild in severity, 3.6% of patients had serious AEs. Conclusions The patient profile was similar to other observational studies. The results obtained from the long-term use of fingolimod showed that it was effective, regardless of prior DMT, and it had adequate safety results, with a positive benefit-risk balance.
Collapse
Affiliation(s)
- J. E. Meca-Lallana
- Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - C. Oreja-Guevara
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - D. Muñoz
- Neurology Department, Hospital Xeral de Vigo, Vigo, Spain
| | - J. Olascoaga
- Neurology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - A. Pato
- Neurology Department, Hospital Povisa, Vigo, Spain
| | - L. Ramió-Torrentà
- Neurology Department, Hospital Universitari de Girona Dr. Josep Trueta, IDIBGI; Medical Sciences Department, University of Girona, Girona, Spain
| | - V. Meca-Lallana
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - M. A. Hernández
- Neurology Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - X. Montalbán
- Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - O. Fernández
- Department of Pharmacology, Faculty of Medicine, Universidad de Málaga; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- * E-mail:
| | | |
Collapse
|
8
|
Arnoriaga-Rodríguez M, Mayneris-Perxachs J, Coll C, Pérez-Brocal V, Ricart W, Moya A, Ramió-Torrentà L, Pamplona R, Jové M, Portero-Otin M, Fernández-Real JM. Subjects with detectable Saccharomyces cerevisiae in the gut microbiota show deficits in attention and executive function. J Intern Med 2021; 290:740-743. [PMID: 34051000 DOI: 10.1111/joim.13307] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M Arnoriaga-Rodríguez
- From the, Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain.,Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain.,Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain.,Department of Medical Sciences, Faculty of Medicine, Girona University, Girona, Spain
| | - J Mayneris-Perxachs
- From the, Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain.,Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain.,Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - C Coll
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Girona, Spain
| | - V Pérez-Brocal
- Department of Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of València Region (FISABIO-Public Health), València, Spain.,Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - W Ricart
- From the, Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain.,Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain.,Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain.,Department of Medical Sciences, Faculty of Medicine, Girona University, Girona, Spain
| | - A Moya
- Department of Genomics and Health, Foundation for the Promotion of Health and Biomedical Research of València Region (FISABIO-Public Health), València, Spain.,Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Institute for Integrative Systems Biology (I2SysBio), University of Valencia and Spanish National Research Council (CSIC), València, Spain
| | - L Ramió-Torrentà
- Department of Medical Sciences, Faculty of Medicine, Girona University, Girona, Spain.,Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Neurodegeneration and Neuroinflammation Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
| | - R Pamplona
- Metabolic Pathophysiology Research Group, Lleida Biomedical Research Institute (IRBLleida)-University of Lleida, Lleida, Spain
| | - M Jové
- Metabolic Pathophysiology Research Group, Lleida Biomedical Research Institute (IRBLleida)-University of Lleida, Lleida, Spain
| | - M Portero-Otin
- Metabolic Pathophysiology Research Group, Lleida Biomedical Research Institute (IRBLleida)-University of Lleida, Lleida, Spain
| | - J M Fernández-Real
- From the, Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain.,Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain.,Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain.,Department of Medical Sciences, Faculty of Medicine, Girona University, Girona, Spain
| |
Collapse
|
9
|
Pérez-Miralles FC, Prefasi D, García-Merino A, Ara JR, Izquierdo G, Meca-Lallana V, Gascón-Giménez F, Martínez-Ginés ML, Ramió-Torrentà L, Costa-Frossard L, Fernández Ó, Moreno-García S, Maurino J, Carreres-Polo J, Casanova B. Brain region volumes and their relationship with disability progression and cognitive function in primary progressive multiple sclerosis. Brain Behav 2021; 11:e02044. [PMID: 33486890 PMCID: PMC8035443 DOI: 10.1002/brb3.2044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/04/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND PURPOSE Evidence on regional changes resulting from neurodegenerative processes underlying primary progressive multiple sclerosis (PPMS) is still limited. We assessed brain region volumes and their relationship with disability progression and cognitive function in PPMS patients. METHODS This was an MRI analysis of 43 patients from the prospective Understanding Primary Progressive Multiple Sclerosis (UPPMS) cohort study. MRI scans were performed within 3 months before enrollment and at month 12. RESULTS Gray matter volume of declive and white matter volumes adjacent to left straight gyrus, right calcarine sulcus, and right inferior occipital gyrus significantly decreased from baseline to month 12. Baseline white matter volumes adjacent to right amygdala and left cuneus significantly differed between patients with and without disability progression, as well as baseline gray matter volumes of left cuneus, right parahippocampal gyrus, right insula, left superior frontal gyrus, declive, right inferior temporal gyrus, right superior temporal gyrus (pole), and right calcarine sulcus. Baseline gray matter volumes of right cuneus and right superior temporal gyrus positively correlated with 12-month Selective Reminding Test and Word List Generation performance, respectively. Gray matter changes in right superior semilunar lobe and white matter adjacent to left declive and right cerebellar tonsil also positively correlated with Word List Generation scores, while white matter change in left inferior semilunar lobe positively correlated with Symbol Digit Modalities Test performance after 12 months. CONCLUSIONS White and gray matter volumes of specific brain regions could predict disability progression and cognitive performance of PPMS patients after one year.
