1
|
Gil-Sánchez A, Gonzalo H, Canudes M, Nogueras L, González-Mingot C, Valcheva P, Torres P, Serrano JC, Peralta S, Solana MJ, Brieva L. Can Glatiramer Acetate Prevent Cognitive Impairment by Modulating Oxidative Stress in Patients with Multiple Sclerosis? Pharmaceuticals (Basel) 2024; 17:459. [PMID: 38675419 PMCID: PMC11053874 DOI: 10.3390/ph17040459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination and neuroinflammation, often accompanied by cognitive impairment. This study aims (1) to investigate the potential of glatiramer acetate (GA) as a therapy for preventing cognitive decline in patients with MS (pwMS) by modulating oxidative stress (OS) and (2) to seek out the differences in cognition between pwMS in a cohort exhibiting good clinical evolution and control subjects (CS). An exploratory, prospective, multicentre, cross-sectional case-control study was conducted, involving three groups at a 1:1:1 ratio-41 GA-treated pwMS, 42 untreated pwMS, and 42 CS. The participants performed a neuropsychological battery and underwent venepuncture for blood sampling. The inclusion criteria required an Expanded Disability Status Scale score of ≤3.0 and a minimum of 5 years of MS disease. Concerning cognition, the CS had a better performance than the pwMS (p = <0.0001), and between those treated and untreated with GA, no statistically significant differences were found. Regarding oxidation, no statistically significant differences were detected. Upon categorizing the pwMS into cognitively impaired and cognitively preserved groups, the lactate was elevated in the pwMS with cognitive preservation (p = 0.038). The pwMS exhibited a worse cognitive performance than the CS. The pwMS treated with GA did not show an improvement in oxidation. Lactate emerged as a potential biomarker for cognitive preservation.
Collapse
Affiliation(s)
- Anna Gil-Sánchez
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
| | - Hugo Gonzalo
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
| | - Marc Canudes
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
| | - Lara Nogueras
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
| | - Cristina González-Mingot
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
- Hospital Universitario Arnau de Vilanova de Lleida (HUAVLleida), 25198 Lleida, Spain
- Neuroimmunology Group, Department of Medicine, University of Lleida, 25198 Lleida, Spain;
| | - Petya Valcheva
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
| | - Pascual Torres
- Neuroimmunology Group, Department of Medicine, University of Lleida, 25198 Lleida, Spain;
| | - Jose Carlos Serrano
- NUTREN-Nutrigenomics, Department of Experimental Medicine, University of Lleida, 25198 Lleida, Spain;
| | - Silvia Peralta
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
- Hospital Universitario Arnau de Vilanova de Lleida (HUAVLleida), 25198 Lleida, Spain
| | - Maria José Solana
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
- Hospital Universitario Arnau de Vilanova de Lleida (HUAVLleida), 25198 Lleida, Spain
| | - Luis Brieva
- Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (H.G.); (M.C.); (L.N.); (C.G.-M.); (P.V.); (S.P.); (M.J.S.)
- Hospital Universitario Arnau de Vilanova de Lleida (HUAVLleida), 25198 Lleida, Spain
- Neuroimmunology Group, Department of Medicine, University of Lleida, 25198 Lleida, Spain;
| |
Collapse
|
2
|
Gil-Sanchez A, Canudes M, Valcheva P, Nogueras L, González-Mingot C, Hervás JV, Peralta S, Solana M, Brieva L. Effects of Vortioxetine on Cognition and Fatigue in Patients with Multiple Sclerosis and Depression: A Case Series Study. CNS Neurol Disord Drug Targets 2024; 23:395-401. [PMID: 36944623 DOI: 10.2174/1871527322666230321093133] [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] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Vortioxetine is a multimodal antidepressant drug that has been reported to have a positive impact on cognition, social function, and fatigue. Nevertheless, it has not been widely studied. Our objective was to explore the effects of vortioxetine on these and other parameters in patients with multiple sclerosis (MS) and depression. PATIENTS AND METHODOLOGY This observational case series study included patients with MS and depression who received treatment with vortioxetine for at least 6 months. The patient history of depression and depressive symptoms was assessed. A neuropsychiatric evaluation was carried out using different scales, both before and after treatment. RESULTS Of the 25 patients who enrolled in the study, 17 completed the treatment. Significant improvements were observed in health status (EQ-5D; p = 0.002), mood (Beck's Depression Inventory, BDI-II; p = 0.006), anxiety (State-Trait Anxiety Inventory, STAI-State; p = 0.021, and STAI-Trait; p = 0.011), and in the general health test (Short Form Health Survey, SF-36) for the vitality (p = 0.028) and mental health (p = 0.025) domains of the patients who completed the treatment. However, no statistically significant differences were observed in the cognitive tests related to attention, information processing speed, or fatigue. CONCLUSION In this population, vortioxetine treatment was effective in reducing the symptoms of depression and improving anxiety, vitality, and mental health. In contrast, it did not produce any improvement in cognition or fatigue but an increase in sample size would be necessary to confirm these results.
Collapse
Affiliation(s)
- Anna Gil-Sanchez
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Marc Canudes
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Petya Valcheva
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Lara Nogueras
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Cristina González-Mingot
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - José Vicente Hervás
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Silvia Peralta
- Multiple Sclerosis Foundation (FEM) of Lleida, Lleida, España
| | - Maria Solana
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Luis Brieva
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| |
Collapse
|
3
|
Brochet B, Solari A, Lechner-Scott J, Piehl F, Langdon D, Hupperts R, Selmaj K, Patti F, Brieva L, Maida EM, Alexandri N, Smyk A, Nolting A, Keller B, Montalban X, Kubala Havrdova E. Improvements in quality of life over 2 years with cladribine tablets in people with relapsing multiple sclerosis: The CLARIFY-MS study. Mult Scler 2023; 29:1808-1818. [PMID: 37978852 PMCID: PMC10687821 DOI: 10.1177/13524585231205962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) negatively affects health-related quality of life (HRQoL). OBJECTIVE To evaluate HRQoL in people with highly active relapsing MS treated with cladribine tablets (CladT; 3.5 mg/kg cumulative dose over 2 years) in CLARIFY-MS. METHODS Changes in the MS quality of life (MSQoL)-54 scores were analysed using a repeated mixed-effects linear model. Subgroup analyses were performed for participants who were pretreatment-naïve and those pretreated with disease-modifying therapies (DMTs) before initiating CladT. Safety and tolerability of CladT were also assessed. RESULTS MSQoL-54 physical (mean change = 4.86; 95% confidence interval (CI) = 3.18, 6.53) and mental health (4.80; 95% CI = 3.13, 6.46) composite scores (primary endpoints) showed significant improvement at Month 24 versus Baseline (p < 0.0001). Changes in the MSQoL-54 scores were consistent across the pretreatment-naïve and DMT-pretreated subgroups. No new severe or opportunistic infections occurred. Most post-baseline lymphopenia events were Grade 1-2 in severity. Transient Grade-3 lymphopenia was observed in 19.7% (95/482) of participants. Grade-4 lymphopenia was not observed. CONCLUSIONS CladT treatment significantly improved the mean MSQoL-54 physical and mental health composite scores over 2 years. CladT efficacy in HRQoL, relapse rates and Expanded Disability Status Scale scores demonstrates its multidimensional effects in MS treatment.
Collapse
Affiliation(s)
- Bruno Brochet
- INSERM U 1215, University of Bordeaux, Bordeaux, France
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jeannette Lechner-Scott
- University of Newcastle, Newcastle, NSW, Australia/Division of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Raymond Hupperts
- Zuyderland Medisch Centrum Sittard, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, and Azienda Ospedaliero Universitaria Policlinico “G. Rodolico” – San Marco, University of Catania, Italy
| | - Luis Brieva
- IRBlLeida, Hospital Arnau de Vilanova, Lérida, Spain
| | | | | | | | | | | | - Xavier Montalban
- Department of Neurology-Neuroimmunology Centre of Multiple Sclerosis of Catalonia (Cemcat), University Hospital Vall d’Hebron, Barcelona, Spain
| | - Eva Kubala Havrdova
- Department of Neurology and Center for Clinical Neuroscience, First Medical Faculty, Charles University, Prague, Czech Republic
| |
Collapse
|
4
|
Koch MW, Moral E, Brieva L, Mostert J, Strijbis EMM, Comtois J, Repovic P, Bowen JD, Wolinsky JS, Lublin FD, Cutter G. Relapse recovery in relapsing-remitting multiple sclerosis: An analysis of the CombiRx dataset. Mult Scler 2023; 29:1776-1785. [PMID: 37830451 PMCID: PMC10687796 DOI: 10.1177/13524585231202320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Clinical relapses are the defining feature of relapsing forms of multiple sclerosis (MS), but relatively little is known about the time course of relapse recovery. OBJECTIVE The aim of this study was to investigate the time course of and patient factors associated with the speed and success of relapse recovery in people with relapsing-remitting MS (RRMS). METHODS Using data from CombiRx, a large RRMS trial (clinicaltrials.gov identifier NCT00211887), we measured the time to recovery from the first on-trial relapse. We used Kaplan-Meier survival analyses and Cox regression models to investigate the association of patient factors with the time to unconfirmed and confirmed relapse recovery. RESULTS CombiRx included 1008 participants. We investigated 240 relapses. Median time to relapse recovery was 111 days. Most recovery events took place within 1 year of relapse onset: 202 of 240 (84%) individuals recovered during follow-up, 161 of 202 (80%) by 180 days, and 189 of 202 (94%) by 365 days. Relapse severity was the only factor associated with relapse recovery. CONCLUSION Recovery from relapses takes place up to approximately 1 year after the event. Relapse severity, but no other patient factors, was associated with the speed of relapse recovery. Our findings inform clinical practice and trial design in RRMS.
Collapse
Affiliation(s)
- Marcus W Koch
- Departments of Clinical Neurosciences and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Ester Moral
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Luis Brieva
- Neuroimmunology Group, Department of Medicine, University of Lleida-IRBLleida, Lleida, Spain Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Jop Mostert
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Eva MM Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jacynthe Comtois
- Department of Medicine, Neurology Service, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Pavle Repovic
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - James D Bowen
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Jerry S Wolinsky
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Fred D Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
5
|
Fernández Ó, Montalban X, Agüera E, Aladro Y, Alonso A, Arroyo R, Brieva L, Calles C, Costa-Frossard L, Eichau S, M. García-Domínguez J, Hernández MÁ, Landete L, Llaneza M, Llufriu S, Meca-Lallana JE, Meca-Lallana V, Mongay-Ochoa N, Moral E, Oreja-Guevara C, Torrentà LRI, Téllez N, Romero-Pinel L, Rodríguez-Antigüedad A. [15th Post-ECTRIMS Meeting: a review of the latest developments presented at the 2022 ECTRIMS Congress (Part II)]. Rev Neurol 2023; 77:47-60. [PMID: 37403243 PMCID: PMC10662183 DOI: 10.33588/rn.7702.2023168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION On 4 and 5 November 2022, Madrid hosted the 15th edition of the Post-ECTRIMS Meeting, where neurologists specialised in multiple sclerosis outlined the latest developments presented at the 2022 ECTRIMS Congress, held in Amsterdam from 26 to 28 October. AIM To synthesise the content presented at the 15th edition of the Post-ECTRIMS Meeting, in an article broken down into two parts. DEVELOPMENT This second part describes the new developments in terms of therapeutic strategies for escalation and de-escalation of disease-modifying therapies (DMT), when and in whom to initiate or switch to highly effective DMT, the definition of therapeutic failure, the possibility of treating radiologically isolated syndrome and the future of personalised treatment and precision medicine. It also considers the efficacy and safety of autologous haematopoietic stem cell transplantation, different approaches in clinical trial design and outcome measures to assess DMT in progressive stages, challenges in the diagnosis and treatment of cognitive impairment, and treatment in special situations (pregnancy, comorbidity and the elderly). In addition, results from some of the latest studies with oral cladribine and evobrutinib presented at ECTRIMS 2022 are shown.
