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Carvajal R, Zabalza A, Carbonell-Mirabent P, Martínez-Gómez X, Esperalba J, Pappolla A, Rando A, Cobo-Calvo A, Tur C, Rodriguez M, Río J, Comabella M, Castilló J, Rodrigo-Pendás JÁ, Braga N, Mongay-Ochoa N, Guío-Sánchez C, Vidal-Jordana Á, Arrambide G, Rodríguez-Acevedo B, Midaglia L, Borras-Bermejo B, Galán I, Sastre-Garriga J, Montalban X, Otero-Romero S, Tintoré M. Vaccine Safety and Immunogenicity in Patients With Multiple Sclerosis Treated With Natalizumab. JAMA Netw Open 2024; 7:e246345. [PMID: 38607624 PMCID: PMC11015356 DOI: 10.1001/jamanetworkopen.2024.6345] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/13/2024] [Indexed: 04/13/2024] Open
Abstract
Importance Vaccination in patients with highly active multiple sclerosis (MS) requiring prompt treatment initiation may result in impaired vaccine responses and/or treatment delay. Objective To assess the immunogenicity and safety of inactivated vaccines administered during natalizumab treatment. Design, Setting, and Participants This self-controlled, prospective cohort study followed adult patients with MS from 1 study center in Spain from September 2016 to February 2022. Eligible participants included adults with MS who completed immunization for hepatitis B virus (HBV), hepatitis A virus (HAV), and COVID-19 during natalizumab therapy. Data analysis was conducted from November 2022 to February 2023. Exposures Patients were categorized according to their time receiving natalizumab treatment at the time of vaccine administration as short-term (≤1 year) or long-term (>1 year). Main Outcomes and Measures Demographic, clinical, and radiological characteristics were collected during the year before vaccination (prevaccination period) and the year after vaccination (postvaccination period). Seroprotection rates and postvaccination immunoglobulin G titers were determined for each vaccine within both periods. Additionally, differences in annualized relapse rate (ARR), new T2 lesions (NT2L), Expanded Disability Status Scale (EDSS) scores, and John Cunningham virus (JCV) serostatus between the 2 periods were assessed. Results Sixty patients with MS (mean [SD] age, 43.2 [9.4] years; 44 female [73.3%]; 16 male [26.7%]; mean [SD] disease duration, 17.0 [8.7] years) completed HBV, HAV, and mRNA COVID-19 immunization during natalizumab treatment, with 12 patients in the short-term group and 48 patients in the long-term group. The global seroprotection rate was 93% (95% CI, 86%-98%), with individual vaccine rates of 92% for HAV (95% CI, 73%-99%), 93% for HBV (95% CI, 76%-99%), and 100% for the COVID-19 messenger RNA vaccine (95% CI, 84%-100%). Between the prevaccination and postvaccination periods there was a significant reduction in the mean (SD) ARR (0.28 [0.66] vs 0.01 [0.12]; P = .004) and median (IQR) NT2L (5.00 [2.00-10.00] vs 0.81 [0.00-0.50]; P = .01). No changes in disability accumulation were detected (median [IQR] EDSS score 3.5 [2.0-6.0] vs 3.5 [2.0-6.0]; P = .62). No differences in safety and immunogenicity were observed for all vaccines concerning the duration of natalizumab treatment. Conclusions and Relevance The findings of this cohort study suggest that immunization with inactivated vaccines during natalizumab therapy was both safe and immunogenic, regardless of the treatment duration. Natalizumab may be a valuable option for proper immunization, averting treatment delays in patients with highly active MS; however, this strategy needs to be formally evaluated.
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Affiliation(s)
- René Carvajal
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Martínez-Gómez
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juliana Esperalba
- Department of Microbiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Pappolla
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ariadna Rando
- Department of Microbiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro Cobo-Calvo
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Tur
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodriguez
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Ángel Rodrigo-Pendás
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nathane Braga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Guío-Sánchez
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Blanca Borras-Bermejo
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya (UVic-UCC)
| | - Susana Otero-Romero
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), 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
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya (UVic-UCC)
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Vidal-Jordana A, Sastre-Garriga J, Tintoré M, Rovira À, Montalban X. Optic nerve topography in multiple sclerosis diagnostic criteria: Existing knowledge and future directions. Mult Scler 2024; 30:139-149. [PMID: 38243584 DOI: 10.1177/13524585231225848] [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] [Indexed: 01/21/2024]
Abstract
Current diagnostic criteria for multiple sclerosis (MS) do not consider the optic nerve as a typical topography for establishing the diagnosis. Recent studies have proved the utility of optic nerve magnetic resonance imaging, optical coherence tomography and visual evoked potentials in detecting optic nerve lesions during the early stages of MS. In addition, emerging evidence supports the inclusion of optic nerve topography as a fifth region to fulfil the dissemination in space criteria. Anticipating a modification in the McDonald criteria, it is crucial for neurologists to familiarize with the diagnostic properties of each test in detecting optic nerve lesions and understand how to incorporate them into the MS diagnostic process. Therefore, the objective of this article is to review the existing evidence supporting the use of these tests in the diagnostic process of MS and provide a practical algorithm that can serve as a valuable guide for clinical practice.
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Affiliation(s)
- Angela Vidal-Jordana
- Neurology Department and Multiple Sclerosis Centre of Catalunya (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology Department and Multiple Sclerosis Centre of Catalunya (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Neurology Department and Multiple Sclerosis Centre of Catalunya (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Neurology Department and Multiple Sclerosis Centre of Catalunya (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Tur C, Tintoré M. Multiple sclerosis in 2023: beyond the boundaries. Lancet Neurol 2024; 23:22-24. [PMID: 38101890 DOI: 10.1016/s1474-4422(23)00459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia, Neurology Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Neurology Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain.