Collapse
Affiliation(s)
| | | | - Antonio García-Merino
- Department of Neurology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - José Ramón Ara
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Guillermo Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | - Lluis Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari Josep Trueta and Hospital Santa Caterina, IDIBGI, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | | | - Óscar Fernández
- Department of Neurology, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Sara Moreno-García
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Maurino
- Department of Medical, Roche Farma S.A, Madrid, Spain
| | - Joan Carreres-Polo
- Department of Radiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
10
|
Pérez-Miralles F, Prefasi D, García-Merino A, Ara JR, Izquierdo G, Meca-Lallana V, Gascón-Giménez F, Martínez-Ginés ML, Ramió-Torrentà L, Costa-Frossard L, Fernández Ó, Moreno-García S, Medrano N, Maurino J, Casanova B. Short-term data on disease activity, cognition, mood, stigma and employment outcomes in a cohort of patients with primary progressive multiple sclerosis (UPPMS study). Mult Scler Relat Disord 2021; 50:102860. [PMID: 33647591 DOI: 10.1016/j.msard.2021.102860] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/20/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary progressive multiple sclerosis (PPMS) has long been defined by progressive disability accrual in the absence of initial relapses. However, its underlying neurodegenerative process seems to be accompanied by central nervous system inflammation. A new classification defined multiple sclerosis courses according to clinical/radiological activity and progression. We provide further insight into PPMS activity according to this classification and other daily living aspects. METHODS This was a multicentre, prospective, cohort study including 55 adult patients with PPMS according to 2010 McDonald criteria, within ten years from neurologic symptom onset and not receiving disease-modifying therapies during the past six months, who were followed up for 12 months. The primary study endpoint was the percentage of patients with active disease based on clinical relapses and/or magnetic resonance activity. Disability progression, cognitive function, physical/psychological impact, depression symptoms, stigma and employment were secondary endpoints. RESULTS Eleven (25.6%) patients exhibited multiple sclerosis activity throughout the 12-month study follow-up. Fourteen showed non-active multiple sclerosis without progression, 11 non-active multiple sclerosis with progression, 6 active multiple sclerosis without progression and 4 active multiple sclerosis with progression; one patient with disease activity was not assessable for progression. Cognitive function scores remained unchanged or increased, disease physical impact was maintained and disease psychological impact significantly decreased. The proportion of patients with depression symptoms or stigma remained without significant changes as well as employment outcomes. CONCLUSION This study shows that one-fourth of PPMS patients may exhibit disease activity over one year, with disability progression in approximately one-third but without worsening of cognitive function, disease impact, depression, stigma or employment outcomes.
Collapse
Affiliation(s)
- Francisco Pérez-Miralles
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - Daniel Prefasi
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Antonio García-Merino
- Neurology Department, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda Spain
| | - José Ramón Ara
- Neurology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Guillermo Izquierdo
- Neurology Department, Hospital Universitario Virgen Macarena, Calle Dr Fedriani, 3, 41009 Seville, Spain
| | - Virginia Meca-Lallana
- Neurology Department, Hospital Universitario La Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain
| | - Francisco Gascón-Giménez
- Neurology Department, Hospital Clínico Universitario de Valencia, Avenida de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - María Luisa Martínez-Ginés
- Neurology Department, Hospital Universitario Gregorio Marañón, Calle del Dr Esquerdo, 46, 28007 Madrid, Spain
| | - Lluis Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Hospital Universitari Josep Trueta and Hospital Santa Caterina, Avenida de Francia, S/N, 17007 Girona, Spain. IDIBGI Calle Dr. Castany s/n, Salt, 17190 Spain. Medical Sciences Department, Faculty of Medicine, University of Girona, Plaça Sant Domènec, 3 17400 Girona, Spain
| | - Lucienne Costa-Frossard
- Neurology Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo km 9.100, 28034 Madrid, Spain
| | - Óscar Fernández
- Neurology Department, Hospital Regional Universitario Carlos Haya, Avenida de Carlos Haya, 84, 29010 Málaga, Spain
| | - Sara Moreno-García
- Neurology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba, S/N, 28041 Madrid, Spain
| | - Nicolás Medrano
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| |
Collapse
|
11
|
Toboso I, Tejeda-Velarde A, Alvarez-Lafuente R, Arroyo R, Hegen H, Deisenhammer F, Sainz de la Maza S, Alvarez-Cermeño JC, Izquierdo G, Paramo D, Oliva P, Casanova B, Agüera-Morales E, Franciotta D, Gastaldi M, Fernández O, Urbaneja P, Garcia-Dominguez JM, Romero F, Laroni A, Uccelli A, Perez-Sempere A, Saiz A, Blanco Y, Galimberti D, Scarpini E, Espejo C, Montalban X, Rasche L, Paul F, González I, Álvarez E, Ramo C, Caminero AB, Aladro Y, Calles C, Eguía P, Belenguer-Benavides A, Ramió-Torrentà L, Quintana E, Martínez-Rodríguez JE, Oterino A, López de Silanes C, Casanova LI, Landete L, Frederiksen J, Bsteh G, Mulero P, Comabella M, Hernández MA, Espiño M, Prieto JM, Pérez D, Otano M, Padilla F, García-Merino JA, Navarro L, Muriel A, Frossard LC, Villar LM. New Algorithms Improving PML Risk Stratification in MS Patients Treated With Natalizumab. Front Neurol 2020; 11:579438. [PMID: 33408681 PMCID: PMC7780851 DOI: 10.3389/fneur.2020.579438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 12/22/2022] Open
Abstract
Overview: We assessed the role of age and disease activity as new factors contributing to establish the risk of progressive multifocal leucoencephalopathy in multiple sclerosis patients treated with natalizumab in 36 University Hospitals in Europe. We performed the study in 1,307 multiple sclerosis patients (70.8% anti-John Cunninghan virus positive antibodies) treated with natalizumab for a median time of 3.28 years. Epidemiological, clinical, and laboratory variables were collected. Lipid-specific IgM oligoclonal band status was available in 277 patients. Factors associated with progressive multifocal leucoencephalopathy onset were explored by uni- and multivariate logistic regression. Results: Thirty-five patients developed progressive multifocal leucoencephalopathy. The multivariate analysis identified anti-John Cunninghan virus antibody indices and relapse rate as the best predictors for the onset of this serious opportunistic infection in the whole cohort. They allowed to stratify progressive multifocal leucoencephalopathy risk before natalizumab initiation in individual patients [area under the curve (AUC) = 0.85]. The risk ranged from <1/3,300 in patients with anti-John Cunninghan virus antibody indices <0.9 and relapse rate >0.5, to 1/50 in the opposite case. In patients with lipid-specific IgM oligoclonal bands assessment, age at natalizumab onset, anti-John Cunninghan virus antibody indices, and lipid-specific IgM oligoclonal band status predicted progressive multifocal leucoencephalopathy risk (AUC = 0.92). The absence of lipid-specific IgM oligoclonal bands was the best individual predictor (OR = 40.94). The individual risk ranged from <1/10,000 in patients younger than 45 years at natalizumab initiation, who showed anti John Cunningham virus antibody indices <0.9 and lipid-specific IgM oligoclonal bands to 1/33 in the opposite case. Conclusions: In a perspective of personalized medicine, disease activity, anti-lipid specific IgM oligoclonal bands, anti Jonh Cunninghan virus antibody levels, and age can help tailor natalizumab therapy in multiple sclerosis patients, as predictors of progressive multifocal leucoencephalopathy.