Collapse
Affiliation(s)
- Óscar Fernández
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaEspaña
| | - Xavier Montalban
- Hospital Universitari Vall d’Hebron-CEMCAT. BarcelonaHospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATBarcelonaEspaña
| | - Eduardo Agüera
- Hospital Universitario Reina Sofía. MadridHospital Universitario Reina SofíaHospital Universitario Reina SofíaMadridEspaña
| | - Yolanda Aladro
- Hospital Universitario de Getafe. Getafe, MadridHospital Universitario de GetafeHospital Universitario de GetafeMadridEspaña
| | - Ana Alonso
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaEspaña
| | - Rafael Arroyo
- Hospital Universitario Quirónsalud. MadridHospital Universitario QuirónsaludHospital Universitario QuirónsaludMadridEspaña
| | - Luis Brieva
- Hospital Universitari Arnau de Vilanova- Universitat de Lleida. LleidaHospital Universitari Arnau de Vilanova- Universitat de LleidaHospital Universitari Arnau de Vilanova- Universitat de LleidaLleidaEspaña
| | - Carmen Calles
- Hospital Universitario Son Espases. Palma de MallorcaHospital Universitario Son EspasesHospital Universitario Son EspasesPalma de MallorcaEspaña
| | - Lucienne Costa-Frossard
- Hospital Universitario Ramón y Cajal. MadridHospital Universitario Ramón y CajalHospital Universitario Ramón y CajalMadridEspaña
| | - Sara Eichau
- Hospital Universitario Virgen Macarena. SevillaHospital Universitario Virgen MacarenaHospital Universitario Virgen MacarenaSevillaEspaña
| | - José M. García-Domínguez
- Hospital Universitario Gregorio Marañón. MadridHospital Universitario Gregorio MarañónHospital Universitario Gregorio MarañónMadridEspaña
| | - Miguel Á. Hernández
- Hospital Nuestra Señora de Candelaria. Santa Cruz de Tenerife. ValenciaHospital Nuestra Señora de CandelariaHospital Nuestra Señora de CandelariaValenciaEspaña
| | - Lamberto Landete
- Hospital Universitario Doctor Peset. ValenciaHospital Universitario Doctor PesetHospital Universitario Doctor PesetValenciaEspaña
| | - Miguel Llaneza
- Complejo Hospitalario Universitario de Ferrol. El Ferrol, La CoruñaComplejo Hospitalario Universitario de FerrolComplejo Hospitalario Universitario de FerrolLa CoruñaEspaña
| | - Sara Llufriu
- Hospital Clínic de Barcelona e IDIBAPS. BarcelonaHospital Clínic de Barcelona e IDIBAPSHospital Clínic de Barcelona e IDIBAPSBarcelonaEspaña
| | - José E. Meca-Lallana
- Hospital Clínico Universitario Virgen de la Arrixaca. MurciaHospital Clínico Universitario Virgen de la ArrixacaHospital Clínico Universitario Virgen de la ArrixacaMurciaEspaña
| | - Virginia Meca-Lallana
- Hospital Universitario de La Princesa. MadridHospital Universitario de La PrincesaHospital Universitario de La PrincesaMadridEspaña
| | - Neus Mongay-Ochoa
- Hospital Universitari Vall d’Hebron-CEMCAT. BarcelonaHospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATBarcelonaEspaña
| | - Ester Moral
- Hospital Sant Joan Despí Moisès Broggi. Sant Joan Despí, BarcelonaHospital Sant Joan Despí Moisès BroggiHospital Sant Joan Despí Moisès BroggiBarcelonaEspaña
| | - Celia Oreja-Guevara
- Hospital Clínico San Carlos-IdISSC-UCM. MadridHospital Clínico San Carlos-IdISSC-UCMHospital Clínico San Carlos-IdISSC-UCMMadridEspaña
| | - Lluís Ramió i Torrentà
- Hospital Universitari de Girona Dr. Josep Trueta-IDIBGIHospital Universitari de Girona Dr. Josep Trueta-IDIBGIHospital Universitari de Girona Dr. Josep Trueta-IDIBGIGironaEspaña
- Hospital Santa Caterina. Universitat de Girona. GironaUniversitat de GironaUniversitat de GironaGironaEspaña
- Departamento de Cièncias Médicas. Universitat de Girona. GironaUniversitat de GironaUniversitat de GironaGironaEspaña
| | - Nieves Téllez
- Hospital Clínico Universitario de Valladolid. ValladolidHospital Clínico Universitario de ValladolidHospital Clínico Universitario de ValladolidValladolidEspaña
| | - Lucía Romero-Pinel
- Hospital Universitari de Bellvitge- IDIBELL. L’Hospitalet de Llobregat, BarcelonaHospital Universitari de Bellvitge- IDIBELLHospital Universitari de Bellvitge- IDIBELLBarcelonaEspaña
| | | |
Collapse
|
6
|
Fernández Ó, Montalban X, Agüera E, Aladro Y, Alonso A, Arroyo R, Brieva L, Calles C, Costa-Frossard L, Eichau S, García-Domínguez JM, Hernández MÁ, Landete L, Llaneza M, Llufriu S, Meca-Lallana JE, Meca-Lallana V, Mongay-Ochoa N, Moral E, Oreja-Guevara C, Ramió-Torrentà L, Téllez N, Romero-Pinel L, Rodríguez-Antigüedad A. [15th Post-ECTRIMS Meeting: a review of the latest developments presented at the 2022 ECTRIMS Congress (Part I)]. Rev Neurol 2023; 77:19-30. [PMID: 37365721 PMCID: PMC10663806 DOI: 10.33588/rn.7701.2023167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION On 4 and 5 November 2022, Madrid hosted the 15th edition of the Post-ECTRIMS Meeting, where neurologists specialised in multiple sclerosis (MS) outlined the most relevant novelties presented at the 2022 ECTRIMS Congress, held in Amsterdam from 26 to 28 October. AIM To synthesise the content presented at the 15th edition of the Post-ECTRIMS Meeting, in an article broken down into two parts. DEVELOPMENT In this first part, the initial events involved in the onset of MS, the role played by lymphocytes and the migration of immune system cells into the central nervous system are presented. It describes emerging biomarkers in body fluids and imaging findings that are predictive of disease progression and useful in the differential diagnosis of MS. It also discusses advances in imaging techniques which, together with a better understanding of the agents involved in demyelination and remyelination processes, provide a basis for dealing with remyelination in the clinical setting. Finally, the mechanisms triggering the inflammatory reaction and neurodegeneration involved in MS pathology are reviewed.
Collapse
Affiliation(s)
- Óscar Fernández
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaSpain
| | - Xavier Montalban
- Hospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATBarcelonaSpain
| | - Eduardo Agüera
- Hospital Universitario Reina SofíaHospital Universitario Reina SofíaHospital Universitario Reina SofíaBarcelonaSpain
| | - Yolanda Aladro
- Hospital Universitario de Getafe. Getafe, MadridHospital Universitario de GetafeHospital Universitario de GetafeMadridSpain
| | - Ana Alonso
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaSpain
| | - Rafael Arroyo
- Hospital Universitario QuirónsaludHospital Universitario QuirónsaludHospital Universitario QuirónsaludBarcelonaSpain
| | - Luis Brieva
- Hospital Universitari Arnau de Vilanova- Universitat de Lleida. LleidaHospital Universitari Arnau de Vilanova- Universitat de LleidaHospital Universitari Arnau de Vilanova- Universitat de LleidaLleidaSpain
| | - Carmen Calles
- Hospital Universitario Son Espases. Palma de MallorcaHospital Universitario Son EspasesHospital Universitario Son EspasesPalma de MallorcaSpain
| | - Lucienne Costa-Frossard
- Hospital Universitario Ramón y CajalHospital Universitario Ramón y CajalHospital Universitario Ramón y CajalBarcelonaSpain
| | - Sara Eichau
- Hospital Universitario Virgen Macarena. SevillaHospital Universitario Virgen MacarenaHospital Universitario Virgen MacarenaSevillaSpain
| | - José M. García-Domínguez
- Hospital Universitario Gregorio MarañónHospital Universitario Gregorio MarañónHospital Universitario Gregorio MarañónBarcelonaSpain
| | - Miguel Á. Hernández
- Hospital Nuestra Señora de Candelaria. Santa Cruz de TenerifeHospital Nuestra Señora de CandelariaHospital Nuestra Señora de CandelariaSanta Cruz de TenerifeSpain
| | - Lamberto Landete
- Hospital Universitario Doctor Peset. ValenciaHospital Universitario Doctor PesetHospital Universitario Doctor PesetValenciaSpain
| | - Miguel Llaneza
- Complejo Hospitalario Universitario de Ferrol. El Ferrol, La CoruñaComplejo Hospitalario Universitario de FerrolComplejo Hospitalario Universitario de FerrolEl FerrolSpain
| | - Sara Llufriu
- Hospital Clínic de Barcelona e IDIBAPS. BarcelonaHospital Clínic de Barcelona e IDIBAPSHospital Clínic de Barcelona e IDIBAPSBarcelonaSpain
| | - José E. Meca-Lallana
- Hospital Regional Universitario de Málaga. MálagaHospital Regional Universitario de MálagaHospital Regional Universitario de MálagaMálagaSpain
| | - Virginia Meca-Lallana
- Hospital Clínico Universitario Virgen de la Arrixaca. MurciaHospital Clínico Universitario Virgen de la ArrixacaHospital Clínico Universitario Virgen de la ArrixacaMurciaSpain
| | - Neus Mongay-Ochoa
- Hospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATHospital Universitari Vall d’Hebron-CEMCATBarcelonaSpain
| | - Ester Moral
- Hospital Sant Joan Despí Moisès Broggi. Sant Joan Despí, BarcelonaHospital Sant Joan Despí Moisès BroggiHospital Sant Joan Despí Moisès BroggiBarcelonaSpain
| | - Celia Oreja-Guevara
- Hospital Clínico San Carlos-IdISSC-UCM. MadridHospital Clínico San Carlos-IdISSC-UCMHospital Clínico San Carlos-IdISSC-UCMMadridSpain
| | - Lluís Ramió-Torrentà
- Departamento de Cièncias Médicas. Universitat de Girona. GironaUniversitat de GironaUniversitat de GironaGironaSpain
| | - Nieves Téllez
- Hospital Clínico Universitario de Valladolid. ValladolidHospital Clínico Universitario de ValladolidHospital Clínico Universitario de ValladolidValladolidSpain
| | - Lucía Romero-Pinel
- Hospital Universitari de Bellvitge- IDIBELL. L’Hospitalet de Llobregat, BarcelonaHospital Universitari de Bellvitge- IDIBELLHospital Universitari de Bellvitge- IDIBELLBarcelonaSpain
| | | |
Collapse
|
7
|
Sainz de la Maza S, Maurino J, Castillo-Triviño T, Borges M, Sebastián Torres B, Sotoca J, Alonso Torres AM, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco MR, Dotor García-Soto J, Rodríguez-Regal A, Navarro-Cantó L, Agüera-Morales E, Garcés M, Carmona O, Gabaldón-Torres L, Forero L, Hervás M, Gómez-Ballesteros R. Hopelessness in Patients with Early-Stage Relapsing-Remitting Multiple Sclerosis. Patient Prefer Adherence 2023; 17:1431-1439. [PMID: 37337517 PMCID: PMC10277026 DOI: 10.2147/ppa.s411069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
Background Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS. Methods A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients' characteristics and state hopelessness. Results A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=<0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders. Conclusion Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.
Collapse
Affiliation(s)
| | | | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari Vall d´Hebrón, Barcelona, Spain
| | | | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | - Ana Rodríguez-Regal
- Department of Neurology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | | | - Moisés Garcés
- Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervás
- Department of Neurology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | |
Collapse
|
8
|
González-Mingot C, Miana-Mena FJ, Iñarrea PJ, Iñiguez C, Capablo JL, Osta R, Gil-Sánchez A, Brieva L, Larrodé P. Mitochondrial Aconitase Enzymatic Activity: A Potential Long-Term Survival Biomarker in the Blood of ALS Patients. J Clin Med 2023; 12:jcm12103560. [PMID: 37240666 DOI: 10.3390/jcm12103560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/07/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a multisystemic, progressive, neurodegenerative disorder. Despite it being generally fatal within a period of 2-4 years, it is highly heterogeneous; as a result, survival periods may vary greatly among individual patients. Biomarkers can serve as tools for diagnosis, prognosis, indicators of therapeutic response, and future therapeutics. Free-radical-dependent mitochondrial damage is believed to play a crucial role in neurodegeneration in ALS. Mitochondrial aconitase, which is also known as aconitase 2 (Aco2), is a key Krebs cycle enzyme and is involved in the regulation of cellular metabolism and iron homeostasis. Aco2 is very sensitive to oxidative inactivation and can aggregate and accumulate in the mitochondrial matrix, causing mitochondrial dysfunction. Loss of Aco2 activity may therefore reflect increased levels of mitochondrial dysfunction due to oxidative damage and could be relevant to ALS pathogenesis. The aim of our study was to confirm changes in mitochondrial aconitase activity in peripheral blood and to determine whether such changes are dependent on, or independent of, the patient's condition and to propose the feasibility of using them as possible valid biomarkers to quantify the progression of the disease and as a predictor of individual prognosis in ALS. METHODS We measured the Aco2 enzymatic activity in the platelets of blood samples taken from 22 controls and 26 ALS patients at different stages of disease development. We then correlated antioxidant activity with clinical and prognostic variables. RESULTS Aco2 activity was significantly lower in the 26 ALS patients than in the 22 controls (p < 0.05). Patients with higher levels of Aco2 activity survived longer than those with lower levels (p < 0.05). Aco2 activity was also higher in patients with earlier onset (p < 0.05) and in those with predominantly upper motor neuron signs. CONCLUSIONS Aco2 activity seems to be an independent factor that could be used in the long-term survival prognosis of ALS. Our findings suggest that blood Aco2 could be a leading candidate for use as a biomarker to improve prognosis. More studies are needed to confirm these results.
Collapse
Affiliation(s)
| | - Francisco Javier Miana-Mena
- LAGENBIO-Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Aragon Institute for Health Research (IIS Aragon), Zaragoza University, 50013 Zaragoza, Spain
| | - Pedro José Iñarrea
- Biochemical-Department of Biology-Faculty, Zaragoza University, 50009 Zaragoza, Spain
| | - Cristina Iñiguez
- Neurology-Department, Hospital Clínico Universitario Lozano Blesa of Zaragoza, 50009 Zaragoza, Spain
| | - José Luis Capablo
- Neurology-Department, Hospital Universitario Miguel Servet of Zaragoza, 50009 Zaragoza, Spain
| | - Rosario Osta
- LAGENBIO-Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Aragon Institute for Health Research (IIS Aragon), Zaragoza University, 50013 Zaragoza, Spain
| | - Anna Gil-Sánchez
- Neurology-Department, Hospital Arnau de Vilanova of Lleida, 25198 Lleida, Spain
| | - Luis Brieva
- Neurology-Department, Hospital Arnau de Vilanova of Lleida, 25198 Lleida, Spain
| | - Pilar Larrodé
- Neurology-Department, Hospital Clínico Universitario Lozano Blesa of Zaragoza, 50009 Zaragoza, Spain
| |
Collapse
|
9
|
Lleixà C, Caballero-Ávila M, Pascual-Goñi E, Martín-Aguilar L, Vidal N, Tejada C, Valdés-Hevia E, Zárate E, Vesperinas A, Collet R, Franco-Leyva T, Martínez-Martínez L, Moga E, Cortés-Vicente E, Rojas-García R, Gómez-Anson B, Gil A, González-Mingot C, Brieva L, Martínez-Yélamos S, Querol L. Antibodies against the flotillin-1/2 complex in patients with multiple sclerosis. Brain Commun 2023; 5:fcad109. [PMID: 37091585 PMCID: PMC10116574 DOI: 10.1093/braincomms/fcad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/16/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Abstract
Multiple sclerosis is a tissue-specific autoimmune disease of the central nervous system in which the antigen(s) remains elusive. Antibodies targeting the flotillin-1/2 complex have been described in 1-2% of the patients in a recent study. Other candidate antigens as anoctamin-2 or neurofascin-155 have been previously described in multiple sclerosis patients, although their clinical relevance remains uncertain. Our study aims to analyse the frequency and clinical relevance of antibodies against neurofascin-155, anoctamin-2 and the flotillin-1/2 complex in multiple sclerosis.
Serum (n = 252) and CSF (n = 50) samples from 282 multiple sclerosis patients were included in the study. The control group was composed of 260 serum samples (71 healthy donors and 189 with other neuroinflammatory disorders). Anti-flotillin-1/2, anti-anoctamin-2 and anti-neurofascin-155 antibodies were tested by cell-based assays using transfected cells. We identified 6 multiple sclerosis patients with antibodies against the flotillin-1/2 complex (2.1%) and 1 multiple sclerosis patient with antibodies against anoctamin-2 (0.35%). All multiple sclerosis patients were negative for anti-neurofascin-155 antibodies. Three of the anti-flotillin-1/2 positive patients showed anti-flotillin-1/2 positivity in other serum samples extracted at different moments of their disease. Immunoglobulin G subclasses of anti-flotillin-1/2 antibodies were predominantly 1 and 3.