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Carvajal R, Tur C, Martínez-Gómez X, Bollo L, Esperalba J, Rodriguez M, Pappolla A, Cobo-Calvo A, Carbonell P, Borras-Bemejo B, Río J, Castilló J, Braga N, Mongay-Ochoa N, Rodrigo-Pendás JÁ, Vidal-Jordana Á, Arrambide G, Rodríguez-Acevedo B, Zabalza A, Midaglia L, Galán I, Comabella M, Sastre-Garriga J, Montalban X, Tintoré M, Otero-Romero S. A single-dose strategy for immunization with live attenuated vaccines is an effective option before treatment initiation in multiple sclerosis patients. Mult Scler 2023; 29:1841-1848. [PMID: 37728389 PMCID: PMC10687797 DOI: 10.1177/13524585231200303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Mumps-Measles-Rubella (MMR) and Varicella zoster vaccines (VAR) are live attenuated vaccines, usually administered in a two-dose scheme at least 4 weeks apart. However, single-dose immunization schemes may also be effective and can reduce delays in immunosuppressive treatment initiation in patients with multiple sclerosis (pwMS) who need to be immunized. OBJECTIVES To evaluate the immunogenicity of a single-dose attempt (SDA) versus the standard immunization scheme (SIS) with VAR and/or MMR in pwMS. METHODS Retrospective observational study in pwMS vaccinated against VAR and/or MMR. We compared seroprotection rates and antibody geometric mean titers (GMTs) between the two strategies. RESULTS Ninety-six patients were included. Thirty-one patients received VAR and 67 MMR. In the SDA group, the seroprotection rate was 66.7% (95% confidence interval (CI): 53.3-78.3) versus 97.2% (95% CI: 85.5-99.9) in the SIS (p < 0.001). For the seroprotected patients, GMTs were similar for both schemes. CONCLUSION An SDA of VAR and/or MMR vaccines could be sufficient to protect almost two-thirds of patients. Testing immunogenicity after a single dose of VZ and/or MMR could be included in routine clinical practice to achieve rapid immunization.
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Affiliation(s)
- René Carvajal
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Pg. Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - Carmen Tur
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Martínez-Gómez
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luca Bollo
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juliana Esperalba
- Department of Microbiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain/CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Rodriguez
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Agustín Pappolla
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro Cobo-Calvo
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Blanca Borras-Bemejo
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nathane Braga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Ángel Rodrigo-Pendás
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain/Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain/Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Barcelona, Spain
| | - Susana Otero-Romero
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), 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
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Coll L, Pareto D, Carbonell-Mirabent P, Cobo-Calvo Á, Arrambide G, Vidal-Jordana Á, Comabella M, Castilló JN, Rodrı Guez-Acevedo B, Zabalza A, Galán I, Midaglia L, Nos C, Auger C, Alberich M, Rı O J, Sastre-Garriga J, Oliver A, Montalban X, Rovira À, Tintoré M, Lladó X, Tur C. Global and Regional Deep Learning Models for Multiple Sclerosis Stratification From MRI. J Magn Reson Imaging 2023. [PMID: 37803817 DOI: 10.1002/jmri.29046] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The combination of anatomical MRI and deep learning-based methods such as convolutional neural networks (CNNs) is a promising strategy to build predictive models of multiple sclerosis (MS) prognosis. However, studies assessing the effect of different input strategies on model's performance are lacking. PURPOSE To compare whole-brain input sampling strategies and regional/specific-tissue strategies, which focus on a priori known relevant areas for disability accrual, to stratify MS patients based on their disability level. STUDY TYPE Retrospective. SUBJECTS Three hundred nineteen MS patients (382 brain MRI scans) with clinical assessment of disability level performed within the following 6 months (~70% training/~15% validation/~15% inference in-house dataset) and 440 MS patients from multiple centers (independent external validation cohort). FIELD STRENGTH/SEQUENCE Single vendor 1.5 T or 3.0 T. Magnetization-Prepared Rapid Gradient-Echo and Fluid-Attenuated Inversion Recovery sequences. ASSESSMENT A 7-fold patient cross validation strategy was used to train a 3D-CNN to classify patients into two groups, Expanded Disability Status Scale score (EDSS) ≥ 3.0 or EDSS < 3.0. Two strategies were investigated: 1) a global approach, taking the whole brain volume as input and 2) regional approaches using five different regions-of-interest: white matter, gray matter, subcortical gray matter, ventricles, and brainstem structures. The performance of the models was assessed in the in-house and the independent external cohorts. STATISTICAL TESTS Balanced accuracy, sensitivity, specificity, area under receiver operating characteristic (ROC) curve (AUC). RESULTS With the in-house dataset, the gray matter regional model showed the highest stratification accuracy (81%), followed by the global approach (79%). In the external dataset, without any further retraining, an accuracy of 72% was achieved for the white matter model and 71% for the global approach. DATA CONCLUSION The global approach offered the best trade-off between internal performance and external validation to stratify MS patients based on accumulated disability. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Llucia Coll
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquı N Castilló
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodrı Guez-Acevedo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Alberich
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Rı O
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Oliver
- Research Institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Lladó
- Research Institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Villacieros-Álvarez J, Espejo C, Arrambide G, Castillo M, Carbonell-Mirabent P, Rodriguez M, Bollo L, Castilló J, Comabella M, Galán I, Midaglia L, Mongay-Ochoa N, Nos C, Rio J, Rodríguez-Acevedo B, Sastre-Garriga J, Tur C, Vidal-Jordana A, Vilaseca A, Zabalza A, Auger C, Rovira A, Montalban X, Tintoré M, Cobo-Calvo Á. Myelin Oligodendrocyte Glycoprotein Antibodies in Adults with a First Demyelinating Event Suggestive of Multiple Sclerosis. Ann Neurol 2023. [PMID: 37705507 DOI: 10.1002/ana.26793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) distinguish multiple sclerosis (MS) from MOG-associated disease in most cases. However, studies analyzing MOG-Ab at the time of a first demyelinating event suggestive of MS in adults are lacking. We aimed to (1) evaluate the prevalence of MOG-Ab in a first demyelinating event suggestive of MS and (2) compare clinical and paraclinical features between seropositive (MOG-Ab+) and seronegative (MOG-Ab-) patients. METHODS Six hundred thirty adult patients with available serum samples obtained within 6 months from the first event were included. MOG-Ab were analyzed using a live cell-based assay. Statistical analyses included parametric and nonparametric tests, logistic regression, and survival models. RESULTS MOG-Ab were positive in 17 of 630 (2.7%). Fourteen out of 17 (82.4%) MOG-Ab+ patients presented with optic neuritis (ON) compared to 227of 613 (37.0%) MOG-Ab- patients (p = 0.009). Cerebrospinal fluid-restricted oligoclonal bands (CSF-OBs) were found in 2 of 16 (12.5%) MOG-Ab+ versus 371 of 601 (61.7%) MOG-Ab- subjects (p < 0.001). Baseline brain magnetic resonance imaging (MRI) was normal in 9 of 17 (52.9%) MOG-Ab+ versus 153 of 585 (26.2%) MOG-Ab- patients (p = 0.029). Absence of CSF-OBs and ON at onset were independently associated with MOG-Ab positivity (odds ratio [OR] = 9.03, 95% confidence interval [CI] = 2.04-53.6, p = 0.009; and OR = 4.17, 95% CI = 1.15-19.8, p = 0.042, respectively). Of MOG-Ab+ patients, 22.9% (95% CI = 0.0-42.7) compared to 67.6% (95% CI = 63.3-71.3) of MOG-Ab- patients fulfilled McDonald 2017 criteria at 5 years (log-rank p = 0.003). INTERPRETATION MOG-Ab are infrequent in adults with a first demyelinating event suggestive of MS. However, based on our results, we suggest to determine these antibodies in those patients with ON and absence of CSF-OBs, as long as the brain MRI is not suggestive of MS. ANN NEUROL 2023.