Collapse
Affiliation(s)
- Inmaculada Toboso
- Immunology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | - Roberto Alvarez-Lafuente
- Instituto de Investigación Sanitaria San Carlos (IDISSC), Hospital Clinico San Carlos, Madrid, Spain
| | - Rafael Arroyo
- Department of Neurology, Hospital Universitario Quiron Salud, Madrid, Spain
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | | - Guillermo Izquierdo
- Neurology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Dolores Paramo
- Neurology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Pedro Oliva
- Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Diego Franciotta
- Istituti di Recovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Istituti di Recovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Oscar Fernández
- Neurology Department, Hospital Regional Universitario, Malaga, Spain
| | - Patricia Urbaneja
- Neurology Department, Hospital Regional Universitario, Malaga, Spain
| | | | - Fernando Romero
- Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alicia Laroni
- University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Uccelli
- University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | - Angel Perez-Sempere
- Neurology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Albert Saiz
- Neurology Service, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Neurology Service, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Daniela Galimberti
- Centro Dino Ferrari, Fondazione Ca' Granda, Istituti di Recovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico, University of Milan, Milan, Italy
| | - Elio Scarpini
- Centro Dino Ferrari, Fondazione Ca' Granda, Istituti di Recovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico, University of Milan, Milan, Italy
| | - Carmen Espejo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ludwig Rasche
- Department of Neurology, NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- Department of Neurology, NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Inés González
- Neurology Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Elena Álvarez
- Neurology Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Cristina Ramo
- Neurology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ana B Caminero
- Neurology Department, Hospital Nuestra Señora de Sonsoles, Avila, Spain
| | - Yolanda Aladro
- Neurology Department, Hospital Universitario Getafe, Getafe, Spain
| | - Carmen Calles
- Neurology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pablo Eguía
- Neurology Department, Hospital Doctor Jose Molina Orosa, Arrecife, Spain
| | | | | | - Ester Quintana
- Neurology Department, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | | | - Agustín Oterino
- Neurology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Luis I Casanova
- Neurology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain
| | - Lamberto Landete
- Neurology Department, Hospital Universitario Dr. Peset, Valencia, Spain
| | | | - Gabriel Bsteh
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Patricia Mulero
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel A Hernández
- Neurology Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Mercedes Espiño
- Immunology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - José M Prieto
- Neurology Department, Hospital Clínico de Santiago, Santiago de Compostela, Spain
| | - Domingo Pérez
- Neurology Department, Hospital del Bierzo, Ponferrada, Spain
| | - María Otano
- Neurology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - Laura Navarro
- Neurology Department, Hospital General de Elche, Elche, Spain
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Univesitario Ramon y Cajal, Instituto Ramon y Cajal para la Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | - Luisa M Villar
- Immunology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| |
Collapse
|
12
|
Pérez-Miralles F, Prefasi D, García-Merino A, Ara JR, Izquierdo G, Meca-Lallana V, Gascón F, Martínez-Ginés ML, Ramió-Torrentà L, Costa-Frossard L, Fernández Ó, Moreno-García S, Maurino J, Casanova-Estruch B. Perception of stigma in patients with primary progressive multiple sclerosis. Mult Scler J Exp Transl Clin 2019; 5:2055217319852717. [PMID: 31205741 PMCID: PMC6537064 DOI: 10.1177/2055217319852717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/14/2019] [Accepted: 04/20/2019] [Indexed: 11/17/2022] Open
Abstract
Stigma associated with neurological disorders may contribute to a poor health-related quality of life. However, limited information is available in primary progressive multiple sclerosis. We investigated the presence and impact of stigma in patients with primary progressive multiple sclerosis. A non-interventional, cross-sectional study was conducted. A total of 55 primary progressive multiple sclerosis patients were studied (mean age 55.8±9.5 years, 56.4% male). The median Expanded Disability Status Scale score was 5.5 (4.0-6.5). Stigma prevalence was 78.2% (n=43). Twenty-four patients (43.6%) were classified as depressed. Scores on the eight-item Stigma Scale for Chronic Illness correlated with physical (rho=0.464, p<0.001) and psychological (rho=0.358, p=0.007) 29-item Multiple Sclerosis Impact Scale subscores. Stigma predicted concurrent depression (odds ratio=1.13; p=0.046). Stigma was highly prevalent with a detrimental effect on quality of life and mood in primary progressive multiple sclerosis.