We confirm that antibodies targeting the flotillin-1/2 complex are present in a subgroup of patients with multiple sclerosis. Further studies are needed to understand the clinical and pathological relevance of anti-flotillin-1/2 autoantibodies in multiple sclerosis.
Collapse
Affiliation(s)
- Cinta Lleixà
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER) , Spain
| | - Marta Caballero-Ávila
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Elba Pascual-Goñi
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Lorena Martín-Aguilar
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Nuria Vidal
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Clara Tejada
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Eduardo Valdés-Hevia
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Elisa Zárate
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Ana Vesperinas
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Roger Collet
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Teresa Franco-Leyva
- Immunology department, Hospital de la Santa Creu i Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Laura Martínez-Martínez
- Immunology department, Hospital de la Santa Creu i Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Esther Moga
- Immunology department, Hospital de la Santa Creu i Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Elena Cortés-Vicente
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER) , Spain
| | - Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER) , Spain
| | - Beatriz Gómez-Anson
- Department of Radiology, Hospital de la Santa Creu i Sant Pau , Universitat Autònoma de Barcelona , Spain
| | - Anna Gil
- Department of Neurology, Hospital Arnau de Vilanova , Lleida , Spain
| | | | - Luis Brieva
- Department of Neurology, Hospital Arnau de Vilanova , Lleida , Spain
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Departament de Ciències Clíniques, Facultat de Medicina , Universitat de Barcelona , Spain
| | - Luis Querol
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau , Universitat Autònoma de Barcelona , Spain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER) , Spain
| |
Collapse
|
10
|
Sainz de la Maza S, Gómez-Ballesteros R, Borges M, Martín-Martínez J, Sotoca J, Alonso A, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco-Quílez MR, Dotor García-Soto J, del Campo-Amigo M, Navarro-Cantó L, Agüera E, Garcés-Redondo M, Carmona O, Gabaldón-Torres L, Forero L, Hervàs M, Medrano N, Maurino J, Castillo-Triviño T. Detecting disability using self-reported and clinical assessments in early-stage relapsing-remitting multiple sclerosis: Looking for a complementary approach. Mult Scler J Exp Transl Clin 2023; 9:20552173231169475. [PMID: 37187856 PMCID: PMC10176560 DOI: 10.1177/20552173231169475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/23/2023] [Indexed: 05/17/2023] Open
Abstract
Disability accrual is mainly driven by progression independent of relapse activity, which is present even in early stages of relapsing-remitting multiple sclerosis (RRMS) and sometimes overlooked. This multicenter, non-interventional study evaluated whether patient-reported outcomes measures (PROMs) could capture disability in 189 early-stage RRMS patients (mean age: 36.1 ± 9.4 years, 71.4% female, mean disease duration: 1.4 ± 0.8 years, median EDSS: 1.0). The 9-Hole Peg Test (9-HPT), NeuroQoL Upper Extremity (NeuroQoL-UE), Timed 25-Foot Walk (T25-FW), Multiple Sclerosis Walking Scale (MSWS-12), Symbol Digit Modalities Test (SDMT), and Perceived Deficits Questionnaire (PDQ-5) were used to assess hand function, gait, and cognition, respectively. These functions were at least mildly affected in this early-stage population, finding significant correlations between PROMs and clinical assessments. PROMs could enable early-stage RRMS patients to communicate their perceived disability in different domains, assisting clinicians in disease monitoring and decision making.
Collapse
Affiliation(s)
- Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario
Ramón y Cajal, IRyCIS, Universidad de Alcalá, Madrid, Spain
| | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen
Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari Mútua
Terrassa, Terrassa, Spain
| | - Ana Alonso
- Department of Neurology, Hospital Regional
Universitario de Málaga, Málaga, Spain
| | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de
Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación
Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari
Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de
Vilanova, Lleida, Spain
| | | | | | - María del Campo-Amigo
- Department of Neurology, Complexo Hospitalario
Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de
Elche, Elche, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital
Universitario Reina Sofía, Córdoba, Spain
| | - Moisés Garcés-Redondo
- Department of Neurology, Hospital Clínico Universitario
Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut
Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital
Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervàs
- Department of Neurology, Consorci Corporació Sanitària
Parc Taulí, Sabadell, Spain
| | | | | | | |
Collapse
|
11
|
Monreal E, Fernández-Velasco JI, García-Sánchez MI, Sainz de la Maza S, Llufriu S, Álvarez-Lafuente R, Casanova B, Comabella M, Ramió-Torrentà L, Martínez-Rodríguez JE, Brieva L, Saiz A, Eichau S, Cabrera-Maqueda JM, Villarrubia N, Espiño M, Pérez-Miralles F, Montalbán X, Tintoré M, Quiroga-Varela A, Domínguez-Mozo MI, Rodríguez-Jorge F, Chico-García JL, Lourido D, Álvarez-Cermeño JC, Masjuan J, Costa-Frossard L, Villar LM. Association of Serum Neurofilament Light Chain Levels at Disease Onset With Disability Worsening in Patients With a First Demyelinating Multiple Sclerosis Event Not Treated With High-Efficacy Drugs. JAMA Neurol 2023; 80:397-403. [PMID: 36848127 PMCID: PMC9972238 DOI: 10.1001/jamaneurol.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/23/2022] [Indexed: 03/01/2023]
Abstract
Importance The value of serum neurofilament light chain (sNfL) levels for predicting long-term disability in patients with multiple sclerosis (MS) remains controversial. Objective To assess whether high sNfL values are associated with disability worsening in patients who underwent their first demyelinating MS event. Design, Setting, and Participants This multicenter cohort study included patients who underwent their first demyelinating event suggestive of MS at Hospital Universitario Ramón y Cajal (development cohort; June 1, 1994, to September 31, 2021, with follow-up until August 31, 2022) and 8 Spanish hospitals (validation cohort; October 1, 1995, to August 4, 2020, with follow-up until August 16, 2022). Exposures Clinical evaluations at least every 6 months. Main Outcomes and Measures The main outcomes were 6-month confirmed disability worsening (CDW) and an Expanded Disability Status Scale (EDSS) score of 3. Levels of sNfL were measured in blood samples obtained within 12 months after disease onset using a single molecule array kit. The cutoffs used were sNfL level of 10 pg/mL and a standardized score (z score) of 1.5. Multivariable Cox proportional hazards regression models were used to evaluate outcomes. Results Of the 578 patients included in the study, 327 were in the development cohort (median age at sNfL analysis, 34.1 years [IQR, 27.2-42.7 years]; 226 female [69.1%]) and 251 patients were in the validation cohort (median age at sNfL analysis, 33.3 years [IQR, 27.4-41.5 years]; 184 female [73.3%]). The median follow-up was 7.10 years (IQR, 4.18-10.0 years). Levels of sNfL greater than 10 pg/mL were independently associated with higher risk of 6-month CDW and an EDSS of 3 in the development cohort (6-month CDW: hazard ratio [HR], 2.39; 95% CI, 1.39-4.12; P = .002; EDSS of 3: HR, 4.12; 95% CI, 2.18-7.77; P < .001) and the validation cohort (6-month CDW: HR, 1.61; 95% CI, 1.07-2.42; P = .02; EDSS of 3: HR, 2.03; 95% CI, 1.23-3.33; P = .005). Highly effective disease-modifying treatments were associated with lower risks of 6-month CDW and an EDSS of 3 in patients with high baseline sNfL values. Conclusions and Relevance This cohort study found that high sNfL values obtained within the first year of disease were associated with long-term disability worsening in MS, suggesting that sNfL level measurement may help identify optimal candidates for highly effective disease-modifying treatments.
Collapse
Affiliation(s)
- Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - José Ignacio Fernández-Velasco
- Department of Immunology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - María Isabel García-Sánchez
- Nodo Biobanco Hospital Virgen Macarena (Biobanco del Sistema Sanitario Público de Andalucía), Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer and Universitat de Barcelona, Barcelona, Spain
| | - Roberto Álvarez-Lafuente
- Grupo Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Bonaventura Casanova
- Multiple Sclerosis and Neuroimmunology Research Group, Fundación para la Investigación La Fe, Valencia, Spain
| | - Manuel Comabella
- Servei de Neurologia, Centre d’Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d’Hebron, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Doctor Josep Trueta University Hospital, Girona, Spain
- Neuroimmunology and Multiple Sclerosis Research Group, Girona Biomedical Research Institute, Doctor Josep Trueta University Hospital, Catalonia, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | | | - Luis Brieva
- Hospital Arnau de Vilanova de Lleida, Universitat de Lleida Medicine Department, Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Albert Saiz
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer and Universitat de Barcelona, Barcelona, Spain
| | - Sara Eichau
- Multiple Sclerosis Unit, Hospital Virgen Macarena, Sevilla, Spain
| | - José María Cabrera-Maqueda
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer and Universitat de Barcelona, Barcelona, Spain
| | - Noelia Villarrubia
- Department of Immunology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Mercedes Espiño
- Department of Immunology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Francisco Pérez-Miralles
- Multiple Sclerosis and Neuroimmunology Research Group, Fundación para la Investigación La Fe, Valencia, Spain
| | - Xavier Montalbán
- Servei de Neurologia, Centre d’Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d’Hebron, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia, Centre d’Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d’Hebron, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Quiroga-Varela
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Doctor Josep Trueta University Hospital, Girona, Spain
- Neuroimmunology and Multiple Sclerosis Research Group, Girona Biomedical Research Institute, Doctor Josep Trueta University Hospital, Catalonia, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - María Inmaculada Domínguez-Mozo
- Grupo Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Fernando Rodríguez-Jorge
- Department of Neurology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Juan Luís Chico-García
- Department of Neurology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Daniel Lourido
- Department of Radiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - José Carlos Álvarez-Cermeño
- Department of Neurology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Jaime Masjuan
- Department of Neurology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Lucienne Costa-Frossard
- Department of Neurology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| | - Luisa María Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, La Red Española de Esclerosis Múltiple, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain
| |
Collapse
|
12
|
Torres P, Sancho-Saldaña A, Gil Sánchez A, Peralta S, Solana MJ, Bakkioui S, González-Mingot C, Quibus L, Ruiz-Fernández E, San Pedro-Murillo E, Brieva L. A prospective study of cellular immune response to booster COVID-19 vaccination in multiple sclerosis patients treated with a broad spectrum of disease-modifying therapies. J Neurol 2023; 270:2380-2391. [PMID: 36933032 PMCID: PMC10024306 DOI: 10.1007/s00415-023-11575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Most people with Multiple Sclerosis (pwMS) are subjected to immunomodulatory disease-modifying treatments (DMTs). As a result, immune responses to COVID-19 vaccinations could be compromised. There are few data on cellular immune responses to the use of COVID-19 vaccine boosters in pwMS under a broad spectrum of DMTs. METHODS In this prospective study, we analysed cellular immune responses to SARS-CoV-2 mRNA booster vaccinations in 159 pwMS with DMT, including: ocrelizumab, rituximab, fingolimod, alemtuzumab, dimethyl fumarate, glatiramer acetate, teriflunomide, natalizumab and cladribine. RESULTS DMTs, and particularly fingolimod, interact with cellular responses to COVID-19 vaccination. One booster dose does not increase cellular immunity any more than two doses, except in the cases of natalizumab and cladribine. SARS-CoV-2 infection combined with two doses of vaccine resulted in a greater cellular immune response, but this was not observed after supplementary booster jabs. Ocrelizumab-treated pwMS who had previously received fingolimod did not develop cellular immunity, even after receiving a booster. The time after MS diagnosis and disability status negatively correlated with cellular immunity in ocrelizumab-treated pwMS in a booster dose cohort. CONCLUSIONS After two doses of SARS-CoV-2 vaccination, a high response yield was achieved, except in patients who had received fingolimod. The effects of fingolimod on cellular immunity persisted for more than 2 years after a change to ocrelizumab (which, in contrast, conserved cellular immunity). Our results confirmed the need to find alternative protective measures for fingolimod-treated people and to consider the possible failure to provide protection against SARS-CoV-2 when switching from fingolimod to ocrelizumab.
Collapse
Affiliation(s)
- Pascual Torres
- Metabolic Pathophysiology Research Group, Department of Experimental Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
| | - Agustín Sancho-Saldaña
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Anna Gil Sánchez
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
| | - Silvia Peralta
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Maria José Solana
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Sofian Bakkioui
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
| | - Cristina González-Mingot
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Laura Quibus
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Emilio Ruiz-Fernández
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | | | - Luis Brieva
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain.
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain.
| |
Collapse
|
13
|
Solari A, Montalban X, Lechner-Scott J, Piehl F, Brochet B, Langdon D, Hupperts R, Selmaj K, Havrdova EK, Patti F, Brieva L, Maida EM, Alexandri N, Smyk A, Nolting A, Keller B, on behalf of the CLARIFY-MS Investigators. Improvements in Quality of Life Over 2 Years in Patients Treated with Cladribine Tablets for Highly Active Relapsing Multiple Sclerosis: Final Analysis of CLARIFY-MS. Mult Scler Relat Disord 2023. [DOI: 10.1016/j.msard.2022.104356] [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: 04/03/2023]
|
14
|
Guasp M, Rosa-Justicia M, Muñoz-Lopetegi A, Martínez-Hernández E, Armangué T, Sugranyes G, Stein H, Borràs R, Prades L, Ariño H, Planagumà J, De-La-Serna E, Escudero D, Llufriu S, Sánchez-Valle R, Santamaria J, Compte A, Castro-Fornieles J, Dalmau J, Páramo D, Medrano V, Casado V, Guanyabens N, Giné-Servén E, Ángeles del Real M, Pardo J, Martin-Gil L, Barrero-Hernández FJ, García-Barragán N, Falip M, Simó M, Rodríguez E, Ruiz Ezquerro JJ, Bataller L, Safont G, Vicente-Hervàs J, Brieva L, Casado I, Portilla JC, Escalante S, Arenillas JF, Erro E, Jericó-Pascual I, Fuerte-Hortigón A, Morató A, Saiz A, Blanco Y, Sepúlveda M, Ruiz R, Naranjo L, Rodés M, Aguilar E, Alba M, Caballero E. Clinical characterisation of patients in the post-acute stage of anti-NMDA receptor encephalitis: a prospective cohort study and comparison with patients with schizophrenia spectrum disorders. Lancet Neurol 2022; 21:899-910. [DOI: 10.1016/s1474-4422(22)00299-x] [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: 04/30/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 10/14/2022]
|
15
|
Sancho-Saldaña A, Gil Sánchez A, Quirant-Sánchez B, Nogueras L, Peralta S, Solana MJ, González-Mingot C, Gallego Y, Quibus L, Ramo-Tello C, Presas-Rodríguez S, Martínez-Cáceres E, Torres P, Hervás JV, Valls J, Brieva L. Seroprevalence of SARS-CoV-2 in a Cohort of Patients with Multiple Sclerosis under Disease-Modifying Therapies. J Clin Med 2022; 11:jcm11092509. [PMID: 35566632 PMCID: PMC9099725 DOI: 10.3390/jcm11092509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) alter the immune system and therefore increase the risk of infection. There is growing concern about the impact of COVID-19 on patients with MS (pwMS), especially those treated with DMTs. Methods: This is a single-center prospective observational study based on data from the Esclerosis Múltiple y COVID-19 (EMCOVID-19) study. Demographic characteristics, MS history, laboratory data and SARS-CoV-2 serology, and symptoms of COVID-19 in pwMS treated with any DTM were extracted. The relationship among demographics, MS status, DMT, and COVID-19 was evaluated. Results: A total of 259 pwMS were included. The administration of interferon was significantly associated with the presence of SARS-CoV-2 antibodies (26.4% vs. 10.7%, p = 0.006). Although patients taking interferon were significantly older (49.1 vs. 43.5, p = 0.003), the association of interferon with the presence of SARS-CoV-2 antibodies was still significant in the multivariate analysis (OR 2.99 (1.38; 6.36), p = 0.006). Conclusions: According to our data, pwMS present a higher risk of COVID-19 infection compared with results obtained from the general population. There is no evidence of a worse COVID-19 outcome in pwMS. DMTs did not significantly change the frequency of COVID-19, except for interferon; however, these findings must be interpreted with caution given the small sample of pwMS taking each DMT.