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Affiliation(s)
- Javier Villacieros-Álvarez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Espejo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Castillo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Marta Rodriguez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Luca Bollo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos Nos
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Rio
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Breogan Rodríguez-Acevedo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Tur
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Andreu Vilaseca
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Auger
- Autonomous University of Barcelona, Barcelona, Spain
- Section of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alex Rovira
- Autonomous University of Barcelona, Barcelona, Spain
- Section of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Montalban
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
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7
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Oreja-Guevara C, Tintoré M, Meca V, Prieto JM, Meca J, Mendibe M, Rodríguez-Antigüedad A. Family Planning in Fertile-Age Patients With Multiple Sclerosis (MS) (ConPlanEM Study): Delphi Consensus Statements. Cureus 2023; 15:e44056. [PMID: 37746391 PMCID: PMC10517726 DOI: 10.7759/cureus.44056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Family planning is essential for establishing Multiple Sclerosis (MS) prognosis, treatment decision, and disease monitoring. We aimed to generate an expert consensus addressing recommendations for family planning in MS patients of childbearing age. Initially, a committee comprising seven neurologists, experts in the MS field, identified the topics to be addressed. Then, the committee elaborated on different evidence-based preliminary statements. Next, using the Delphi methodology, a panel of neurologists manifested their level of agreement on the different statements using a Likert-type scale. Consensus was reached when ⩾70% of respondents expressed an agreement or disagreement using a five-point scale. Consensus was achieved on 47 out of 63 recommendations after three rounds of evaluations. The panel considered it essential to address family planning in all patients of childbearing age. There was also consensus that treatment should not be delayed due to the patient's desire for pregnancy. Additionally, in highly active patients, planning the pregnancy in the medium to long term using depletory drugs such as cladribine or alemtuzumab might represent a useful strategy. However, risks of adverse effects on the fetus due to drug-associated secondary autoimmunity should be addressed when alemtuzumab is considered. Moreover, the maintenance of natalizumab during pregnancy in very active patients reached expert consensus. Also, the panel supported the use of certain disease-modifying treatment (DMT) during lactation in selected cases. Our results identified specific areas of pregnancy planning in MS patients, where different treatment strategies might be considered to facilitate a safe and successful pregnancy while maintaining clinical and radiological stability.
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Affiliation(s)
| | - Mar Tintoré
- Neurology, Multiple Sclerosis Center of Catalonia (Cemcat) Vall d'Hebrón University Hospital, Barcelona, ESP
| | - Virginia Meca
- Neurology, Princess University Hospital, Madrid, ESP
| | - José María Prieto
- Neurology, University Clinical Hospital of Santiago de Compostela, Madrid, ESP
| | - José Meca
- Neurology, Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit, Virgen de la Arrixaca Clinical University Hospital, Cartagena, ESP
| | - Mar Mendibe
- Neurology, Neuroimmunology Group, Biocruces Bizkaia Research Institute, Cruces University Hospital, Bizkaia, ESP
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8
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Midaglia L, Felipe-Rucián A, Delgado Alvarez I, Montalban X, Tintoré M. Diagnostic challenge in children with an acquired demyelinating syndrome: an illustrative case report. Front Neurosci 2023; 17:1205065. [PMID: 37547139 PMCID: PMC10399123 DOI: 10.3389/fnins.2023.1205065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
The clinical-radiological and biological overlap of the spectrum of pediatric demyelinating disorders makes the diagnostic process of a child with an acquired demyelinating syndrome truly challenging. We present a 9-year-old girl with subacute symptoms of severe decrease in bilateral visual acuity and gait ataxia. An urgent MRI showed inflammatory-demyelinating lesions affecting the periaqueductal gray matter, the cerebellar hemispheres, the area postrema as well as both optic nerves and chiasm. Likewise, multisegmental involvement of the cervical and dorsal spinal cord was found, with short and peripheral lesions. Anti myelin oligodendrocyte glycoprotein (MOG) antibodies (Abs) were positive in cerebrospinal fluid (CSF) and weakly in serum. Oligoclonal bands (OB) were positive in CSF. Based on all this, the diagnosis of MOG antibody disease (MOGAD) with a neuromyelitis optica spectrum disorder (NMOSD)-like picture was made. Given the good clinical and radiological recovery after the acute phase treatment, and that anti MOG Abs became negative, it was decided to keep the patient without specific treatment. However, during follow-up, while the patient was asymptomatic, a control brain MRI showed the appearance of new lesions with morphology and topography suggestive of multiple sclerosis (MS). This, added to the presence of OB, made the diagnosis of pediatric-onset MS (POMS) likely. Immunosuppressive treatment was restarted with a good response since then. Unlike adult-onset MS, children with POMS may usually not have entirely typical clinical and radiological features at presentation. In many cases, the time factor and close clinical and radiological monitoring could be critical to make an accurate diagnosis.