Collapse
Affiliation(s)
- Francisco Pérez-Miralles
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - José R Ara
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Francisco Gascón
- Department of Neurology, Hospital Clínico Universitario, Valencia, Spain
| | | | - Lluis Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari Josep Trueta, IDIBGI, University of Girona, Girona, Spain
| | | | - Óscar Fernández
- Institute of Biomedical Research (IBIMA), Hospital Regional Universitario, Málaga, Spain
| | - Sara Moreno-García
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | |
Collapse
|
13
|
Hervás-García JV, Ramió-Torrentà L, Brieva-Ruiz L, Batllé-Nadal J, Moral E, Blanco Y, Cano-Orgaz A, Presas-Rodríguez S, Torres F, Capellades J, Ramo-Tello C. Comparison of two high doses of oral methylprednisolone for multiple sclerosis relapses: a pilot, multicentre, randomized, double-blind, non-inferiority trial. Eur J Neurol 2018; 26:525-532. [PMID: 30351511 DOI: 10.1111/ene.13851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/18/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Oral or intravenous methylprednisolone (≥500 mg/day for 5 days) is recommended for multiple sclerosis (MS) relapses. Nonetheless, the optimal dose remains uncertain. We compared clinical and radiological effectiveness, safety and quality of life (QoL) of oral methylprednisolone [1250 mg/day (standard high dose)] versus 625 mg/day (lesser high dose), both for 3 days] in MS relapses. METHODS A total of 49 patients with moderate to severe MS relapse within the previous 15 days were randomized in a pilot, double-blind, multicentre, non-inferiority trial (ClinicalTrial.gov, NCT01986998). The primary endpoint was non-inferiority of the lesser high dose by Expanded Disability Status Scale (EDSS) score improvement on day 30 (non-inferiority margin, 1 point). The secondary endpoints were EDSS score change on days 7 and 90, changes in T1 gadolinium-enhanced and new/enlarged T2 lesions on days 7 and 30, and safety and QoL results. RESULTS The primary outcome was achieved [mean (95% confidence interval) EDSS score difference, -0.26 (-0.7 to 0.18) at 30 days (P = 0.246)]. The standard high dose yielded a superior EDSS score improvement on day 7 (P = 0.028). No differences were observed in EDSS score on day 90 (P = 0.352) or in the number of T1 gadolinium-enhanced or new/enlarged T2 lesions on day 7 (P = 0.401, 0.347) or day 30 (P = 0.349, 0.529). Safety and QoL were good at both doses. CONCLUSIONS A lesser high-dose oral methylprednisolone regimen may not be inferior to the standard high dose in terms of clinical and radiological response.
Collapse
Affiliation(s)
- J V Hervás-García
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
| | - L Ramió-Torrentà
- Neurology Department, Hospital Doctor Josep Trueta, Girona, Spain
| | - L Brieva-Ruiz
- Neurology Department, Hospital Arnau Vilanova, Lleida, Spain
| | - J Batllé-Nadal
- Neurology Department, Xarxa Sanitaria i Social Santa Tecla, Tarragona, Spain
| | - E Moral
- Neurology Department, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Y Blanco
- Institut Biomedical Research August-Pi-Sunyer, Hospital Clinic, Barcelona, Spain
| | - A Cano-Orgaz
- Neurology Department, Hospital Mataro, Mataro, Spain
| | - S Presas-Rodríguez
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
| | - F Torres
- Institut Biomedical Research August-Pi-Sunyer, Hospital Clinic, Barcelona, Spain
| | - J Capellades
- Neuroradiology department, Hospital Mar, Barcelona, Spain
| | - C Ramo-Tello
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
| |
Collapse
|
14
|
Rodríguez M, Blasco G, Coll C, Ricart W, Puig J, Garre-Olmo J, Gich J, Ramió-Torrentà L, Fernández-Real J. Cognitive function in obese subjects. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
15
|
Quintana E, Coll C, Salavedra-Pont J, Muñoz-San Martín M, Robles-Cedeño R, Tomàs-Roig J, Buxó M, Matute-Blanch C, Villar LM, Montalban X, Comabella M, Perkal H, Gich J, Ramió-Torrentà L. Cognitive impairment in early stages of multiple sclerosis is associated with high cerebrospinal fluid levels of chitinase 3-like 1 and neurofilament light chain. Eur J Neurol 2018; 25:1189-1191. [DOI: 10.1111/ene.13687] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- E. Quintana
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
- Red Española de Esclerosis Múltiple (REEM); Madrid
- Medical Sciences Department; Faculty of Medicine; University of Girona; Girona
| | - C. Coll
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
| | - J. Salavedra-Pont
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
| | - M. Muñoz-San Martín
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
| | - R. Robles-Cedeño
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
- Red Española de Esclerosis Múltiple (REEM); Madrid
- Medical Sciences Department; Faculty of Medicine; University of Girona; Girona
| | - J. Tomàs-Roig
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
| | - M. Buxó
- Girona Biomedical Research Institute (IDIBGI); Girona
| | - C. Matute-Blanch
- Servei de Neurologia-Neuroimmunologia; Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitari Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona
| | - L. M. Villar
- Red Española de Esclerosis Múltiple (REEM); Madrid
- Immunology Department; IRYCIS; Hospital Ramón y Cajal; Madrid Spain
| | - X. Montalban
- Red Española de Esclerosis Múltiple (REEM); Madrid
- Servei de Neurologia-Neuroimmunologia; Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitari Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona
| | - M. Comabella
- Red Española de Esclerosis Múltiple (REEM); Madrid
- Servei de Neurologia-Neuroimmunologia; Centre d'Esclerosi Múltiple de Catalunya (Cemcat); Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitari Vall d'Hebron; Universitat Autònoma de Barcelona; Barcelona
| | - H. Perkal
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
| | - J. Gich
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
- Medical Sciences Department; Faculty of Medicine; University of Girona; Girona
| | - L. Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit [Girona Biomedical Research Institute] IDIBGI; Neurology Department; Dr. Josep Trueta University Hospital; Girona Spain