Collapse
Affiliation(s)
- Agustín Sancho-Saldaña
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Anna Gil Sánchez
- Neuroimmunology Group, Institut de Recerca Biomèdica, Universitat de Lleida, 25001 Lleida, Spain; (A.G.S.); (L.N.); (P.T.)
| | - Bibiana Quirant-Sánchez
- Immunology Division, Hospital Germans Trias i Pujol, LCMN, 08916 Badalona, Spain; (B.Q.-S.); (E.M.-C.)
- Department of Cell Biology, Physiology, Immunology, Autonomous University, Bellaterra, 08193 Barcelona, Spain
| | - Lara Nogueras
- Neuroimmunology Group, Institut de Recerca Biomèdica, Universitat de Lleida, 25001 Lleida, Spain; (A.G.S.); (L.N.); (P.T.)
| | - Silvia Peralta
- Multiple Sclerosis Foundation from Lleida, 25198 Lleida, Spain;
| | - Maria José Solana
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Cristina González-Mingot
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Yhovanni Gallego
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Laura Quibus
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
| | - Cristina Ramo-Tello
- Multiple Sclerosis and Clinical Neuroimmunology Unit, Neurosciences Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (C.R.-T.); (S.P.-R.)
| | - Silvia Presas-Rodríguez
- Multiple Sclerosis and Clinical Neuroimmunology Unit, Neurosciences Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (C.R.-T.); (S.P.-R.)
| | - Eva Martínez-Cáceres
- Immunology Division, Hospital Germans Trias i Pujol, LCMN, 08916 Badalona, Spain; (B.Q.-S.); (E.M.-C.)
- Department of Cell Biology, Physiology, Immunology, Autonomous University, Bellaterra, 08193 Barcelona, Spain
| | - Pascual Torres
- Neuroimmunology Group, Institut de Recerca Biomèdica, Universitat de Lleida, 25001 Lleida, Spain; (A.G.S.); (L.N.); (P.T.)
| | | | - Joan Valls
- Biostatistics Group, Institut de Recerca Biomèdica de Lleida, 25198 Lleida, Spain;
| | - Luis Brieva
- Neurology Department, Hospital Universitario Arnau de Vilanova, IRB Lleida, 25198 Lleida, Spain; (A.S.-S.); (M.J.S.); (C.G.-M.); (Y.G.); (L.Q.)
- Correspondence: ; Tel.: +34-973705200 (ext. 2601)
| |
Collapse
|
16
|
Fernández-Velasco JI, Monreal E, Kuhle J, Meca-Lallana V, Meca-Lallana J, Izquierdo G, Oreja-Guevara C, Gascón-Giménez F, Sainz de la Maza S, Walo-Delgado PE, Lapuente-Suanzes P, Maceski A, Rodríguez-Martín E, Roldán E, Villarrubia N, Saiz A, Blanco Y, Diaz-Pérez C, Valero-López G, Diaz-Diaz J, Aladro Y, Brieva L, Íñiguez C, González-Suárez I, Rodríguez de Antonio LA, García-Domínguez JM, Sabin J, Llufriu S, Masjuan J, Costa-Frossard L, Villar LM. Baseline Inflammatory Status Reveals Dichotomic Immune Mechanisms Involved In Primary-Progressive Multiple Sclerosis Pathology. Front Immunol 2022; 13:842354. [PMID: 35386690 PMCID: PMC8977599 DOI: 10.3389/fimmu.2022.842354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To ascertain the role of inflammation in the response to ocrelizumab in primary-progressive multiple sclerosis (PPMS). Methods Multicenter prospective study including 69 patients with PPMS who initiated ocrelizumab treatment, classified according to baseline presence [Gd+, n=16] or absence [Gd-, n=53] of gadolinium-enhancing lesions in brain MRI. Ten Gd+ (62.5%) and 41 Gd- patients (77.4%) showed non-evidence of disease activity (NEDA) defined as no disability progression or new MRI lesions after 1 year of treatment. Blood immune cell subsets were characterized by flow cytometry, serum immunoglobulins by nephelometry, and serum neurofilament light-chains (sNfL) by SIMOA. Statistical analyses were corrected with the Bonferroni formula. Results More than 60% of patients reached NEDA after a year of treatment, regardless of their baseline characteristics. In Gd+ patients, it associated with a low repopulation rate of inflammatory B cells accompanied by a reduction of sNfL values 6 months after their first ocrelizumab dose. Patients in Gd- group also had low B cell numbers and sNfL values 6 months after initiating treatment, independent of their treatment response. In these patients, NEDA status was associated with a tolerogenic remodeling of the T and innate immune cell compartments, and with a clear increase of serum IgA levels. Conclusion Baseline inflammation influences which immunological pathways predominate in patients with PPMS. Inflammatory B cells played a pivotal role in the Gd+ group and inflammatory T and innate immune cells in Gd- patients. B cell depletion can modulate both mechanisms.
Collapse
Affiliation(s)
| | - Enric Monreal
- Neurology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - José Meca-Lallana
- Multiple Sclerosis and Clinical Neuroimmunology Unit, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | - Celia Oreja-Guevara
- Neurology Department, Cliínico San Carlos Hospital, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | - Aleksandra Maceski
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Ernesto Roldán
- Immunology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Albert Saiz
- Center of Neuroimmunology, Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | | | - Gabriel Valero-López
- Multiple Sclerosis and Clinical Neuroimmunology Unit, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Judit Diaz-Diaz
- Neurology Department, Cliínico San Carlos Hospital, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Yolanda Aladro
- Neurology Department, Getafe University Hospital, Madrid, Spain
| | - Luis Brieva
- Neurology Department, Arnau de Vilanova Hospital, Lleida, Spain
| | - Cristina Íñiguez
- Neurology Department, Lozano Blesa Clinic University Hospital, Zaragoza, Spain
| | | | | | | | - Julia Sabin
- Neurology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Jaime Masjuan
- Neurology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Luisa M Villar
- Immunology Department, Ramon y Cajal University Hospital, Madrid, Spain
| |
Collapse
|
17
|
Brieva L, Estruch BC, Merino JAG, Meca-Lallana V, Río J, Rodríguez-Antigüedad A, Agüera E, Ara JR, Luque AA, Garcia CA, Blanco Y, Castillo-Triviño T, Costa-Frossard L, Platas MG, Pascual LL, Llaneza-González M, Ginés MLM, Matías-Guiu J, Meca-Lallana JE, Bilbao MM, Sempere AP, Romero-Pinel L, Saiz A, Moral E. DISEASE MODIFYING THERAPY SWITCHING IN RELAPSING MULTIPLE SCLEROSIS: A Delphi consensus of the demyelinating expert group of the Spanish Society of Neurology. Mult Scler Relat Disord 2022; 63:103805. [DOI: 10.1016/j.msard.2022.103805] [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: 05/12/2021] [Revised: 03/05/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
|
18
|
Solari A, Montalban X, Lechner-Scott J, Piehl F, Brochet B, Langdon D, Hupperts R, Selmaj K, Havrdova EK, Patti F, Brieva L, Maida EM, Alexandri N, Kamudoni P, Nolting A, Keller B. Improvements in Quality of Life at 1 Year in Patients Treated with Cladribine Tablets for Highly Active Relapsing Multiple Sclerosis: An Interim Analysis of Clarify-MS. Mult Scler Relat Disord 2022. [DOI: 10.1016/j.msard.2022.103623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Sainz de la Maza S, Maurino J, Borges M, Martín-Martínez J, Sotoca J, Alonso A, Caminero AB, Borrega L, Sánchez-Menoyo JL, Barrero-Hernández FJ, Calles C, Brieva L, Blasco MR, García-Soto JD, Campo-Amigo MD, Navarro-Cantó L, Agüera E, Garcés M, Carmona O, Gabaldón-Torres L, Forero L, Hervás M, de Alda LR, Gómez-Ballesteros R, Castillo-Triviño T. Measuring productivity loss in early relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 58:103398. [PMID: 35216781 DOI: 10.1016/j.msard.2021.103398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their autonomy and capacity to maintain employment. OBJECTIVE The aim of this study was to assess the impact on work productivity in early-stage relapsing-remitting multiple sclerosis (RRMS). METHODS A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. Absenteeism, presenteeism, and unpaid work loss due to RRMS were measured using the Valuation of Lost Productivity (VOLP) questionnaire. The EDSS, SymptoMScreen, 5-item Modified Fatigue Impact Scale, Hospital Anxiety and Depression Scale, Symbol Digit Modalities Test, and Multiple Sclerosis Work Difficulties Questionnaire were used to gather information on disability, patients' perception of symptom severity, fatigue, mood/anxiety, cognition, and problems in the workplace, respectively. Associations between the VOLP and clinical and work outcomes were analyzed using Spearman's rank correlations. RESULTS A total of 189 patients were included. Mean age (SD) was 36.1 ± 9.4 years and 71.4% were female. Mean disease duration was 1.2 ± 0.8 years. Median EDSS score was 1.0 (IQR 0, 2.0). One hundred thirty patients (68.8%) were working for pay or self-employed. Fifty-three patients (40.8%) reported absence from work in the past 3 months with an average of 14.3 absent workdays. Their health problems resulted in the loss of 3.4% of their actual work time in the past 7 days. Thirty patients got help (11.8 h) with their unpaid work activities in the past 7 days. Absenteeism was significantly correlated with anxiety and depression (rho=0.298 and 0.291, p<0.001), fatigue (rho=0.214, p = 0.014), and symptom severity (rho=0.213, p = 0.015). Presenteeism was significantly correlated with fatigue (rho=0.375, p<0.001), symptom severity (rho=0.373, p<0.001), depression (rho=0.263, p = 0.008), and disability (rho=0.215, p = 0.031). CONCLUSIONS Productivity loss even in a RRMS population with short disease duration stresses the need for more efficient treatment control of disease activity from earlier stages.
Collapse
Affiliation(s)
| | | | - Mónica Borges
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Javier Sotoca
- Department of Neurology, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Ana Alonso
- Department of Neurology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana B Caminero
- Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain
| | - Laura Borrega
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Maria R Blasco
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - María Del Campo-Amigo
- Department of Neurology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Laura Navarro-Cantó
- Department of Neurology, Hospital General Universitario de Elche, Elche, Spain
| | - Eduardo Agüera
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Moisés Garcés
- Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olga Carmona
- Department of Neurology, Fundació Salut Empordà, Figueres, Spain
| | | | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mariona Hervás
- Department of Neurology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | | | | |
Collapse
|
20
|
Ramo-Tello C, Blanco Y, Brieva L, Casanova B, Martínez-Cáceres E, Ontaneda D, Ramió-Torrentá L, Rovira À. Recommendations for the Diagnosis and Treatment of Multiple Sclerosis Relapses. J Pers Med 2021; 12:jpm12010006. [PMID: 35055321 PMCID: PMC8780774 DOI: 10.3390/jpm12010006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Minimizing the risk of relapse is essential in multiple sclerosis (MS). As none of the treatments currently available are capable of completely preventing relapses, treatment of these episodes remains a cornerstone of MS care. The objective of this manuscript is to reduce uncertainty and improve quality of care of this neurological process. This article addresses definitions of key concepts, recommendations for clinical examination, classification criteria, magnetic resonance imaging, biomarkers, and specific therapeutic counsels including special populations such as pregnant and breastfeeding women, and children. An algorithm for treating MS relapses is also provided.
Collapse
Affiliation(s)
- Cristina Ramo-Tello
- Multiple Sclerosis and Clinical Neuroimmunology Unit, Germans Trias University Hospital, 08916 Badalona, Spain
- Correspondence:
| | - Yolanda Blanco
- Multiple Sclerosis Unit, Clínic Hospital, 08036 Barcelona, Spain;
| | - Luis Brieva
- Multiple Sclerosis Unit, IRBLLEIDA. Arnau de Vilanova Hospital, 25198 Lleida, Spain;
| | - Bonaventura Casanova
- Multiple Sclerosis and Clinical Neuroimmunology Unit, La Fe Hospital, 46026 Valencia, Spain;
| | - Eva Martínez-Cáceres
- Immunology Service, LCMN, Germans Trias University Hospital, 08916 Badalona, Spain;
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Lluís Ramió-Torrentá
- Multiple Sclerosis and Neuroimmunology Unit, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, IDIBGI, 17004 Girona, Spain;
- Department of Medical Sciences, University of Girona, 17004 Girona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Radiology Service, Vall d’Hebron Universitary Hospital, 08035 Barcelona, Spain;
| |
Collapse
|
21
|
Meca-Lallana J, García-Merino JA, Martínez-Yélamos S, Vidal-Jordana A, Costa L, Eichau S, Rovira À, Brieva L, Agüera E, Zarranz ARA. Identification of patients with relapsing multiple sclerosis eligible for high-efficacy therapies. Neurodegener Dis Manag 2021; 11:251-261. [PMID: 33966475 DOI: 10.2217/nmt-2020-0049] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Relapsing multiple sclerosis (RMS) presents a highly variable clinical evolution among patients, and its management should be personalized. Although there is no cure at present, effective disease-modifying therapies (DMTs) are available. Selection of the most appropriate DMT for each patient is influenced by several clinical, radiological and demographic aspects as well as personal preferences that, at times, are not covered in the regulatory criteria. This may be a source of difficulty, especially in certain situations where so-called 'high-efficacy DMTs' (usually considered second-line) could be of greater benefit to the patient. In this narrative review, we discuss evidence and experience, and propose a pragmatic guidance on decision-making with respect to the indication and management of high-efficacy DMT in adult patients with RMS based on expert opinion.