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Affiliation(s)
- Luciana Midaglia
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Felipe-Rucián
- Secció de Neurologia Pediàtrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignacio Delgado Alvarez
- Servei de Radiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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9
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Gold R, Barnett M, Chan A, Feng H, Fujihara K, Giovannoni G, Montalbán X, Shi FD, Tintoré M, Xue Q, Yang C, Zhou H. Clinical use of dimethyl fumarate in multiple sclerosis treatment: an update to include China, using a modified Delphi method. Ther Adv Neurol Disord 2023; 16:17562864231180734. [PMID: 37465201 PMCID: PMC10350766 DOI: 10.1177/17562864231180734] [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: 12/20/2022] [Accepted: 05/20/2023] [Indexed: 07/20/2023] Open
Abstract
Dimethyl fumarate (DMF) is a widely used oral disease-modifying therapy for multiple sclerosis (MS). Its efficacy and safety profiles are supported by over a decade of experience. Differences exist between Asia and Europe/United States in the prevalence and characteristics of MS; most data for DMF are derived from populations outside Asia. DMF was recently (2021) approved for use in China. The objectives of this review were to evaluate the evidence for DMF's profile, to provide an update to healthcare providers on current knowledge surrounding its use and to assess the relevance of existing data to use in China. This study used a modified Delphi method based on the insights of a scientific Steering Committee (SC), with a structured literature review conducted to assess the data of DMF. The literature review covered all papers in English (from 01 January 2011 to 21 February 2022) that include 'dimethyl fumarate' and 'multiple sclerosis', and their MeSH terms, on PubMed, supplemented by EMBASE and Citeline searches. Papers were categorized by topic and assessed for relevance and quality, before being used to formulate statements summarizing the literature on each subject. SC members voted on/revised statements, requiring ⩾80% agreement and ⩽10% disagreement for inclusion. Statements not reaching this level were discussed further until agreement was reached or until there was agreement to remove the statement. A total of 1030 papers were retrieved and used to formulate the statements and evidence summaries considered by the SC members. A total of 45 statements were agreed by the SC members. The findings support the positive efficacy and safety profile of DMF in treating patients with MS. Limited Chinese patient data are an ongoing consideration; however, based on current evidence, the statements are considered applicable to both the global and Chinese populations. DMF is a valuable addition to address unmet MS treatment needs in China. Registration: Not applicable.
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Affiliation(s)
- Ralf Gold
- Department of Neurology, Ruhr University Bochum, Bochum 44791, Germany
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Andrew Chan
- Department of Neurology, Inselspital (Bern University Hospital), University of Bern, Bern, Switzerland
| | - Huiyu Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Gavin Giovannoni
- Department of Neurology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Xavier Montalbán
- Neurology Department, Multiple Sclerosis Center of Catalonia (Cemcat), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Fu-Dong Shi
- Department of Neurology, Institute of Neuroimmunology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mar Tintoré
- Neurology Department, Multiple Sclerosis Center of Catalonia (Cemcat), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Qun Xue
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunsheng Yang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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10
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Otero-Romero S, Lebrun-Frénay C, Reyes S, Amato MP, Campins M, Farez M, Filippi M, Hacohen Y, Hemmer B, Juuti R, Magyari M, Oreja-Guevara C, Siva A, Vukusic S, Tintoré M. ECTRIMS/EAN consensus on vaccination in people with multiple sclerosis: Improving immunization strategies in the era of highly active immunotherapeutic drugs. Mult Scler 2023; 29:904-925. [PMID: 37293841 PMCID: PMC10338708 DOI: 10.1177/13524585231168043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/30/2023] [Accepted: 03/19/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND With the new highly active drugs available for people with multiple sclerosis (pwMS), vaccination becomes an essential part of the risk management strategy. OBJECTIVE To develop a European evidence-based consensus for the vaccination strategy of pwMS who are candidates for disease-modifying therapies (DMTs). METHODS This work was conducted by a multidisciplinary working group using formal consensus methodology. Clinical questions (defined as population, interventions, and outcomes) considered all authorized DMTs and vaccines. A systematic literature search was conducted and quality of evidence was defined according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The recommendations were formulated based on the quality of evidence and the risk-benefit balance. RESULTS Seven questions, encompassing vaccine safety, vaccine effectiveness, global vaccination strategy and vaccination in sub-populations (pediatric, pregnant women, elderly and international travelers) were considered. A narrative description of the evidence considering published studies, guidelines, and position statements is presented. A total of 53 recommendations were agreed by the working group after three rounds of consensus. CONCLUSION This first European consensus on vaccination in pwMS proposes the best vaccination strategy according to current evidence and expert knowledge, with the goal of homogenizing the immunization practices in pwMS.
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Affiliation(s)
- Susana Otero-Romero
- Department of Preventive Medicine and Epidemiology, Vall d’Hebron Barcelona Hospital, Barcelona, Spain Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron Barcelona Hospital, Barcelona, Spain
| | | | - Saúl Reyes
- Fundación Santa Fe de Bogotá, Bogotá, Colombia School of Medicine, Universidad de los Andes, Bogotá, Colombia Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Magda Campins
- Department of Preventive Medicine and Epidemiology, Vall d’Hebron Barcelona Hospital, Barcelona, Spain
| | - Mauricio Farez
- Centro para la Investigación de Enfermedades Neuroinmunológicas (CIEN), FLENI, Buenos Aires, Argentina
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Rosa Juuti
- Multiple Sclerosis International Federation, London, UK
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center and the Danish Multiple Sclerosis Registry, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico San Carlos, IdISSC, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Aksel Siva
- Department of Neurology, School of Medicine, Istanbul University Cerrahpasa, Cerrahpasa, Istanbul, Turkey
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron Barcelona Hospital, Barcelona, Spain
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11
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Otero-Romero S, Lebrun-Frénay C, Reyes S, Amato MP, Campins M, Farez M, Filippi M, Hacohen Y, Hemmer B, Juuti R, Magyari M, Oreja-Guevara C, Siva A, Vukusic S, Tintoré M. European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology consensus on vaccination in people with multiple sclerosis: Improving immunization strategies in the era of highly active immunotherapeutic drugs. Eur J Neurol 2023. [PMID: 37293849 DOI: 10.1111/ene.15809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND PURPOSE With the new highly active drugs available for people with multiple sclerosis (pwMS), vaccination becomes an essential part of the risk management strategy. We aimed to develop a European evidence-based consensus for the vaccination strategy of pwMS who are candidates for disease-modifying therapies (DMTs). METHODS This work was conducted by a multidisciplinary working group using formal consensus methodology. Clinical questions (defined as population, interventions and outcomes) considered all authorized DMTs and vaccines. A systematic literature search was conducted and quality of evidence was defined according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The recommendations were formulated based on the quality of evidence and the risk-benefit balance. RESULTS Seven questions, encompassing vaccine safety, vaccine effectiveness, global vaccination strategy and vaccination in subpopulations (pediatric, pregnant women, elderly and international travelers) were considered. A narrative description of the evidence considering published studies, guidelines and position statements is presented. A total of 53 recommendations were agreed by the working group after three rounds of consensus. CONCLUSION This first European consensus on vaccination in pwMS proposes the best vaccination strategy according to current evidence and expert knowledge, with the goal of homogenizing the immunization practices in pwMS.