- Red Española de Esclerosis Múltiple (REEM); Madrid
- Medical Sciences Department; Faculty of Medicine; University of Girona; Girona
| |
Collapse
|
16
|
Ramió-Torrentà L, Álvarez-Cermeño J, Arroyo R, Casanova-Estruch B, Fernández O, García-Merino J, Hernández M, Izquierdo G, Martínez-Yélamos S, Meca J, Moral E, Olascoaga J, Prieto J, Saiz A. A guide to treating gait impairment with prolonged-release fampridine (Fampyra ® ) in patients with multiple sclerosis. Neurología (English Edition) 2018. [DOI: 10.1016/j.nrleng.2015.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
17
|
Sepúlveda M, Armangué T, Sola-Valls N, Arrambide G, Meca-Lallana JE, Oreja-Guevara C, Mendibe M, Alvarez de Arcaya A, Aladro Y, Casanova B, Olascoaga J, Jiménez-Huete A, Fernández-Fournier M, Ramió-Torrentà L, Cobo-Calvo A, Viñals M, de Andrés C, Meca-Lallana V, Cervelló A, Calles C, Rubio MB, Ramo-Tello C, Caminero A, Munteis E, Antigüedad AR, Blanco Y, Villoslada P, Montalban X, Graus F, Saiz A. Neuromyelitis optica spectrum disorders: Comparison according to the phenotype and serostatus. Neurol Neuroimmunol Neuroinflamm 2016; 3:e225. [PMID: 27144216 PMCID: PMC4841645 DOI: 10.1212/nxi.0000000000000225] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/24/2016] [Indexed: 12/20/2022]
Abstract
Objective: To (1) determine the value of the recently proposed criteria of neuromyelitis optica (NMO) spectrum disorder (NMOSD) that unify patients with NMO and those with limited forms (NMO/LF) with aquaporin-4 immunoglobulin G (AQP4-IgG) antibodies; and (2) investigate the clinical significance of the serologic status in patients with NMO. Methods: This was a retrospective, multicenter study of 181 patients fulfilling the 2006 NMO criteria (n = 127) or NMO/LF criteria with AQP4-IgG (n = 54). AQP4-IgG and myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) antibodies were tested using cell-based assays. Results: Patients were mainly white (86%) and female (ratio 6.5:1) with median age at onset 39 years (range 10–77). Compared to patients with NMO and AQP4-IgG (n = 94), those with NMO/LF presented more often with longitudinally extensive transverse myelitis (LETM) (p < 0.001), and had lower relapse rates (p = 0.015), but similar disability outcomes. Nonwhite ethnicity and optic neuritis presentation doubled the risk for developing NMO compared with white race (p = 0.008) or LETM presentation (p = 0.008). Nonwhite race (hazard ratio [HR] 4.3, 95% confidence interval [CI] 1.4–13.6) and older age at onset were associated with worse outcome (for every 10-year increase, HR 1.7, 95% CI 1.3–2.2). Patients with NMO and MOG-IgG (n = 9) had lower female:male ratio (0.8:1) and better disability outcome than AQP4-IgG-seropositive or double-seronegative patients (p < 0.001). Conclusions: In patients with AQP4-IgG, the similar outcomes regardless of the clinical phenotype support the unified term NMOSD; nonwhite ethnicity and older age at onset are associated with worse outcome. Double-seronegative and AQP4-IgG-seropositive NMO have a similar clinical outcome. The better prognosis of patients with MOG-IgG and NMO suggests that phenotypic and serologic classification is useful.
Collapse
Affiliation(s)
| | - Thaís Armangué
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | - Mar Mendibe
- Authors' affiliations are listed at the end of the article
| | | | - Yolanda Aladro
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | | | | | | | | | | | | | - Carmen Calles
- Authors' affiliations are listed at the end of the article
| | | | | | - Ana Caminero
- Authors' affiliations are listed at the end of the article
| | - Elvira Munteis
- Authors' affiliations are listed at the end of the article
| | | | - Yolanda Blanco
- Authors' affiliations are listed at the end of the article
| | | | | | - Francesc Graus
- Authors' affiliations are listed at the end of the article
| | - Albert Saiz
- Authors' affiliations are listed at the end of the article
| |
Collapse
|
18
|
Valverde S, Oliver A, Díez Y, Cabezas M, Vilanova JC, Ramió-Torrentà L, Rovira À, Lladó X. Evaluating the effects of white matter multiple sclerosis lesions on the volume estimation of 6 brain tissue segmentation methods. AJNR Am J Neuroradiol 2015; 36:1109-15. [PMID: 25678478 DOI: 10.3174/ajnr.a4262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/20/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The accuracy of automatic tissue segmentation methods can be affected by the presence of hypointense white matter lesions during the tissue segmentation process. Our aim was to evaluate the impact of MS white matter lesions on the brain tissue measurements of 6 well-known segmentation techniques. These include straightforward techniques such as Artificial Neural Network and fuzzy C-means as well as more advanced techniques such as the Fuzzy And Noise Tolerant Adaptive Segmentation Method, fMRI of the Brain Automated Segmentation Tool, SPM5, and SPM8. MATERIALS AND METHODS Thirty T1-weighted images from patients with MS from 3 different scanners were segmented twice, first including white matter lesions and then masking the lesions before segmentation and relabeling as WM afterward. The differences in total tissue volume and tissue volume outside the lesion regions were computed between the images by using the 2 methodologies. RESULTS Total gray matter volume was overestimated by all methods when lesion volume increased. The tissue volume outside the lesion regions was also affected by white matter lesions with differences up to 20 cm(3) on images with a high lesion load (≈50 cm(3)). SPM8 and Fuzzy And Noise Tolerant Adaptive Segmentation Method were the methods less influenced by white matter lesions, whereas the effect of white matter lesions was more prominent on fuzzy C-means and the fMRI of the Brain Automated Segmentation Tool. CONCLUSIONS Although lesions were removed after segmentation to avoid their impact on tissue segmentation, the methods still overestimated GM tissue in most cases. This finding is especially relevant because on images with high lesion load, this bias will most likely distort actual tissue atrophy measurements.