Collapse
Affiliation(s)
- José Meca-Lallana
- Multiple Sclerosis CSUR, Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, 30120, Spain
| | | | - Sergio Martínez-Yélamos
- Neurology Department, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, 08907, Spain
| | - Angela Vidal-Jordana
- Neurology-Neuroimmunology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, 08035, Spain
| | - Lucienne Costa
- CSUR de Esclerosis Múltiple, Neurology Department, Fundación para la Investigación Biomédica IRyCIS, Hospital Universitario Ramón y Cajal, Madrid, 28034, Spain
| | - Sara Eichau
- EM Unit, Neurology Department, Hospital Universitario Virgen de la Macarena, Seville, 41009, Spain
| | - Àlex Rovira
- Neuroradiology Section, Radiology Department, Hospital Universitario Vall d'Hebron, Barcelona, 08035, Spain
| | - Luis Brieva
- Neurology Section, Hospital Universitario Arnau de Vilanova, IRB Lleida, Lleida, 25198, Spain
| | - Eduardo Agüera
- Neurology department, Hospital Universitario Reina Sofía, Cordoba, 14004, Spain
| | | |
Collapse
|
22
|
Fernández-Velasco JI, Kuhle J, Monreal E, Meca-Lallana V, Meca-Lallana J, Izquierdo G, Gascón-Giménez F, Sainz de la Maza S, Walo-Delgado PE, Maceski A, Rodríguez-Martín E, Roldán E, Villarrubia N, Saiz A, Blanco Y, Sánchez P, Carreón-Guarnizo E, Aladro Y, Brieva L, Íñiguez C, González-Suárez I, Rodríguez de Antonio LA, Masjuan J, Costa-Frossard L, Villar LM. Effect of Ocrelizumab in Blood Leukocytes of Patients With Primary Progressive MS. Neurol Neuroimmunol Neuroinflamm 2021; 8:e940. [PMID: 33408167 PMCID: PMC7862094 DOI: 10.1212/nxi.0000000000000940] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the changes induced by ocrelizumab in blood immune cells of patients with primary progressive MS (PPMS). METHODS In this multicenter prospective study including 53 patients with PPMS who initiated ocrelizumab treatment, we determined effector, memory, and regulatory cells by flow cytometry at baseline and after 6 months of therapy. Wilcoxon matched paired tests were used to assess differences between baseline and 6 months' results. p Values were corrected using the Bonferroni test. RESULTS Ocrelizumab reduced the numbers of naive and memory B cells (p < 0.0001) and those of B cells producing interleukin (IL)-6, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor-alpha (TNFα) (p < 0.0001 in all cases). By contrast, the proportions of plasmablasts and B cells producing GM-CSF and TNFα increased significantly, suggesting the need for treatment continuation. We also observed a decrease in CD20+ T-cell numbers (p < 0.0001) and percentages (p < 0.0001), and a clear remodeling of the T-cell compartment characterized by relative increases of the naive/effector ratios in CD4+ (p = 0.002) and CD8+ (p = 0.002) T cells and relative decreases of CD4+ (p = 0.03) and CD8+ (p = 0.004) T cells producing interferon-gamma. Total monocyte numbers increased (p = 0.002), but no changes were observed in those producing inflammatory cytokines. The immunologic variations were associated with a reduction of serum neurofilament light chain (sNfL) levels (p = 0.008). The reduction was observed in patients with Gd-enhanced lesions at baseline and in Gd- patients with baseline sNfL >10 pg/mL. CONCLUSIONS In PPMS, effector B-cell depletion changed T-cell response toward a low inflammatory profile, resulting in decreased sNfL levels.
Collapse
Affiliation(s)
- José I. Fernández-Velasco
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Jens Kuhle
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Enric Monreal
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Virginia Meca-Lallana
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - José Meca-Lallana
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Guillermo Izquierdo
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Francisco Gascón-Giménez
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Susana Sainz de la Maza
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Paulette E. Walo-Delgado
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Aleksandra Maceski
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Eulalia Rodríguez-Martín
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Ernesto Roldán
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Noelia Villarrubia
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Albert Saiz
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Yolanda Blanco
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Pedro Sánchez
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Ester Carreón-Guarnizo
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Yolanda Aladro
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Luis Brieva
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Cristina Íñiguez
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Inés González-Suárez
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Luis A. Rodríguez de Antonio
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Jaime Masjuan
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Lucienne Costa-Frossard
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| | - Luisa M. Villar
- From the Immunology Department (J.I.F.-V., P.E.W.-D., E.R.-M., E.R., N.V., L.M.V.), Ramon y Cajal University Hospital, Madrid, Spain; Neurologic Clinic and Policlinic (J.K., A.M.), Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Neurology Department (E.M., S.S.d.l.M., J.M., L.C.-F.), Ramon y Cajal University Hospital, Madrid; Neurology Department (V.M.-L., P.S.), La Princesa University Hospital, Madrid; Multiple Sclerosis and Clinical Neuroimmunology Unit (J.M.-L., E.C.-G.), Virgen de la Arrixaca University Hospital, Murcia; Multiple Sclerosis Unit (G.I.), Vithas Nisa Sevilla Hospital; Neurology Department (F.G.-G.), Valencia Clinic University Hospital; Center of Neuroimmunology (A.S., Y.B.), Neurology Department, Clínic of Barcelona Hospital, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Institut de Neurociències, Universitat de Barcelona; Neurology Department (Y.A.), Getafe University Hospital, Madrid; Neurology Department (L.B.), Arnau de Vilanova Hospital, Lleida; Neurology Department (C.Í.), Lozano Blesa Clinic University Hospital, Zaragoza; Neurology Department (I.G.-S.), Alvaro Cunqueiro Hospital, Vigo; Neurology Department (L.A.R.d.A.), Fuenlabrada University Hospital, Madrid, Spain
| |
Collapse
|
23
|
Otero-Romero S, Rodríguez-García J, Vilella A, Ara J, Brieva L, Calles C, Carmona O, Casanova V, Costa-Frossard L, Eichau S, García-Merino J, Garcia-Vidal C, González-Platas M, Llaneza M, Martínez-Ginés M, Meca-Lallana J, Prieto J, Rodríguez-Antigüedad A, Tintoré M, Blanco Y, Moral E. Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
24
|
Otero-Romero S, Rodríguez-García J, Vilella A, Ara JR, Brieva L, Calles C, Carmona O, Casanova V, Costa-Frossard L, Eichau S, García-Merino JA, Garcia-Vidal C, González-Platas M, Llaneza M, Martínez-Ginés M, Meca-Lallana JE, Prieto JM, Rodríguez-Antigüedad A, Tintoré M, Blanco Y, Moral E. Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement. Neurologia 2020; 36:50-60. [PMID: 32561334 DOI: 10.1016/j.nrl.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The recent development of highly effective treatments for multiple sclerosis (MS) and the potential risk of infectious complications require the development of prevention and risk minimisation strategies. Vaccination is an essential element of the management of these patients. This consensus statement includes a series of recommendations and practical scenarios for the vaccination of adult patients with MS who are eligible for highly effective immunosuppressive treatments. METHODOLOGY A formal consensus procedure was followed. Having defined the scope of the statement, we conducted a literature search on recommendations for the vaccination of patients with MS and specific vaccination guidelines for immunosuppressed patients receiving biological therapy for other conditions. The modified nominal group technique methodology was used to formulate the recommendations. DEVELOPMENT Vaccination in patients who are candidates for immunosuppressive therapy should be considered before starting immunosuppressive treatment providing the patient's clinical situation allows. Vaccines included in the routine adult vaccination schedule, as well as some specific ones, are recommended depending on the pre-existing immunity status. If immunosuppressive treatment is already established, live attenuated vaccines are contraindicated. For vaccines with a correlate of protection, it is recommended to monitor the serological response in an optimal interval of 1-2 months from the last dose.
Collapse
Affiliation(s)
- S Otero-Romero
- Servicio de Medicina Preventiva, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España; Centro de Esclerosis Múltiple de Catalunya (Cemcat), Departamento de Neurología/Neuroimmunología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España.
| | - J Rodríguez-García
- Servicio de Medicina Preventiva, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - A Vilella
- Servicio de Medicina Preventiva, Hospital Clínic, Universidad de Barcelona-ISGlobal, Barcelona, España
| | - J R Ara
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - L Brieva
- Servicio de Neurología. IRBLLEIDA. Hospital Arnau de Vilanova, Lérida, España
| | - C Calles
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - O Carmona
- Servicio de Neurología, Fundació Salut Empordà, Figueras, Gerona, España
| | - V Casanova
- Unidad de Esclerosis Múltiple, Hospital Universitario La Fe, Valencia, España
| | - L Costa-Frossard
- Servicio de Neurología, Fundación para la Investigación Biomédica IRyCIS, Hospital Ramón y Cajal, Madrid, España
| | - S Eichau
- Unidad CSUR de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - C Garcia-Vidal
- Departamento de Enfermedades Infecciosas, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - M González-Platas
- Servicio de Neurología, Hospital Universitario de Canarias, Tenerife, España
| | - M Llaneza
- Sección de Neurología, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España
| | | | - J E Meca-Lallana
- CSUR Esclerosis Múltiple, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, Universidad Católica San Antonio, Murcia, España
| | - J M Prieto
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - A Rodríguez-Antigüedad
- Servicio de Neurología, Hospital Universitario Cruces-Osakidetza, Baracaldo, Vizcaya, España
| | - M Tintoré
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Departamento de Neurología/Neuroimmunología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España
| | - Y Blanco
- Servicio de Neurología, Hospital Clinic, Barcelona, España
| | - E Moral
- Servicio de Neurología, Hospital Moises Broggi y Hospital General de L'Hospitalet, Hospitalet de Llobregat, Barcelona, España
| | | |
Collapse
|
25
|
Meca-Lallana J, Maurino J, Hernández-Pérez MÁ, Sempere ÁP, Brieva L, García-Arcelay E, Terzaghi M, Saposnik G, Ballesteros J. Psychometric Properties of the SymptoMScreen Questionnaire in a Mild Disability Population of Patients with Relapsing-Remitting Multiple Sclerosis: Quantifying the Patient's Perspective. Neurol Ther 2020; 9:173-179. [PMID: 31955391 PMCID: PMC7229098 DOI: 10.1007/s40120-020-00176-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 12/11/2022] Open
Abstract
Crucial elements for achieving optimal long-term outcomes in multiple sclerosis (MS) are patient confidence and effective physician-patient communication. Patient-reported instruments may provide the means to fill the gap in currently available clinician-rated measures. The SymptoMScreen (SMSS) is a brief self-assessment tool for measuring symptom severity in 12 neurologic domains commonly affected by MS. We conducted a non-interventional study to assess the dimensional structure and item characteristics of the SMSS. A total of 218 patients with relapsing-remitting MS and mild disability (median Expanded Disability Status Scale score 2.0) were studied. Symptom severity was low (SMSS score 13.5, interquartile range 4.2-27), fatigue being the domain with the highest impact. A non-parametric item response theory, i.e., Mokken analysis, found that the SMSS is a robust one-dimensional scale (overall scalability index H 0.60) with high reliability (Cronbach's alpha 0.94). The confirmatory factor analysis model confirmed the unidimensional structure (comparative fit index 1.0, root-mean-square error of approximation 0.001). Samejima's model fitted well an unconstrained model with different item difficulties. The SMSS shows appropriate psychometric characteristics and may constitute a valuable and easy-to-implement addition to measure the symptom severity in clinical practice.
Collapse
Affiliation(s)
- José Meca-Lallana
- Clinical Neuroimmunology Unit and Multiple Sclerosis CSUR, Department of Neurology, Hospital Universitario "Virgen de la Arrixaca", Biomedical Research Institute of Murcia (IMIB-Arrixaca), Universidad Católica San Antonio (UCAM), Murcia, Spain
| | | | | | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | | | - María Terzaghi
- Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada
| | - Gustavo Saposnik
- Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, ON, Toronto, Canada
| | - Javier Ballesteros
- Department of Neurosciences and CIBERSAM, University of Basque Country (UPV/EHU), Leioa, Spain
| |
Collapse
|
26
|
Gonzalo H, Nogueras L, Gil-Sánchez A, Hervás JV, Valcheva P, González-Mingot C, Martin-Gari M, Canudes M, Peralta S, Solana MJ, Pamplona R, Portero-Otin M, Boada J, Serrano JCE, Brieva L. Impairment of Mitochondrial Redox Status in Peripheral Lymphocytes of Multiple Sclerosis Patients. Front Neurosci 2019; 13:938. [PMID: 31551694 PMCID: PMC6738270 DOI: 10.3389/fnins.2019.00938] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/21/2019] [Indexed: 11/13/2022] Open
Abstract
Literature suggests that oxidative stress (OS) may be involved in the pathogenesis of multiple sclerosis (MS), in which the immune system is known to play a key role. However, to date, the OS in peripheral lymphocytes and its contribution to the disease remain unknown. The aim of the present study was to explore the influence of OS in peripheral lymphocytes of MS patients. To that end, a cross-sectional, observational pilot study was conducted [n = 58: 34 MS and 24 healthy subjects (control group)]. We have measured superoxide production and protein mitochondrial complex levels in peripheral blood mononuclear cells (PBMCs) isolated from MS patients and control. Lactate levels and the antioxidant capacity were determined in plasma. We adjusted the comparisons between study groups by age, sex and cell count according to case. Results demonstrated that PBMCs, specifically T cells, from MS patients exhibited significantly increased superoxide anion production compared to control group (p = 0.027 and p = 0.041, respectively). Increased superoxide production in PBMCs was maintained after the adjustment (p = 0.044). Regarding mitochondrial proteins, we observe a significant decrease in the representative protein content of the mitochondrial respiratory chain complexes I-V in PBMCs of MS patients (p = 0.002, p = 0.037, p = 0.03, p = 0.044, and p = 0.051, respectively), which was maintained for complexes I, III, and V after the adjustment (p = 0.026; p = 0.033; p = 0.033, respectively). In MS patients, a trend toward increased plasma lactate concentration was detected [8.04 mg lactate/dL (5.25, 9.49) in the control group, 11.36 mg lactate/dL (5.41, 14.81) in MS patients] that was statistically significant after the adjustment (p = 0.013). This might be indicative of compromised mitochondrial function. Finally, antioxidant capacity was also decreased in plasma from MS patients, both before (p = 0.027) and after adjusting for sex and age (p = 0.006). Our findings demonstrate that PBMCs of MS patients show impaired mitochondrial redox status and deficient antioxidant capacity. These results demonstrate for the first time the existence of mitochondrial alterations in the cells immune cells of MS patients already at the peripheral level.