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Affiliation(s)
- Susana Otero-Romero
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Saúl Reyes
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mauricio Farez
- Centro para la Investigación de Enfermedades Neuroinmunológicas (CIEN), FLENI, Buenos Aires, Argentina
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Rosa Juuti
- Patient representative, Multiple Sclerosis International Federation, London, UK
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center and the Danish Multiple Sclerosis Registry, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Celia Oreja-Guevara
- Department of Neurology, Departamento de Medicina, Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Cerrahpasa, 34098, Istanbul, Turkey
| | - Sandra Vukusic
- Service de neurologie, Sclérose en plaques, Pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon/Bron, France
- Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France
- Faculté de médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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12
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Renom M, Galán I, Vidal X, Aldevert M, Curto G, Feliu P, García I, Gonzalo L, Sibera X, Anglada E, Meza R, García M, Najas V, Mongay-Ochoa N, Arévalo MJ, Vidal-Jordana Á, Tintoré M, Bascuñana H, Montalban X, Terré R, Sastre-Garriga J. Validation of the Spanish version of DYsphagia in MUltiple Sclerosis questionnaire (DYMUS). Mult Scler Relat Disord 2023; 74:104724. [PMID: 37086636 DOI: 10.1016/j.msard.2023.104724] [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: 02/08/2023] [Revised: 03/31/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Dysphagia is a common symptom in multiple sclerosis that can occur even early in the disease course and can lead to serious complications. Early recognition and treatment can promote comfort, safety and optimal nutritional status. Few dysphagia rating scales are available in Spanish. The aim of this study was to translate the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS) into Spanish and to validate it. METHODS Forward and backward translation method was used to translate the original English version of DYMUS into Spanish. A pilot-study with 10 PwMS was carried on in order to improve the intelligibility of the instrument, comprehensibility and content validity of the questionnaire. The questionnaire was filled out by 100 PwMS who were asked a dichotomous question on their swallowing ("Do you have swallowing troubles?"). Descriptive data are presented as median and quartiles for continuous variables and frequency and percentage for categorical ones. Internal consistency reliability was estimated by Cronbach's alfa. Test-retest reliability was estimated by intraclass correlation coefficient. Concurrent validity with a speech and language therapy assessment (SLT-A) was measured with the weighted kappa statistic for the concordance for both dysphagia type and degree categories. Confirmatory factor analysis by means of structural equation models was used to verify the two-factor (solids and liquids) structure of the DYMUS questionnaire. As the goodness of fit evaluation was poor, an additional exploratory factor analysis was carried out. RESULTS Internal consistency was high. The globus sensation question and the weight loss questions (item 3 and 10) are the least specific with dysphagia symptomatology so they are worst correlated with the sum of the others (item-rest correlation, 0.243 and 0.248, respectively). The test-retest reliability of the DYMUS among 40 patients using ICC was 0.75 (95% CI 0.57 - 0.86). Concurrent validity with SLT-A was poor (weighted kappa 0.37 for dysphagia type and 0.38 for dysphagia degree). The DYMUS questionnaire detected three times more dysphagia (53% versus 17%) than the dichotomous question. Confirmatory factors analysis failed to confirm the bidimensional structure (solid and liquid items) often reported in other validation studies. The subsequent exploratory factor analysis also identified two factors, but with poor interpretability. CONCLUSION DYMUS-SP scale is not a sufficiently useful scale to detect dysphagia in PwMS due to the poor concurrent validity and the probable overdiagnosis of the condition; however, it can be helpful as a screening tool when combined with other measures.
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Affiliation(s)
- Marta Renom
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Servei de Medicina Física i Rehabilitació, Departament de logopèdia, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Ingrid Galán
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Vidal
- Departament de Farmacologia Clínica. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mireia Aldevert
- Centre Neurorehabilitador Miquel Martí i Pol, Fundació Esclerosi Múltiple, Lleida, Spain
| | - Gemma Curto
- Centre Neurorehabilitador Mas Sabater, Reus, Tarragona, Spain
| | - Patricia Feliu
- Hospital Clínico Universidad Católica de Chile, Santiago de Chile, Chile
| | - Itziar García
- Asociación de Esclerosis Múltiple de Bizkaya (ADEMBI), Bilbao, Spain
| | - Lorena Gonzalo
- Asociación de Esclerosis Múltiple de Bizkaya (ADEMBI), Bilbao, Spain
| | - Xavier Sibera
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisenda Anglada
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roger Meza
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat García
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor Najas
- Servei de Medicina Física i Rehabilitació, Departament de logopèdia, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Jesús Arévalo
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Helena Bascuñana
- Servei de Medicina Física i Rehabilitació, Departament de logopèdia, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Terré
- Servei de Rehabilitació, Hospital Universitari de Vic, Barcelona, Spain; Institut Guttmann Hospital de Neurorehabilitació, Badalona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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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.