Collapse
Affiliation(s)
- S Valverde
- From the Computer Vision and Robotics Group (S.V., A.O., Y.D., X.L.), University of Girona, Campus Montilivi, Girona, Spain
| | - A Oliver
- From the Computer Vision and Robotics Group (S.V., A.O., Y.D., X.L.), University of Girona, Campus Montilivi, Girona, Spain
| | - Y Díez
- From the Computer Vision and Robotics Group (S.V., A.O., Y.D., X.L.), University of Girona, Campus Montilivi, Girona, Spain
| | - M Cabezas
- Magnetic Resonance Unit (M.C., A.R.), Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J C Vilanova
- Girona Magnetic Resonance Center (J.C.V.), Girona, Spain
| | - L Ramió-Torrentà
- Multiple Sclerosis and Neuroimmunology Unit (L.R.-T.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - À Rovira
- Magnetic Resonance Unit (M.C., A.R.), Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - X Lladó
- From the Computer Vision and Robotics Group (S.V., A.O., Y.D., X.L.), University of Girona, Campus Montilivi, Girona, Spain
| |
Collapse
|
19
|
Villar LM, Costa-Frossard L, Masterman T, Fernandez O, Montalban X, Casanova B, Izquierdo G, Coret F, Tumani H, Saiz A, Arroyo R, Fink K, Leyva L, Espejo C, Simó-Castelló M, García-Sánchez MI, Lauda F, Llufriú S, Álvarez-Lafuente R, Olascoaga J, Prada A, Oterino A, de Andrés C, Tintoré M, Ramió-Torrentà L, Rodríguez-Martín E, Picón C, Comabella M, Quintana E, Agüera E, Díaz S, Fernandez-Bolaños R, García-Merino JA, Landete L, Menéndez-González M, Navarro L, Pérez D, Sánchez-López F, Serrano-Castro PJ, Tuñón A, Espiño M, Muriel A, Bar-Or A, Álvarez-Cermeño JC. Lipid-specific immunoglobulin M bands in cerebrospinal fluid are associated with a reduced risk of developing progressive multifocal leukoencephalopathy during treatment with natalizumab. Ann Neurol 2015; 77:447-57. [PMID: 25581547 DOI: 10.1002/ana.24345] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/16/2014] [Accepted: 12/24/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Luisa M. Villar
- Department of Immunology; Ramón y Cajal University Hospital, Institute Ramon y Cajal for Biomedical Research; Madrid Spain
- Spanish Network for the Research in Multiple Sclerosis; Spain
| | - Lucienne Costa-Frossard
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Ramon y Cajal University Hospital; Institute Ramon y Cajal for Biomedical Research; Madrid Spain
| | - Thomas Masterman
- Department of Clinical Neuroscience; Karolinska Institute; Karolinska University Hospital; Huddinge Sweden
| | - Oscar Fernandez
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Regional University Hospital of Malaga; Malaga Spain
| | - Xavier Montalban
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology-Neuroimmunology; Catalunya Center for Multiple Sclerosis; Vall d'Hebron Institute of Research; Vall d'Hebron University Hospital; Autonomous University of Barcelona; Barcelona Spain
| | - Bonaventura Casanova
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; La Fe University Hospital; Valencia Spain
| | - Guillermo Izquierdo
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Virgen Macarena University Hospital; Seville Spain
| | - Francisco Coret
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Clinic University Hospital of Valencia; Valencia Spain
| | | | - Albert Saiz
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Clinic Hospital and Institute August Pi i Sunyer for Biomedical Research of; University of Barcelona; Barcelona Spain
| | - Rafael Arroyo
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; San Carlos Clinic University Hospital; Institute for Biomedical Research of San Carlos Clinic University Hospital; Madrid Spain
| | - Katharina Fink
- Department of Clinical Neuroscience; Karolinska Institute; Karolinska University Hospital; Huddinge Sweden
| | - Laura Leyva
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Regional University Hospital of Malaga; Malaga Spain
| | - Carmen Espejo
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology-Neuroimmunology; Catalunya Center for Multiple Sclerosis; Vall d'Hebron Institute of Research; Vall d'Hebron University Hospital; Autonomous University of Barcelona; Barcelona Spain
| | - María Simó-Castelló
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; La Fe University Hospital; Valencia Spain
| | - María I. García-Sánchez
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Virgen Macarena University Hospital; Seville Spain
| | - Florian Lauda
- Department of Neurology; University of Ulm; Ulm Germany
| | - Sara Llufriú
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Clinic Hospital and Institute August Pi i Sunyer for Biomedical Research of; University of Barcelona; Barcelona Spain
| | - Roberto Álvarez-Lafuente
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; San Carlos Clinic University Hospital; Institute for Biomedical Research of San Carlos Clinic University Hospital; Madrid Spain
| | - Javier Olascoaga
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Donostia University Hospital; San Sebastián Spain
| | - Alvaro Prada
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Immunology; Donostia University Hospital; San Sebastián Spain
| | - Agustín Oterino
- Department of Neurology; Marqués de Valdecilla University Hospital; Santander Spain