Collapse
Affiliation(s)
- Hugo Gonzalo
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain.,Clinical University Hospital of Valladolid (HCUV), Department of Research and Innovation, SACYL/IECSCYL, Valladolid, Spain
| | - Lara Nogueras
- Universitat de Lleida, Departament de Medicina Experimental, Lleida, Spain
| | | | | | | | | | | | - Marc Canudes
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | | | | | - Reinald Pamplona
- Universitat de Lleida, Departament de Medicina Experimental, Lleida, Spain
| | | | - Jordi Boada
- Universitat de Lleida, Departament de Medicina Experimental, Lleida, Spain
| | | | - Luis Brieva
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| |
Collapse
|
27
|
Vázquez-Justes D, Carreño-Gago L, García-Arumi E, Traveset A, Montoya J, Ruiz-Pesini E, López R, Brieva L. Mitochondrial m.13513G>A Point Mutation in ND5 in a 16-Year-Old Man with Leber Hereditary Optic Neuropathy Detected by Next-Generation Sequencing. J Pediatr Genet 2019; 8:231-234. [PMID: 31687263 DOI: 10.1055/s-0039-1691812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
This article reports a Leber hereditary optic neuropathy (LHON) case associated for the first time with mitochondrial m.13513G>A mutation. We present a 16-year-old man who complained of subacute, painless, visual loss. Ocular examination showed optic nerve atrophy, papillary pseudoedema, and optic disc pallor. Extraocular manifestations included hypertrophic myocardiopathy and myopathy. Initial genetic analysis excluded the three most common LHON mutations. Sanger sequencing of the whole mitochondrial deoxyribonucleic acid showed no mutation. Next-generation sequencing (NGS) revealed m.13513G>A mutation in the NADH dehydrogenase (ND5) subunit gene ( MT-ND5 ). The m.13513G>A mutation has never been associated with LHON phenotype without Leigh/mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes features. NGS techniques should be considered when this diagnosis is strongly suspected.
Collapse
Affiliation(s)
| | - Lidia Carreño-Gago
- Departament de Patología Mitocondrial i Neuromuscular, Hospital Universitari Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Barcelona, Spain
| | - Elena García-Arumi
- Departament de Patología Mitocondrial i Neuromuscular, Hospital Universitari Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Barcelona, Spain.,Àrea de Genètica Clínica i Molecular, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alicia Traveset
- Department of Ophthalmology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Julio Montoya
- Departamento de Bioquimica, Biologia Molecular y Celular, Universidad de Zaragoza, Centro de Investigaciones Biomédicas en Red de Enfermedades Raras, CIBERER, Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
| | - Eduardo Ruiz-Pesini
- Departamento de Bioquimica, Biologia Molecular y Celular, Universidad de Zaragoza, Centro de Investigaciones Biomédicas en Red de Enfermedades Raras, CIBERER, Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
| | - Ricard López
- Unitat de Citogenètica, Laboratori Clínic ICS, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| |
Collapse
|
28
|
Quirant-Sánchez B, Hervás-García JV, Teniente-Serra A, Brieva L, Moral-Torres E, Cano A, Munteis E, Mansilla MJ, Presas-Rodriguez S, Navarro-Barriuso J, Ramo-Tello C, Martínez-Cáceres EM. Predicting therapeutic response to fingolimod treatment in multiple sclerosis patients. CNS Neurosci Ther 2018; 24:1175-1184. [PMID: 29656444 DOI: 10.1111/cns.12851] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 11/01/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022] Open
Abstract
AIMS Fingolimod, an orally active immunomodulatory drug for relapsing-remitting multiple sclerosis (RRMS), sequesters T cells in lymph nodes through functional antagonism of the sphingosine-1-phosphate receptor, reducing the number of potential autoreactive cells that migrate to the central nervous system. However, not all RRMS patients respond to this therapy. Our aim was to test the hypothesis that by immune-monitoring RRMS patient's leukocyte subpopulations it is possible to find biomarkers associated with clinical response to fingolimod. METHODS Prospective study. Analysis of peripheral blood mononuclear cell subpopulations by multiparametric flow cytometry, at baseline and +1, +3, +6, +12 months of follow-up in 40 RRMS patients starting fingolimod therapy. RESULTS Fingolimod treatment induced a severe lymphopenia affecting mainly T and B cells. A relative increase in Treg (memory Treg : 3.8 ± 1.0% baseline vs 8.8 ± 4.4% month +1; activated Treg : 1.5 ± 0.7% baseline vs 3.7 ± 2.1% month +1, P < 0.001) as well as transitional B cells (10.5 ± 12.3% baseline vs 18.7 ± 14.6% month +1, P < 0.001) was observed. Interestingly, lymphocyte subpopulations were already at baseline significantly different in responder patients. The percentage of recent thymic emigrants (RTE) used to stratify fingolimod responder, and no responder patients was the best biomarker (4.0 ± 1.4% vs 7.4 ± 1.9%, respectively [P < 0.001]). CONCLUSION The results support that immune-monitoring of lymphocyte subpopulations in peripheral blood is a promising tool to select RRMS candidate for fingolimod treatment.
Collapse
Affiliation(s)
- Bibiana Quirant-Sánchez
- Immunology Division, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José V Hervás-García
- Multiple Sclerosis Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Aina Teniente-Serra
- Immunology Division, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Brieva
- Neurology Department of Hospital Arnau Vilanova, Lerida, Spain
| | - Ester Moral-Torres
- Neurology Department of Hospital San Joan Despi Moises Broggi, Barcelona, Spain
| | - Antonio Cano
- Neurology Department of Hospital de Mataró, Barcelona, Spain
| | - Elvira Munteis
- Neurology Department of Hospital del Mar, Barcelona, Spain
| | - María J Mansilla
- Immunology Division, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Presas-Rodriguez
- Multiple Sclerosis Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Juan Navarro-Barriuso
- Immunology Division, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Ramo-Tello
- Multiple Sclerosis Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Eva M Martínez-Cáceres
- Immunology Division, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
29
|
Sepúlveda M, Aldea M, Escudero D, Llufriu S, Arrambide G, Otero-Romero S, Sastre-Garriga J, Romero-Pinel L, Martínez-Yélamos S, Sola-Valls N, Armangué T, Sotoca J, Escartín A, Robles-Cedeño R, Ramió-Torrentà L, Presas-Rodríguez S, Ramo-Tello C, Munteis E, Pelayo R, Gubieras L, Brieva L, Ortiz N, Hervás M, Mañé-Martínez MA, Cano A, Vela E, Tintoré M, Blanco Y, Montalban X, Graus F, Saiz A. Epidemiology of NMOSD in Catalonia: Influence of the new 2015 criteria in incidence and prevalence estimates. Mult Scler 2017; 24:1843-1851. [PMID: 28984163 DOI: 10.1177/1352458517735191] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Population-based studies on neuromyelitis optica spectrum disorders (NMOSD) are limited, and it is unclear whether the rates have changed with the implementation of the new 2015 criteria. OBJECTIVES To estimate the incidence and prevalence of NMOSD in Catalonia (Spain), using both the 2006 and the 2015 criteria. METHODS In this clinic-based retrospective study, patients diagnosed with NMOSD between 2006 and 2015 were identified using multiple sources, including direct contact to all Catalan hospitals, identification of cases through the Catalan Health Surveillance System, and registry of antibodies to aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) in a reference laboratory. The incidence rate was calculated for the period 1 January 2006-1 January 2016 and prevalence for the date 1 January 2016. RESULTS We identified 74 patients (by the 2015 criteria). Most patients were Caucasian (81%), and female (76%) with a median age at disease onset of 42 years (range, 10-76 years). In total, 54 (73%) patients were positive for AQP4-IgG, 11 (15%) double-seronegative, and 9 (12%) MOG-IgG-positive. Rates of incidence and prevalence (0.63/1,000,000 person-years and 0.89/100,000, respectively) were 1.5-fold higher than those reported by the 2006 criteria. Lowest rates were seen in children and elder people and highest in women and middle-aged people (40-59 years). The female predominance was lost in incident AQP4-IgG-seronegative children and AQP4-IgG-positive elder people. MOG-IgG and double-seronegativity contributed similarly but did not influence the long-term outcome. CONCLUSION The new criteria increase the estimates, but NMOSD remains as a rare disease. The differences in age- and sex-specific estimates highlight the importance of the serologic classification.
Collapse
Affiliation(s)
- Maria Sepúlveda
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marta Aldea
- Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Domingo Escudero
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lucía Romero-Pinel
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - N Sola-Valls
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Thais Armangué
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain/Pediatric Neuroimmunology and Neuroinfections Unit, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Spain/Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Javier Sotoca
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Escartín
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - René Robles-Cedeño
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Doctor Josep Trueta University Hospital, Girona, Spain/ Santa Caterina Hospital, Girona, Spain/Biomedical Research Institute (IDIBGI), Girona, Spain/Medical Sciences Department, University of Girona, Girona, Spain
| | - Lluís Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Doctor Josep Trueta University Hospital, Girona, Spain/ Santa Caterina Hospital, Girona, Spain/Biomedical Research Institute (IDIBGI), Girona, Spain/Medical Sciences Department, University of Girona, Girona, Spain
| | - Silvia Presas-Rodríguez
- Multiple Sclerosis Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Cristina Ramo-Tello
- Multiple Sclerosis Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Elvira Munteis
- Multiple Sclerosis Unit, Neurology Department, Parc de Salut Mar, Barcelona, Spain
| | | | - Laura Gubieras
- Multiple Sclerosis Unit, Neurology Department, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Luis Brieva
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Nicolau Ortiz
- Neurology Department, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - Mariona Hervás
- Multiple Sclerosis Unit, Neurology Department, Hospital Parc Taulí de Sabadell, Barcelona, Spain
| | | | - Antonio Cano
- Neurology Department, Hospital de Mataró, Barcelona, Spain
| | - Emili Vela
- Unit of Information and Knowledge, Catalan Health Service, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Francesc Graus
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Albert Saiz
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| |
Collapse
|
30
|
Ballesteros J, Moral E, Brieva L, Ruiz-Beato E, Prefasi D, Maurino J. Psychometric properties of the SDM-Q-9 questionnaire for shared decision-making in multiple sclerosis: item response theory modelling and confirmatory factor analysis. Health Qual Life Outcomes 2017; 15:79. [PMID: 28431587 PMCID: PMC5401467 DOI: 10.1186/s12955-017-0656-2] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/21/2022] Open
Abstract
Background Shared decision-making is a cornerstone of patient-centred care. The 9-item Shared Decision-Making Questionnaire (SDM-Q-9) is a brief self-assessment tool for measuring patients’ perceived level of involvement in decision-making related to their own treatment and care. Information related to the psychometric properties of the SDM-Q-9 for multiple sclerosis (MS) patients is limited. The objective of this study was to assess the performance of the items composing the SDM-Q-9 and its dimensional structure in patients with relapsing-remitting MS. Methods A non-interventional, cross-sectional study in adult patients with relapsing-remitting MS was conducted in 17 MS units throughout Spain. A nonparametric item response theory (IRT) analysis was used to assess the latent construct and dimensional structure underlying the observed responses. A parametric IRT model, General Partial Credit Model, was fitted to obtain estimates of the relationship between the latent construct and item characteristics. The unidimensionality of the SDM-Q-9 instrument was assessed by confirmatory factor analysis. Results A total of 221 patients were studied (mean age = 42.1 ± 9.9 years, 68.3% female). Median Expanded Disability Status Scale score was 2.5 ± 1.5. Most patients reported taking part in each step of the decision-making process. Internal reliability of the instrument was high (Cronbach’s α = 0.91) and the overall scale scalability score was 0.57, indicative of a strong scale. All items, except for the item 1, showed scalability indices higher than 0.30. Four items (items 6 through to 9) conveyed more than half of the SDM-Q-9 overall information (67.3%). The SDM-Q-9 was a good fit for a unidimensional latent structure (comparative fit index = 0.98, root-mean-square error of approximation = 0.07). All freely estimated parameters were statistically significant (P < 0.001). All items presented standardized parameter estimates with salient loadings (>0.40) with the exception of item 1 which presented the lowest loading (0.26). Items 6 through to 8 were the most relevant items for shared decision-making. Conclusions The SDM-Q-9 presents appropriate psychometric properties and is therefore useful for assessing different aspects of shared decision-making in patients with multiple sclerosis.
Collapse
Affiliation(s)
- Javier Ballesteros
- Department of Neurosciences and CIBERSAM, University of Basque Country, Leioa, Spain
| | - Ester Moral
- Department of Neurology, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Elena Ruiz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma SA, Madrid, Spain
| | - Daniel Prefasi
- Medical Department, Roche Farma SA, Eucalipto 33, 28016, Madrid, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma SA, Eucalipto 33, 28016, Madrid, Spain.
| |
Collapse
|
31
|
Guasp M, Solà-Valls N, Martínez-Hernández E, Gil MP, González C, Brieva L, Saiz A, Dalmau J, Graus F, Ariño H. Cerebellar ataxia and autoantibodies restricted to glutamic acid decarboxylase 67 (GAD67). J Neuroimmunol 2016; 300:15-17. [PMID: 27806870 DOI: 10.1016/j.jneuroim.2016.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 02/03/2023]
Abstract
Cerebellar ataxia is one of the most frequent syndromes associated with autoantibodies against glutamic acid decarboxylase (GAD-ab). Antibodies recognize the isoform GAD65, which is the standard biomarker, but additional immunoreactivity against GAD67 is found in high proportion of patients with GAD-ab-associated neurological disorders. We describe the case of a 59-year-old woman who presented with pancerebellar syndrome of subacute onset (9weeks to nadir). In the etiological study, high titers of GAD-ab were found, but these only recognized the GAD67 isoform and not the GAD65. Screening of GAD67-ab should be considered in late-onset cerebellar ataxia when GAD65-ab are absent.