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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
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Coll L, Pareto D, Carbonell-Mirabent P, Cobo-Calvo Á, Arrambide G, Vidal-Jordana Á, Comabella M, Castilló J, Rodríguez-Acevedo B, Zabalza A, Galán I, Midaglia L, Nos C, Salerno A, Auger C, Alberich M, Río J, Sastre-Garriga J, Oliver A, Montalban X, Rovira À, Tintoré M, Lladó X, Tur C. Deciphering multiple sclerosis disability with deep learning attention maps on clinical MRI. Neuroimage Clin 2023; 38:103376. [PMID: 36940621 PMCID: PMC10034138 DOI: 10.1016/j.nicl.2023.103376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/14/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
The application of convolutional neural networks (CNNs) to MRI data has emerged as a promising approach to achieving unprecedented levels of accuracy when predicting the course of neurological conditions, including multiple sclerosis, by means of extracting image features not detectable through conventional methods. Additionally, the study of CNN-derived attention maps, which indicate the most relevant anatomical features for CNN-based decisions, has the potential to uncover key disease mechanisms leading to disability accumulation. From a cohort of patients prospectively followed up after a first demyelinating attack, we selected those with T1-weighted and T2-FLAIR brain MRI sequences available for image analysis and a clinical assessment performed within the following six months (N = 319). Patients were divided into two groups according to expanded disability status scale (EDSS) score: ≥3.0 and < 3.0. A 3D-CNN model predicted the class using whole-brain MRI scans as input. A comparison with a logistic regression (LR) model using volumetric measurements as explanatory variables and a validation of the CNN model on an independent dataset with similar characteristics (N = 440) were also performed. The layer-wise relevance propagation method was used to obtain individual attention maps. The CNN model achieved a mean accuracy of 79% and proved to be superior to the equivalent LR-model (77%). Additionally, the model was successfully validated in the independent external cohort without any re-training (accuracy = 71%). Attention-map analyses revealed the predominant role of frontotemporal cortex and cerebellum for CNN decisions, suggesting that the mechanisms leading to disability accrual exceed the mere presence of brain lesions or atrophy and probably involve how damage is distributed in the central nervous system.
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Affiliation(s)
- Llucia Coll
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Alberich
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Oliver
- Research institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Lladó
- Research institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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15
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Carta S, Cobo Calvo Á, Armangué T, Saiz A, Lechner C, Rostásy K, Breu M, Baumann M, Höftberger R, Ayzenberg I, Schwake C, Sepulveda M, Martínez-Hernández E, Olivé-Cirera G, Arrambide G, Tintoré M, Bernard-Valnet R, Du Pasquier R, Brilot F, Ramanathan S, Schanda K, Gajofatto A, Ferrari S, Sechi E, Flanagan EP, Pittock SJ, Redenbaugh V, Reindl M, Marignier R, Mariotto S. Significance of Myelin Oligodendrocyte Glycoprotein Antibodies in CSF: A Retrospective Multicenter Study. Neurology 2023; 100:e1095-e1108. [PMID: 36526426 PMCID: PMC10074465 DOI: 10.1212/wnl.0000000000201662] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although the diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is based on serum MOG antibodies (MOG-Abs) positivity, patients with coexisting or restricted MOG-Abs in the CSF have been reported. The aim of this study is to characterize the relevance of CSF MOG-Abs positivity in clinical practice. METHODS Eleven medical centers retrospectively collected clinical and laboratory data of adult and pediatric patients with suspected inflammatory CNS disease and MOG-Abs positivity in serum and/or CSF using live cell-based assays. Comparisons were performed using parametric or nonparametric tests, as appropriate. Potential factors of unfavorable outcomes were explored by Cox proportional hazard models and logistic regression. RESULTS The cohort included 255 patients: 139 (55%) women and 132 (52%) children (i.e., <18-year-old). Among them, 145 patients (56.8%) had MOG-Abs in both serum and CSF (MOG-Abs seropositive and CSF positive), 79 (31%) only in serum (MOG-Abs seropositive and CSF negative), and 31 (12%) only in CSF (MOG-Abs seronegative and CSF positive). MOG-Abs seronegative and CSF positive predominated in adults (22% vs 3% of children), presented more commonly with motor (n = 14, 45%) and sensory symptoms (n = 13, 42%), and all but 4 (2 multiple sclerosis, 1 polyradiculoneuritis, and 1 Susac syndrome) had a final diagnosis compatible with MOGAD. When comparing seropositive patients according to MOG-Abs CSF status, MOG-Abs seropositive and CSF positive patients had a higher Expanded Disability Status Scale (EDSS) at nadir during the index event (median 4.5, interquartile range [IQR] 3.0-7.5 vs 3.0, IQR 2.0-6.8, p = 0.007) and presented more commonly with sensory (45.5% vs 24%, p = 0.002), motor (33.6% vs 19%, p = 0.021), and sphincter symptoms (26.9% vs 7.8%, p = 0.001) than MOG-Abs seropositive and CSF negative. At the last follow-up, MOG-Abs seropositive and CSF positive cases had more often persistent sphincter dysfunction (17.3% vs 4.3%, p = 0.008). Compared with seropositive patients, those MOG-Abs seronegative and CSF positive had higher disability at the last follow-up (p ≤ 0.001), and MOG-Abs seronegative and CSF positive status were independently associated with an EDSS ≥3.0. DISCUSSION Paired serum and CSF MOG-Abs positivity are common in MOGAD and are associated with a more severe clinical presentation. CSF-only MOG-Abs positivity can occur in patients with a phenotype suggestive of MOGAD and is associated with a worse outcome. Taken together, these data suggest a clinical interest in assessing CSF MOG-Abs in patients with a phenotype suggestive of MOGAD, regardless of the MOG-Abs serostatus.
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Affiliation(s)
- Sara Carta
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Álvaro Cobo Calvo
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Thaís Armangué
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Albert Saiz
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Christian Lechner
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Kevin Rostásy
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Markus Breu
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Matthias Baumann
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Romana Höftberger
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Ilya Ayzenberg
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Carolin Schwake
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Maria Sepulveda
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Eugenia Martínez-Hernández
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Gemma Olivé-Cirera
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Georgina Arrambide
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Mar Tintoré
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Raphael Bernard-Valnet
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Renaud Du Pasquier
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Fabienne Brilot
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Sudarshini Ramanathan
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Kathrin Schanda
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Alberto Gajofatto
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Sergio Ferrari
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Elia Sechi
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Eoin P Flanagan
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Sean J Pittock
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Vyanka Redenbaugh
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Markus Reindl
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Romain Marignier
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Sara Mariotto
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France.