| | - Clara de Andrés
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Gregorio Marañón University Hospital; Madrid Spain
| | - Mar Tintoré
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology-Neuroimmunology; Catalunya Center for Multiple Sclerosis; Vall d'Hebron Institute of Research; Vall d'Hebron University Hospital; Autonomous University of Barcelona; Barcelona Spain
| | - Lluis Ramió-Torrentà
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Doctor Josep Trueta University Hospital; Institute for Biomedical Research of Girona; Girona Spain
| | - Eulalia Rodríguez-Martín
- Department of Immunology; Ramón y Cajal University Hospital, Institute Ramon y Cajal for Biomedical Research; Madrid Spain
- Spanish Network for the Research in Multiple Sclerosis; Spain
| | - Carmen Picón
- Department of Immunology; Ramón y Cajal University Hospital, Institute Ramon y Cajal for Biomedical Research; Madrid Spain
- Spanish Network for the Research in Multiple Sclerosis; Spain
| | - Manuel Comabella
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology-Neuroimmunology; Catalunya Center for Multiple Sclerosis; Vall d'Hebron Institute of Research; Vall d'Hebron University Hospital; Autonomous University of Barcelona; Barcelona Spain
| | - Ester Quintana
- Department of Neurology; Doctor Josep Trueta University Hospital; Institute for Biomedical Research of Girona; Girona Spain
| | - Eduardo Agüera
- Institute Maimónides for Biomedical Research, Reina Sofía University Hospital, University of Córdoba; Córdoba Spain
| | - Santiago Díaz
- Department of Neurology; Doctor Negrin University Hospital, Las Palmas de Gran Canaria; Spain
| | | | - Juan A. García-Merino
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Puerta de Hierro University Hospital; Madrid Spain
| | - Lamberto Landete
- Department of Neurology; Doctor Peset University Hospital; Valencia Spain
| | | | - Laura Navarro
- Department of Neurology; Elche General Hospital; Elche Spain
| | - Domingo Pérez
- Department of Neurology; Hospital of El Bierzo, Ponferrada; Ponferrada Spain
| | - Fernando Sánchez-López
- Institute Maimónides for Biomedical Research, Reina Sofía University Hospital, University of Córdoba; Córdoba Spain
| | | | - Alberto Tuñón
- Department of Neurology; Central University Hospital of Asturias; Oviedo Spain
| | - Mercedes Espiño
- Department of Immunology; Ramón y Cajal University Hospital, Institute Ramon y Cajal for Biomedical Research; Madrid Spain
- Spanish Network for the Research in Multiple Sclerosis; Spain
| | - Alfonso Muriel
- Biostatistics Unit; Ramón y Cajal University Hospital; Institute Ramon y Cajal for Biomedical Research; CIBERESP; Madrid Spain
| | - Amit Bar-Or
- Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec Canada
| | - José C. Álvarez-Cermeño
- Spanish Network for the Research in Multiple Sclerosis; Spain
- Department of Neurology; Ramon y Cajal University Hospital; Institute Ramon y Cajal for Biomedical Research; Madrid Spain
| |
Collapse
|
20
|
Sepúlveda M, Blanco Y, Rovira A, Rio J, Mendibe M, Llufriu S, Gabilondo I, Villoslada P, Castilló J, Corral J, Ayuso T, Iñiguez C, Santos S, Guijarro C, Ramió-Torrentà L, Sempere AP, Olascoaga J, Graus F, Montalban X, Saiz A. Analysis of prognostic factors associated with longitudinally extensive transverse myelitis. Mult Scler 2012; 19:742-8. [PMID: 23037550 DOI: 10.1177/1352458512461968] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to report the clinical profile and outcome of longitudinally extensive transverse myelitis (LETM). METHODS We prospectively studied adult patients who presented with LETM from January 2008 to December 2011. Information on demographic, clinical course, magnetic resonance imaging (MRI) and outcome was collected. HLA-DRB1 genotype was compared with those of 225 normal controls and patients with MS (228) and neuromyelitis optica (NMO) (22). RESULTS In total, 23 patients (16 female) with a median age of 44.5 years (range: 20-77 years) were included. Most (74%) had moderate-severe disability at nadir (48% non-ambulatory), normal/non-multiple sclerosis (MS) brain MRI (96%) and a median MRI cord lesion of 5 vertebral segments (range: 3-19). Laboratory analysis showed cerebrospinal fluid pleocytosis (45%), NMO-IgG (9%), antinuclear antibodies (70%), and genotype HLA-DRB1*13 (57%). The frequency of DRB1*13 genotype was higher compared with controls (p=0.002), MS (p=0.001) and NMO (p=0.003) patients. After a median follow-up of 32 months, one patient converted to MS, two had relapsing LETM with NMO-IgG, and 20 remained as idiopathic with recurrences in four (20%). Twelve (52%) patients recovered with minimal disability (Expanded Disability Status Scale (EDSS) ≤2.5) and three (13%) remained wheelchair dependent. Disability at nadir was associated with the final outcome and extension of the spinal cord lesion with risk of recurrence. Recurrence was not associated with worse outcome. CONCLUSIONS Inflammatory LETM is mostly idiopathic with a good outcome. It includes a relatively homogenous group of patients with an overrepresentation of the HLA-DRB1*13 genotype. EDSS at nadir is a predictor of the final outcome and extension of the myelitis of the recurrence risk.