Collapse
Affiliation(s)
- Mar Guasp
- Service of Neurology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Solà-Valls
- Service of Neurology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Eugenia Martínez-Hernández
- Service of Neurology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain
| | - M Pilar Gil
- Service of Neurology, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Luis Brieva
- Service of Neurology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Albert Saiz
- Service of Neurology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Dalmau
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain; Neurology, University of Pennsylvania, United States
| | - Francesc Graus
- Service of Neurology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Helena Ariño
- Service of Neurology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain.
| |
Collapse
|
32
|
Espejo C, Brieva L, Ruggiero G, Río J, Montalban X, Martínez-Cáceres EM. IFN-β treatment modulates the CD28/CTLA-4-mediated pathway for IL-2 production in patients with relapsing -remitting multiple sclerosis. Mult Scler 2016; 10:630-5. [PMID: 15584487 DOI: 10.1191/1352458504ms1094oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system probably mediated by Th1 lymphocytes. IFN-b is an established therapy for relapsing MS patients, although the mechanisms underlying its efficacy are yet to be well characterized. We determined IL-2 production, CD25 expression and T-cell proliferation from relapsing -remitting MS patients before and three months after starting therapy. A decrease in the percentage of CD80-induced IL-2-producing cells was observed after in vivo IFN-b treatment. These data support that one of the immunomodulatory effects of IFN-b treatment in MS may be a limitation of the autoimmune response modifying the CD80:CD28/CTLA-4 pathway.
Collapse
Affiliation(s)
- C Espejo
- Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
33
|
Ramo-Tello C, Tintoré M, Rovira A, Ramió-Torrenta L, Brieva L, Saiz A, Cano A, Carmona O, Hervás JV, Grau-López L. Baseline clinical status as a predictor of methylprednisolone response in multiple sclerosis relapses. Mult Scler 2015; 22:117-21. [PMID: 26540732 DOI: 10.1177/1352458515590648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND To date, there are no available factors to predict the outcome after multiple sclerosis relapse. AIM To investigate factors that may be useful for predicting response to methylprednisolone treatment, following a relapse of multiple sclerosis (MS). METHODS The study included 48 MS patients enrolled in a double-blind multicenter trial to receive intravenous versus oral high-dose methylprednisolone treatment. Associations were sought between the disability status prior to relapse and the relapse severity, determined by changes in the Expanded Disability Status Scale (EDSS) score, as well as the improvements after treatment. We also analyzed the relationships between the number of magnetic resonance imaging (MRI) gadolinium-enhancing lesions (Gd+) and improvement. RESULTS A higher EDSS score before relapse was associated with more severe relapses (p = 0.04) and less marked improvement (odds ratio (OR) 1.8; 95% CI (1.2-2.2); p = 0.05) after methylprednisolone treatment. Relapse severity (p = 0.29) and the number of Gd+ lesions at relapse (p = 0.41) were not related with improvement. CONCLUSIONS Clinical baseline status prior to MS relapse is a predictor of response to methylprednisolone treatment.
Collapse
|
34
|
Grau-López L, Teniente-Serra A, Tintoré M, Rovira A, Ramió-Torrenta L, Brieva L, Saiz A, Cano A, Carmona O, Hervás JV, Martínez-Cáceres EM, Ramo-Tello C. Similar biological effect of high-dose oral versus intravenous methylprednisolone in multiple sclerosis relapses. Mult Scler 2014; 21:646-50. [PMID: 25145693 DOI: 10.1177/1352458514546786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Our aim was to investigate differences in immune mechanisms in multiple sclerosis (MS) relapse, after high-dose oral methylprednisolone (oMP) or intravenous methylprednisolone (ivMP). We measured serum cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α and IFN-γ) in 39 of 49 MS patients with moderate-severe relapse, whom were treated with ivMP or oMP in a placebo-controlled, non-inferiority clinical trial. We assessed these cytokine levels at baseline and at 1 and 4 weeks post-treatment. The cytokine levels between oMP and ivMP were similar at any time. Proinflammatory cytokines (IL-6 and IFN-γ) were significantly decreased in both groups at week 1 (p = 0.05 / p = 0.03) and at week 4 (p = 0.04 / p = 0.05). This study provides further confirmatory evidence that oMP is not inferior to ivMP. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT00753792.
Collapse
Affiliation(s)
- L Grau-López
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| | - A Teniente-Serra
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| | - M Tintoré
- Hospital Vall D' Hebron, Barcelona, Spain
| | - A Rovira
- Hospital Vall D' Hebron, Barcelona, Spain
| | | | - L Brieva
- Hospital Arnau de Vilanova, Lleida, Spain
| | - A Saiz
- Hospital Clinic, Barcelona, Spain
| | - A Cano
- Hospital de Mataró, Mataró, Spain
| | - O Carmona
- Hospital de Figueres, Figueres, Spain
| | - J V Hervás
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| | - E M Martínez-Cáceres
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| | - C Ramo-Tello
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| |
Collapse
|
35
|
Ramo-Tello C, Grau-López L, Tintoré M, Rovira A, Ramió i Torrenta L, Brieva L, Cano A, Carmona O, Saiz A, Torres F, Giner P, Nos C, Massuet A, Montalbán X, Martínez-Cáceres E, Costa J. A randomized clinical trial of oral versus intravenous methylprednisolone for relapse of MS. Mult Scler 2013; 20:717-25. [DOI: 10.1177/1352458513508835] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Steroids improve multiple sclerosis (MS) relapses but therapeutic window and dose, frequency and administration route remain uncertain. Objective: The objective of this paper is to compare the clinical and radiologic efficacy, tolerability and safety of intravenous methylprednisolone (ivMP) vs oral methylprednisolone (oMP), at equivalent high doses, for MS relapse. Methods: Forty-nine patients with moderate or severe relapse within the previous 15 days were randomized in a double-blind, noninferiority, multicenter trial to receive ivMP or oMP and their matching placebos. Expanded Disability Status Scale (EDSS) scores were determined at baseline and weeks 1, 4 and 12. Brain MRI were assessed at baseline and at weeks 1 and 4. Primary endpoint was a noninferiority assessment of EDSS improvement at four weeks (noninferiority margin of one point), with further key efficacy assessments of number and volume of T1 gadolinium-enhancing (Gd+), and new or enlarged T2 lesions at four weeks’ post-treatment initiation. Secondary outcomes were safety and tolerability. Results: The study achieved the main outcome of noninferiority at four weeks for improved EDSS score. No differences were found between ivMP and oMP in the number of Gd+ lesions (0 (0–1) vs 0 (0–0.5), p = 0.630), volume of Gd+ lesions (0 (0–88.0) vs 0 (0–32.9) mm3, p = 0.735), or new or enlarged T2 lesions (0 (0–194) vs 0 (0–123), p = 0.769). MP was well tolerated, and no serious adverse events were reported. Conclusions: This study provides confirmatory evidence that oMP is not inferior to ivMP in reducing EDSS, similar in MRI lesions at four weeks for MS relapses and is equally well tolerated and safe. Trial registration: clinicaltrials.gov identifier: NCT00753792
Collapse
Affiliation(s)
| | | | | | | | | | - L Brieva
- Hospital Arnau de Vilanova, Spain
| | - A Cano
- Hospital de Mataró, Spain
| | | | - A Saiz
- Hospital Clínic i Provincial, Spain
| | - F Torres
- Hospital Clínic i Provincial, Spain
| | - P Giner
- Hospital Germans Trias i Pujol, Spain
| | - C Nos
- Hospital Vall d’Hebron, Spain
| | - A Massuet
- Hospital Germans Trias i Pujol, Spain
| | | | | | - J Costa
- Hospital Germans Trias i Pujol, Spain
| |
Collapse
|
36
|
Gonzalo H, Brieva L, Tatzber F, Jové M, Cacabelos D, Cassanyé A, Lanau-Angulo L, Boada J, Serrano JCE, González C, Hernández L, Peralta S, Pamplona R, Portero-Otin M. Lipidome analysis in multiple sclerosis reveals protein lipoxidative damage as a potential pathogenic mechanism. J Neurochem 2012; 123:622-34. [PMID: 22924648 DOI: 10.1111/j.1471-4159.2012.07934.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 08/18/2012] [Accepted: 08/19/2012] [Indexed: 11/30/2022]
Abstract
Metabolomic and lipidomic analyses have been used for the profiling of neurodegenerative processes, both in targeted and untargeted approaches. In this work we have applied these techniques to the study of CSF samples of multiple sclerosis (MS) patients (n = 9), compared with samples of non-MS individuals (n = 9) using mass-spectrometry. We have used western-blot and analyzed cell culture to confirm pathogenic pathways suggested by mass-spectrometric measurements. The results of the untargeted approach of metabolomics and lipidomics suggest the existence of several metabolites and lipids discriminating both populations. Applying targeted lipidomic analyses focused to a pathogenic pathway in MS, oxidative stress, reveal that the lipid peroxidation marker 8-iso-prostaglandin F2α is increased in CSF from MS patients. Furthermore, as lipid peroxidation exerts its pathogenical effects through protein modification, we studied the incidence of protein lipoxidation, revealing specific increases in carboxymethylated, neuroketal and malondialdehyde-mediated protein modifications in proteins of CSF from MS patients, despite the absence of their precursors glyoxal and methylglyoxal. Finally, we report that the level of neuroketal-modified proteins correlated with a hitherto unknown increased amount of autoantibodies against lipid peroxidation-modified proteins in CSF, without compensation by signaling induced by lipid peroxidation via peroxisome proliferator-activated receptor γ (PPARγ). The results, despite the limitation of being obtained in a small population, strongly suggest that autoimmunity against in situ produced epitopes derived from lipid peroxidation can be a relevant pathogenic factor in MS.
Collapse
Affiliation(s)
- Hugo Gonzalo
- Department of Experimental Medicine, PCiTAL-Universitat de Lleida-IRBLLEIDA, Lleida, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Ramo C, Grau L, Giner P, Ramio L, Brieva L, Saiz A, Cano A, Carmona O, Martinez-Caceres E, Costa J. A Multicentric, Double Blind Randomized Clinical and MRI Study of High-Dose Oral vs Intravenous Methylprednisolone in Acute Relapses of Multiple Sclerosis (P01.128). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
38
|
Purroy F, Montserrat J, Begué R, Gil MI, Quílez A, Sanahuja J, Brieva L, Pardina M, Piñol-Ripoll G. Higher Carotid Intima Media Thickness Predicts Extracranial Vascular Events and Not Stroke Recurrence among Transient Ischemic Attack Patients. Int J Stroke 2012; 7:125-32. [DOI: 10.1111/j.1747-4949.2011.00764.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Increased common carotid artery intima-media thickness has been associated with an increased risk of vascular ischemic events. We investigated the relationship between common carotid artery intima-media thickness and extracranial vascular events (coronary heart disease and peripheral arterial disease) or stroke recurrence in a cohort of transient ischemic attack patients from the REGITELL registry. Methods High-resolution B-mode ultrasonographic measurements of the common carotid artery intima-media thickness were performed in a series of 283 consecutive transient ischemic attack patients. Clinical, neuroimaging, ultrasonographic, and etiological data were collected. Patients were followed prospectively for six-months or more. Extracranial vascular events and stroke recurrence were recorded. Results Fifteen extracranial vascular events (12 coronary heart disease and three peripheral arterial disease) and 29 recurrent strokes occurred during a median follow-up period of 12·3 months. Patients who experienced extracranial vascular events had significantly ( P < 0·001) higher common carotid artery intima-media thickness values (1·087 (standard deviation 0·189) mm) than subjects who were free of extracranial vascular events (0·887 (standard deviation 0·195) mm). Nevertheless, common carotid artery intima-media thickness was not found to correlate with stroke recurrence. Cox proportional hazards multivariate analyses identified hypercholesterolemia (hazard ratio 6·87, 95% confidence interval: 1·93–24·39, P = 0·003) and common carotid artery intima-media thickness >0·939 mm (hazard ratio 8·90, 95% confidence interval: 2·00–39·49, P = 0·004) as independent predictors of extracranial vascular events after transient ischemic attack. Almost one of every three patients with hypercholesterolemia and high common carotid artery intima-media thickness had extracranial vascular events. Conclusions An elevated common carotid artery intima-media thickness value was associated with a higher long-term risk of extracranial vascular events but no with stroke recurrence. Hypercholesterolemia was the main risk factor for extracranial vascular events. The combination of hypercholesterolemia and common carotid artery intima-media thickness >0·939 mm justify the establishment of aggressive therapies and the study of subclinical coronary heart disease and peripheral arterial disease.
Collapse
Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Josep Montserrat
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Robert Begué
- Institut de diagnòstic per la imatge, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Maria Isabel Gil
- Institut de diagnòstic per la imatge, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Alejandro Quílez
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Jordi Sanahuja
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Luis Brieva
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Marina Pardina
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Gerard Piñol-Ripoll
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| |
Collapse
|
39
|
Purroy F, Quílez-Martínez A, Pardina M, Suárez-Luis I, Sanahuja-Montesinos J, Brieva L, Piñol-Ripoll G. [How can determination of the carotid intima-media thickness contribute to the process of diagnosing transient ischaemic attacks?]. Rev Neurol 2010; 51:721-728. [PMID: 21157734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PATIENTS AND METHODS The carotid intima media thickness (IMT) is a new prognostic marker of vascular events. We studied its usefulness in the diagnosis workup of 211 consecutive transient ischemic attack (TIA) patients from the REGITELL registration. GIM was measured according to Mannheim criteria. It was established its relationship to the main prognostic variables described in TIA: ABCD2 scale, symptomatology and etiologic subtypes according to TOAST classification. RESULTS Men value of carotid IMT was 0.91 ± 0.20 mm. After Bonferroni adjustment, IMT was associated with age of 60 years or older (0.95 ± 0.19 mm; p < 0.001), male sex (0.95 ± 0.20 mm; p = 0.003), ABCD2 scale (p < 0.001), association of risk factors are greater than or equal to 2 (0.94 ± 0.20 mm; p < 0.001), carotid plaque presence (0.98 ± 0.19 mm; p < 0.001), intracranial stenosis (1.09 ± 0.18 mm; p = 0.001), presence of ischemic chronic lesions on head CT (p <0.001) and etiology (p < 0.001). The patients presented with isolated sensory symptoms had significantly lower IMT (0.77 ± 0.18 mm; p = 0.002). Belonging to the third tertile of IMT was only an independent predictor of large-artery atherosclerosis (OR = 3,06; CI 95% = 1.31-7.13; p = 0.01). CONCLUSION Based on our results, IMT determination seems to not improve the diagnostic accuracy of other ultrasonographic characteristics like the presence of plaques or the degree of stenosis.