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Tur C, Carbonell-Mirabent P, Cobo-Calvo Á, Otero-Romero S, Arrambide G, Midaglia L, Castilló J, Vidal-Jordana Á, Rodríguez-Acevedo B, Zabalza A, Galán I, Nos C, Salerno A, Auger C, Pareto D, Comabella M, Río J, Sastre-Garriga J, Rovira À, Tintoré M, Montalban X. Association of Early Progression Independent of Relapse Activity With Long-term Disability After a First Demyelinating Event in Multiple Sclerosis. JAMA Neurol 2023; 80:151-160. [PMID: 36534392 PMCID: PMC9856884 DOI: 10.1001/jamaneurol.2022.4655] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Progression independent of relapse activity (PIRA) is the main event responsible for irreversible disability accumulation in relapsing multiple sclerosis (MS). Objective To investigate clinical and neuroimaging predictors of PIRA at the time of the first demyelinating attack and factors associated with long-term clinical outcomes of people who present with PIRA. Design, Setting, and Participants This cohort study, conducted from January 1, 1994, to July 31, 2021, included patients with a first demyelinating attack from multiple sclerosis; patients were recruited from 1 study center in Spain. Patients were excluded if they refused to participate, had alternative diagnoses, did not meet protocol requirements, had inconsistent demographic information, or had less than 3 clinical assessments. Exposures Exposures included (1) clinical and neuroimaging features at the first demyelinating attack and (2) presenting PIRA, ie, confirmed disability accumulation (CDA) in a free-relapse period at any time after symptom onset, within (vs after) the first 5 years of the disease (ie, early/late PIRA), and in the presence (vs absence) of new T2 lesions in the previous 2 years (ie, active/nonactive PIRA). Main Outcomes and Measures Expanded Disability Status Scale (EDSS) yearly increase rates since the first attack and adjusted hazard ratios (HRs) for predictors of time to PIRA and time to EDSS 6.0. Results Of the 1128 patients (mean [SD] age, 32.1 [8.3] years; 781 female individuals [69.2%]) included in the study, 277 (25%) developed 1 or more PIRA events at a median (IQR) follow-up time of 7.2 (4.6-12.4) years (for first PIRA). Of all patients with PIRA, 86 of 277 (31%) developed early PIRA, and 73 of 144 (51%) developed active PIRA. Patients with PIRA were slightly older, had more brain lesions, and were more likely to have oligoclonal bands than those without PIRA. Older age at the first attack was the only predictor of PIRA (HR, 1.43; 95% CI, 1.23-1.65; P < .001 for each older decade). Patients with PIRA had steeper EDSS yearly increase rates (0.18; 95% CI, 0.16-0.20 vs 0.04; 95% CI, 0.02-0.05; P < .001) and an 8-fold greater risk of reaching EDSS 6.0 (HR, 7.93; 95% CI, 2.25-27.96; P = .001) than those without PIRA. Early PIRA had steeper EDSS yearly increase rates than late PIRA (0.31; 95% CI, 0.26-0.35 vs 0.13; 95% CI, 0.10-0.16; P < .001) and a 26-fold greater risk of reaching EDSS 6.0 from the first attack (HR, 26.21; 95% CI, 2.26-303.95; P = .009). Conclusions and Relevance Results of this cohort study suggest that for patients with multiple sclerosis, presenting with PIRA after a first demyelinating event was not uncommon and suggests an unfavorable long-term prognosis, especially if it occurs early in the disease course.
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Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Otero-Romero
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vega E, Arrambide G, Olivé G, Castillo M, Felipe-Rucián A, Tintoré M, Montalban X, Espejo C, Sepúlveda M, Armangué T, Cobo-Calvo A. Non-ADEM encephalitis in patients with myelin oligodendrocyte glycoprotein antibodies: a systematic review. Eur J Neurol 2023; 30:1515-1527. [PMID: 36704861 DOI: 10.1111/ene.15684] [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: 07/10/2022] [Revised: 11/21/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Non-(acute disseminated encephalomyelitis) (non-ADEM) encephalitis and/or fluid attenuated inversion recovery hyperintense lesions in anti-myelin-oligodendrocyte-glycoprotein-associated encephalitis with seizures (FLAMES) are rarely described in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies (Abs). The aim was (i) to describe the clinical features and disease course of children and adults with non-ADEM encephalitis and/or FLAMES associated with MOG Abs and (ii) to describe their association with other central nervous system autoantibodies. METHODS This was a systematic review following the PRISMA guidelines. Patients fulfilled criteria for non-ADEM encephalitis and/or FLAMES, and all were MOG Ab positive. RESULTS In total, 83 (79%) patients with non-ADEM encephalitis (48 also had FLAMES) and 22 (21%) with isolated FLAMES were included. At the first episode, children (n = 45) had more infections (11/45, 24.4%; p = 0.017) and more of the phenotype consisting of non-ADEM encephalitis (42/45, 93.3%; p = 0.014) than adults (n = 38). Children had more episodes consistent with working memory deficits (25/54, 46.3%; p = 0.014) but fewer psychiatric symptoms (16/54, 29.6%; p = 0.002). Twenty-eight (40.6%) of 69 patients had N-methyl-d-aspartate receptor (NMDAR) Abs in cerebrospinal fluid (CSF), being more frequent in adults (19/29, 65.5%; p < 0.001). Compared to negatives, positive CSF NMDAR Abs had more relapses (14/20, 70%; p = 0.050), required ventilatory support more frequently (8/34, 23.5%; p = 0.009) and had more psychiatric episodes (28/34, 82%; p < 0.001) or abnormal movements (14/34, 41.2%; p = 0.008). Apart from an older age in FLAMES, positive and negative CSF NMDAR Ab groups shared similar features. CONCLUSION Non-ADEM encephalitis patients with MOG Abs show specific clinical and radiological features, depending on the age at first episode. The presence of MOG Abs in non-ADEM encephalitis patients should not rule out to test other autoantibodies, especially concomitant NMDAR Abs in patients with suggestive symptoms such as behavioural or movement alterations.