Collapse
Affiliation(s)
- María Sepúlveda
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Genis D, Ferrer I, Solé JV, Corral J, Volpini V, San Nicolás H, Gich J, Ramió-Torrentà L, Ferrándiz M, Puig J, Márquez F. A kindred with cerebellar ataxia and thermoanalgesia. J Neurol Neurosurg Psychiatry 2009; 80:518-23. [PMID: 18710877 DOI: 10.1136/jnnp.2008.151548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To characterise the clinical, neurophysiological, neuropathological and genetic features of a family with cerebellar autosomal dominant ataxia. DESIGN Patients were submitted to clinical, neuroradiological and neurophysiological examinations. Molecular studies were undertaken to exclude SCAs 1-3, 6-8, 12 and 17. Studies were performed to rule out linkage to SCA4 on chromosome 16, and for all still uncharacterised SCA loci. Neuropathological examination of the proband was performed with immunocytochemistry. RESULTS These patients presented a late onset cerebellar ataxia with thermoanalgesia and deep sensory loss. Unlike in SCA4, reflexes were preserved. MRI revealed cerebellar, medullar and spinal cord atrophy. Neurophysiological studies showed absence or marked reduction of the sensory nerve action potentials and somatosensory evoked potentials in lower and upper limbs but preservation of the soleus H reflex. No triplet repeat expansion mutations in the studied SCA genes were identified. Our studies ruled out linkage of the disease to the SCA4 locus on chromosome 16 and the remaining reported SCA loci. The neuropathological study of the proband revealed severe loss of Purkinje cells and dentate neurons. The inferior olive and lower cranial nerve nuclei also showed extensive cell loss. Posterior columns and spinocerebellar tracts were demyelinated. Ubiquitin immunoreactive intranuclear inclusions were absent. CONCLUSION This kind of cerebellar ataxia, associated with thermoanalgesia as well as deep sensory loss with retained reflexes, does not associate to any known SCA loci. Therefore, we identify and describe a new form of late onset dominant spinocerebellar ataxia.
Collapse
Affiliation(s)
- D Genis
- Neurodegenerative Disease Unit, Dr Josep Trueta University Hospital, Girona, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Saiz A, Blanco Y, Sabater L, González F, Bataller L, Casamitjana R, Ramió-Torrentà L, Graus F. Spectrum of neurological syndromes associated with glutamic acid decarboxylase antibodies: diagnostic clues for this association. Brain 2008; 131:2553-63. [DOI: 10.1093/brain/awn183] [Citation(s) in RCA: 434] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
| | | | | | | | | | - Roser Casamitjana
- Laboratory of Hormonal, Hospital Clinic and Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona
| | | | | |
Collapse
|
23
|
Ramió-Torrentà L, Sastre-Garriga J, Ingle GT, Davies GR, Ameen V, Miller DH, Thompson AJ. Abnormalities in normal appearing tissues in early primary progressive multiple sclerosis and their relation to disability: a tissue specific magnetisation transfer study. J Neurol Neurosurg Psychiatry 2006; 77:40-5. [PMID: 16361590 PMCID: PMC2117405 DOI: 10.1136/jnnp.2004.052316] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with primary progressive multiple sclerosis (PPMS) often develop severe disability despite low levels of abnormality on conventional magnetic resonance imaging (MRI). This may relate to diffuse pathological processes occurring in normal appearing brain tissue (NABT) involving both white matter (NAWM) and grey matter (NAGM). Magnetisation transfer imaging (MTI) is capable of identifying these processes and may be particularly informative when applied to patients with early PPMS. AIM To assess the relationship between abnormalities in NABT identified by MTI and disability and other radiological data in patients with early PPMS. METHODS We studied 43 patients within 5 years of disease onset and 43 controls. The Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) were scored. Magnetisation transfer ratios (MTR) of NABT, NAWM, and NAGM were calculated and the following MTR parameters were measured: mean, peak height, peak location, and MTR value at the 25th, 50th, and 75th percentiles. Proton density, T2, T1, and gadolinium enhancing lesion loads were also calculated. RESULTS Differences were found between patients and controls in mean, peak height, and peak location of NAWM and NAGM (p < or = 0.001). Weak to moderate correlations were found between MTR parameters and disability in both NAWM and NAGM. Strong correlations between MTR parameters and lesion loads were found, particularly in NAWM. CONCLUSION MTR abnormalities are seen in NAWM and NAGM in early PPMS and both are associated with disability. NAWM MTR abnormalities are more closely related to conventional MRI measures than those seen in NAGM.
Collapse
Affiliation(s)
- L Ramió-Torrentà
- Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | | | | | | | | | | | | |
Collapse
|
24
|
Davies GR, Ramió-Torrentà L, Hadjiprocopis A, Chard DT, Griffin CMB, Rashid W, Barker GJ, Kapoor R, Thompson AJ, Miller DH. Evidence for grey matter MTR abnormality in minimally disabled patients with early relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2004; 75:998-1002. [PMID: 15201359 PMCID: PMC1739100 DOI: 10.1136/jnnp.2003.021915] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To establish whether magnetisation transfer ratio (MTR) histograms are sensitive to change in normal appearing grey matter (NAGM) in early relapsing-remitting multiple sclerosis (RRMS) in the absence of significant disability; and to assess whether grey or white matter MTR measures are associated with clinical measures of impairment in early RRMS METHODS: 38 patients were studied (mean disease duration 1.9 years (range 0.5 to 3.7); median expanded disability status scale (EDSS) 1.5 (0 to 3)), along with 35 healthy controls. MTR was determined from proton density weighted images with and without MT presaturation. SPM99 was used to generate normal appearing white matter (NAWM) and NAGM segments of the MTR map, and partial voxels were minimised with a 10 pu threshold and voxel erosions. Mean MTR was calculated from the tissue segments. Atrophy measures were determined using a 3D fast spoiled gradient recall sequence from 37 patients and 17 controls. RESULTS Mean NAGM and NAWM MTR were both reduced in early RRMS (NAGM MTR: 31.9 pu in patients v 32.2 pu in controls; p<0.001; NAWM MTR: 37.9 v 38.3 pu, p = 0.001). Brain parenchymal fraction (BPF) correlated with NAGM MTR, but when BPF was included as a covariate NAGM MTR was still lower in the patients (p = 0.009). EDSS correlated with NAGM MTR (r = 0.446 p = 0.005). CONCLUSIONS In early RRMS, grey matter MTR abnormality is apparent. The correlation with mild clinical impairment (in this essentially non-disabled cohort) suggests that NAGM MTR could be a clinically relevant surrogate marker in therapeutic trials.
Collapse
Affiliation(s)
- G R Davies
- NMR Research Unit, Institute of Neurology, University College London, Queen Square, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|