Collapse
Affiliation(s)
- Francisco Purroy
- Unidad de Ictus, Seccion de Neurologia, Hospital Universitari Arnau de Vilanova, 25006 Lleida, España.
| | | | | | | | | | | | | |
Collapse
|
40
|
Purroy F, Begué R, Gil MI, Quílez A, Sanahuja J, Brieva L, Piñol-Ripoll G. Patterns of diffusion-weighted magnetic resonance imaging associated with etiology improve the accuracy of prognosis after transient ischaemic attack. Eur J Neurol 2010; 18:121-8. [DOI: 10.1111/j.1468-1331.2010.03080.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Purroy F, Piñol-Ripoll G, Quílez A, Sanahuja J, Brieva L, Suárez Luis I. Validación de las escalas ABCDI y ABCD2I en el registro de pacientes con ataque isquémico transitorio de Lleida (REGITELL). Med Clin (Barc) 2010; 135:351-6. [DOI: 10.1016/j.medcli.2009.10.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 10/12/2009] [Accepted: 10/20/2009] [Indexed: 11/17/2022]
|
42
|
Bosma LVAE, Kragt JJ, Brieva L, Khaleeli Z, Montalban X, Polman CH, Thompson AJ, Tintoré M, Uitdehaag BMJ. Progression on the Multiple Sclerosis Functional Composite in multiple sclerosis: what is the optimal cut-off for the three components? Mult Scler 2010; 16:862-7. [DOI: 10.1177/1352458510370464] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For the Timed 25-Foot Walk (T25FW) and 9-Hole Peg Test (9HPT), components of the Multiple Sclerosis Functional Composite (MSFC), cut-off points of 20% change have previously been defined as meaningful endpoints of functional decline. Recently, however, a 15% change of MSFC components was introduced. The objective of this study was to determine optimal cut-offs for all MSFC components to indicate clinical disease progression in a primary progressive (PP) multiple sclerosis (MS) population. T25FW, 9HPT and the Paced Auditory Serial Addition Test (PASAT) were performed in 161 patients with PPMS with a 2-year interval. Absolute and relative differences in test scores were calculated. For each cut-off point of relative change, proportions of patients who progressed (deterioration beyond cut-off value) and improved (improvement beyond cut-off value) were calculated. Further, we calculated the ratio of ‘improved’ versus ‘progressed’ patients. Line graphs were created indicating: percentage progressed patients, percentage improved patients, and ratio of improved versus progressed patients. The optimal cut-off was determined by searching the cut-off point with the lowest ratio of improved versus progressed patients, while at the same time capturing a substantial amount of progression. For both T25FW and 9HPT, the ratio between patients that improved and worsened clearly decreased between the cut-offs of 15% and 20%. For the PASAT, the ratio between patients improved and worsened was persistently poor. In conclusion, a cut-off of 20% for both T25FW and 9HPT has a better signal-to-noise ratio than lower values (e.g. 15%) and is therefore preferable for the assessment of disease progression. No satisfactory cut-off point for the PASAT could be determined.
Collapse
Affiliation(s)
- LVAE Bosma
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands,
| | - JJ Kragt
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - L. Brieva
- Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Z. Khaleeli
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College, London, UK
| | - X. Montalban
- Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - CH Polman
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - AJ Thompson
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College, London, UK
| | - M. Tintoré
- Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - BMJ Uitdehaag
- Department of Neurology/ Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
43
|
Purroy F, Solé A, Oró M, Quilez-Martínez A, Llobet C, Sanahuja-Montesinos J, Brieva L, Cabré-Ollé X, Setó E, Piñol-Ripoll G. [Study of the prognostic implications in patients with a transient ischaemic attack before the implementation of an agreed process of treatment in the health region of Lleida]. Rev Neurol 2010; 50:77-83. [PMID: 20112215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The transient ischemic attack (TIA) is a medical emergency because of their high risk of early recurrence. We study the evolution and management of patients with a TIA in our hospital before establishing a process management and treatment of this condition. PATIENTS AND METHODS We included 180 consecutive patients with suspected TIA attended in the emergency department of our hospital between January 2006 and March 2007. We collected clinical variables (risk factors, age, clinical symptoms, duration, ABCD2). Cases were reviewed by two neurologists to establish the correlation with the diagnosis. We established the risk of cerebral infarction after one year follow-up. RESULTS 31% of patients were discharged home. There were differences between the two groups regarding age (82.9 Y 7.5 vs 70.53 Y 10.7 years); ABCD2 scale score (1.5 Y 5.32 vs 4.44 Y 1.37); and atrial fibrillation (27.5% vs 8.6%). There was much greater delay and lack of complementary explorations. During follow-up, 23% of patients not hospitalized had recurrent stroke versus 6.7% of hospitalized patients. Despite the fact that only age more than 80 years was identified as predictor of stroke recurrence (hazard ratio = 8,72; 95% CI = 2.4-31.74; p = 0.001) in regression multivariate model, the Kaplan-Meier model showed a higher risk of stroke recurrence among not admitted patients (p = 0.012). CONCLUSION In our area, the management of TIA patients in the emergency room had high impact on the evolution of these patients. A process management should be performed in order to achieve improvement in clinical praxis.
Collapse
Affiliation(s)
- F Purroy
- Hospital Universitari Arnau de Vilanova, 25006 Lleida, Espana.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Purroy F, Coll B, Oró M, Setó E, Piñol-Ripoll G, Plana A, Quílez A, Sanahuja J, Brieva L, Vega L, Fernández E. Predictive value of ankle brachial index in patients with acute ischaemic stroke. Eur J Neurol 2009; 17:602-6. [DOI: 10.1111/j.1468-1331.2009.02874.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Montalban X, Sastre-Garriga J, Tintoré M, Brieva L, Aymerich FX, Río J, Porcel J, Borràs C, Nos C, Rovira À. A single-center, randomized, double-blind, placebo-controlled study of interferon beta-1b on primary progressive and transitional multiple sclerosis. Mult Scler 2009; 15:1195-205. [DOI: 10.1177/1352458509106937] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inflammation and neurodegeneration may have differential impacts on disease evolution in the different forms of multiple sclerosis. However, a beneficial effect of immunomodulatory drugs should not be ruled out in primary progressive multiple sclerosis. Our aim is to investigate the safety and efficacy of interferon beta-1b in primary progressive multiple sclerosis. We conducted a double-blind, stratified, randomized, parallel group, phase II pilot study where patients with primary progressive multiple sclerosis or ‘transitional’ forms of multiple sclerosis received interferon beta-1b at doses of 8 MIU or placebo for 24 months. The main objective of the study was to investigate the safety and tolerability of interferon beta-1b. The primary efficacy variable was the time to neurological deterioration (Expanded Disability Status Scale) confirmed at 3 months. Seventy-three patients were included and three dropped out the study. More patients in the treatment arm had at least one related adverse event (94.4% versus 45.9%; p < 0.001); no other significant differences in safety endpoints were observed. Time to neurological deterioration was not different between trial arms (log-rank test, p = 0.3135). Statistically significant differences favoring treatment were observed for the Multiple Sclerosis Functional Composite score at several timepoints, T1 and T2 lesion volume changes at 12 and 24 months, mean number of active lesions and proportion of patients with active lesions at 24 months. We conclude that interferon beta-1b is safe and well tolerated in patients with primary progressive multiple sclerosis and transitional multiple sclerosis. Positive effects of interferon beta on secondary clinical and magnetic resonance imaging outcomes were observed, but a beneficial effect on Expanded Disability Status Scale progression was not demonstrated.
Collapse
Affiliation(s)
- X. Montalban
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain,
| | - J. Sastre-Garriga
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - M. Tintoré
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - L. Brieva
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - FX Aymerich
- Unitat de Ressonància Magnètica, Hospital Vall d'Hebron, Barcelona, Spain
| | - J. Río
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - J. Porcel
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - C. Borràs
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - C. Nos
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - À. Rovira
- Unitat de Ressonància Magnètica, Hospital Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
46
|
Purroy F, Begué R, Quílez A, Piñol-Ripoll G, Sanahuja J, Brieva L, Setó E, Gil MI. Implicaciones diagnósticas del perfil de recurrencia tras un ataque isquémico transitorio. Med Clin (Barc) 2009; 133:283-9. [DOI: 10.1016/j.medcli.2008.10.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 12/10/2008] [Indexed: 11/29/2022]
|
47
|
Bosma LVAE, Kragt JJ, Brieva L, Khaleeli Z, Montalban X, Polman CH, Thompson AJ, Tintoré M, Uitdehaag BMJ. The search for responsive clinical endpoints in primary progressive multiple sclerosis. Mult Scler 2009; 15:715-20. [DOI: 10.1177/1352458509102626] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To determine whether in primary progressive multiple sclerosis (PPMS) combining scores of Expanded Disability Status Scale (EDSS) with data from Timed 25-Foot Walk (T25FW) and 9-Hole Peg Test (9HPT) would produce a clinical endpoint that has a higher event rate than EDSS alone. Methods In a group of 161 PPMS patients, EDSS, T25FW, and 9HPT were performed at three time points over 2 years. We calculated how many patients showed clinically meaningful deterioration (or improvement) on individual and combined scales. We defined improvements on one scale with deterioration on the other as “opposing changes.” We investigated the possible effect of baseline disability on the definition of our endpoint by dividing the population into two subsets of patients determined by baseline EDSS level. Results On individual scales, event rates were highest on T25FW: 34% and 46% 1 year and 2 years after baseline. On a combination of two scales, at 1 year the event rate was highest on T25FW/9HPT (46%; with a high rate of opposing changes) and at 2 years on T25FW/EDSS (57%; with a lower rate of opposing changes). In both subsets, event rates were highest on T25FW and (at 2 years) on the combination of T25FW/EDSS. Conclusions T25FW has the highest event rate as a single scale, independent of baseline disability level. A term of 2 years turned out to be more meaningful to observe than 1 year. “Worsening on either T25FW or EDSS” is the most appropriate composite endpoint in this patient group.
Collapse
Affiliation(s)
- LVAE Bosma
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - JJ Kragt
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - L Brieva
- Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Z Khaleeli
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College, London, UK
| | - X Montalban
- Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - CH Polman
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - AJ Thompson
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College, London, UK
| | - M Tintoré
- Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - BMJ Uitdehaag
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands; Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
48
|
Purroy F, Begué R, Quílez A, Piñol-Ripoll G, Sanahuja J, Brieva L, Setó E, Gil MI. The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients. Stroke 2009; 40:2229-32. [PMID: 19372450 DOI: 10.1161/strokeaha.108.537969] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Some clinical models, like California ABCD and unified ABCD2 scores, are now available to predict the early risk of stroke after a TIA. Despite the transitivity of symptoms, DWI identified an area of acute brain ischemia in almost half of patients. It would be interesting to know how the presence of DWI abnormalities relates to clinical risk scores to plan other prognostic variables or to recommend the performance of DWI. METHODS We prospectively studied 135 consecutive TIA patients visited by the neurologists in our institution. All patients underwent DWI (3.8+/-1.7 days after symptoms onset). Clinical risk scores (California, ABCD, and ABCD2) were calculated prospectively for each patient. The identification of acute ischemic lesions (positive DWI) was related to the presence of clinical features and clinical risk scores. RESULTS DWI were positive in 67 (49.6%) patients. After Bonferroni adjustment, elevated ABCD, ABCD2, and California scores were not associated with a positive DWI. However, some clinical symptoms such as facial palsy and motor weakness were associated with a positive DWI (P<0.001). The logistic regression model identified only facial palsy as an independent predictor of acute ischemic lesions (odds ratio 6.26, 95% CI 2.49 to 15.71, P<0.001). CONCLUSIONS Clinical symptoms such as motor impairment, but not clinical risk scores, were associated with a positive DWI. Performing a DWI may add prognostic information to clinical risk scales as a predictor of stroke recurrence after TIA in future large studies.
Collapse
|
49
|
Sanahuja J, Ordoñez-Palau S, Begué R, Brieva L, Boquet D. Primary Sjögren Syndrome with tumefactive central nervous system involvement. AJNR Am J Neuroradiol 2008; 29:1878-9. [PMID: 18784216 DOI: 10.3174/ajnr.a1204] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Brain MR imaging abnormalities in primary Sjögren syndrome (pSS) are generally discrete white matter lesions. We describe a 50-year-old woman with recurrent neurologic deficits. MR imaging revealed a large brain lesion. A diagnosis of pSS was made on the basis of clinical features, positive anti-Ro and anti-La antibodies, abnormal Schirmer test findings, and salivary gland scintigraphy. The patient was treated with oral prednisone with good response. Large tumefactive brain lesions are a complication of pSS.
Collapse
Affiliation(s)
- J Sanahuja
- Department of Neurology, Hospital Universitari Arnau de Vilanova-IRBLleida, Lleida, Spain.
| | | | | | | | | |
Collapse
|
50
|
Purroy F, Oró M, Quílez A, Sanahuja J, Brieva L, Granés P. [Detection of silent peripheral arterial disease in stroke patients with a low ankle-arm index]. Neurologia 2008; 23:10-14. [PMID: 18365774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION A low ankle-arm index (AAI) is a strong predictor of vascular events and stroke. Nevertheless few studies have prospectively determined AAI in stroke patients. We aimed to investigated the prevalence of low AAI in stroke patients and which variables are associated with abnormal AAI. METHODS Clinical data and ultrasonographic findings were collected in 79 consecutive stroke patients (20 transient ischemic attacks and 59 cerebral < ischemic infarction). During admission, AAI was measured in all subjects with the Doppler. An AAI cutoff of 0.90 was used to categorize individuals (< or =0.90: abnormal). RESULTS A low AAI was calculated in 16 (20.3%) patients. AAI < or = 0.90 was associated with hypertension, smoking, hypercholesterolemia, coronary disease, previous peripheral arterial disease, male gender, internal carotid stenosis>50% (p<0.10). The presence of peripheral artery disease varied between subtypes. The incidence was higher for large artery atherosclerosis, 25.0 % and small vessel disease (31.5%). Multivariate analyses (logistic regression) only identify the association of>3 risk factors as independent predictor of low AAI (odds ratio: 4.41; confidence interval 95%: 1.39-4.01; p=0.012). CONCLUSION Stroke patients had higher incidence of low AAI. Abnormal AAI was associated with classical risk factors. Existence of silent peripheral arterial disease in these patients may be an indicator of cerebral atherosclerosis extension. The measurement of AAI may be useful in order to plan adequate prevention therapies.
Collapse
Affiliation(s)
- F Purroy
- Servicio de Neurología. Hospital Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|