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Affiliation(s)
- Enrique Vega
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, University Autònoma of Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, University Autònoma of Barcelona, Barcelona, Spain
| | - Gemma Olivé
- Pediatric Neuroimmunology Unit, Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Mireia Castillo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, University Autònoma of Barcelona, Barcelona, Spain
| | - Ana Felipe-Rucián
- Department of Pediatric Neurology, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, University Autònoma of Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, University Autònoma of Barcelona, Barcelona, Spain
| | - Carmen Espejo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, University Autònoma of Barcelona, Barcelona, Spain
| | - María Sepúlveda
- Neuroimmunology Program, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Thais Armangué
- Pediatric Neuroimmunology Unit, Neurology Service, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona, Barcelona, Spain.,Neuroimmunology Program, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alvaro Cobo-Calvo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, University Autònoma of Barcelona, Barcelona, Spain
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18
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Sánchez-Velasco S, Midaglia L, Vidal-Jordana A, Castillo F, Horno R, Carreras E, Serrano B, Bosch M, Agustí A, Montalban X, Tintoré M. [Esclerosis multiple. Lactancia. Lactante. Planificacion familiar. Posparto. Tratamiento modificador de la enfermedad.]. Rev Neurol 2023; 76:21-30. [PMID: 36544373 PMCID: PMC10364020 DOI: 10.33588/rn.7601.2022404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Multiple sclerosis mainly affects women of childbearing age, and the pregnancy and postpartum period is of special interest because of the peculiarities of the disease course and the therapeutic consequences that derive from it. During the period of breastfeeding (BF), the choice of treatment strategy must weigh up the well-established benefits of BF for both the newborn and the mother against the safety profile and potential adverse effects on the infant resulting from exposure to disease-modifying drugs transferred through breast milk. DEVELOPMENT The study reviews the current evidence on the safety of disease-modifying drugs available for the treatment of multiple sclerosis during the BF period, and gathers data on the transfer of the different drugs into breast milk, as well as the potential adverse effects described in the infant. The drugs of first choice during this period are interferon beta and glatiramer acetate. The rest of the disease modifying drugs are not accepted for use in the BF period according to their summary of product characteristics. However, in recent years, data from studies of clinical practice and case series have been published suggesting that some of these drugs could be used safely during this period. CONCLUSIONS Given the recognised health benefits of BF for both mother and infant, exclusive breastfeeding is recommended whenever possible. It is essential to carry out an individualised assessment prior to pregnancy and to evaluate the different treatment options depending on each patient.
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Affiliation(s)
| | - L Midaglia
- Centre d'esclerosi múltiple de Catalunya, Barcelona, España.,Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - A Vidal-Jordana
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España.,Centre d'esclerosi múltiple de Catalunya, Barcelona, España
| | - F Castillo
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - R Horno
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - E Carreras
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - B Serrano
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - M Bosch
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - A Agustí
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - X Montalban
- Centre d'esclerosi múltiple de Catalunya, Barcelona, España.,Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - M Tintoré
- Centre d'esclerosi múltiple de Catalunya, Barcelona, España.,Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
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19
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Meca-Lallana JE, Fernández-Prada M, García Vázquez E, Moreno Guillén S, Otero Romero S, Rus Hidalgo M, Villar Guimerans LM, Eichau Madueño S, Fernández Fernández Ó, Izquierdo Ayuso G, Álvarez Cermeño JC, Arnal García C, Arroyo González R, Brieva Ruiz L, Calles Hernández C, García Merino A, González Platas M, Hernández Pérez MÁ, Moral Torres E, Olascoaga Urtaza J, Oliva-Nacarino P, Oreja-Guevara C, Ortiz Castillo R, Oterino A, Prieto González JM, Ramió-Torrentá L, Rodríguez-Antigüedad A, Saiz A, Tintoré M, Montalbán Gairin X. Consensus statement on the use of alemtuzumab in daily clinical practice in Spain. Neurologia 2022; 37:615-630. [PMID: 31987648 DOI: 10.1016/j.nrl.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.
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Affiliation(s)
- 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, UCAM. Universidad Católica San Antonio, Murcia, España.
| | - M Fernández-Prada
- Servicio de Medicina Preventiva y Salud Pública, Hospital Vital Álvarez-Buylla, Mieres (Asturias), España
| | - E García Vázquez
- Servicio de MI-Infecciosas. Hospital Clínico Universitario Virgen de la Arrixaca, Departamento de Medicina. Facultad de Medicina. Universidad de Murcia. IMIB-Arrixaca, Murcia, España
| | - S Moreno Guillén
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - S Otero Romero
- Centro de Esclerosis Múltiple de Cataluña (Cemcat), Servicio de Neurología/Neuroinmunología, Hospital Universitario Vall de Hebrón, Barcelona, España
| | - M Rus Hidalgo
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - L M Villar Guimerans
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - S Eichau Madueño
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - Ó Fernández Fernández
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, España
| | - G Izquierdo Ayuso
- Unidad de Investigación y Tratamiento de Esclerosis Múltiple, Hospital Vithas Nisa, Castilleja de la Cuesta (Sevilla), España
| | - J C Álvarez Cermeño
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Arnal García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Hospital General, Granada, España
| | - R Arroyo González
- Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón (Madrid), España
| | - L Brieva Ruiz
- Servicio de Neurología, Hospital Arnau de Vilanova, IRBLLEIDA, Lérida, España
| | | | - A García Merino
- Servicio de Neurología, Unidad de Neuroinmunología, Hospital Universitario Puerta de Hierro, Majadahonda (Madrid), España
| | - M González Platas
- Hospital Universitario de Canarias, La Cuesta (Santa Cruz de Tenerife), España
| | - M Á Hernández Pérez
- Servicio de Neurología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - E Moral Torres
- Servicio de Neurología, Hospital Moisés Broggi y Hospital General de ĺHospitaletí, Sant Joan Despí (Barcelona), España
| | - J Olascoaga Urtaza
- Unidad de EM Hospital Universitario Donostia-Instituto de Investigación BIODONOSTIA, San Sebastián (Guipúzcoa), España
| | - P Oliva-Nacarino
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
| | - C Oreja-Guevara
- Neurología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, España
| | | | - A Oterino
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J M Prieto González
- Servicio de Neurología, Hospital Clínico Universitario de Santiago, Santiago de Compostela (La Coruña), España
| | - L Ramió-Torrentá
- Unidad de Neuroinmunología y Esclerosis Múltiple Territorial de Gerona, Servicio de Neurología. Hospital Universitario Doctor Josep Trueta, Grupo Neurodegeneración y Neuroinflamación. IDIBGI, Facultad de Medicina. Universidad de Gerona, Gerona, España
| | | | - A Saiz
- Servicio de Neurología, Hospital Clínico, Universidad de Barcelona, Barcelona, España
| | - M Tintoré
- Centro de Esclerosis Múltiple de Cataluña (Cemcat), Servicio de Neurología/Neuroinmunología, Hospital Universitario Vall de Hebrón, Barcelona, España
| | - X Montalbán Gairin
- Centro de Esclerosis Múltiple de Cataluña (Cemcat), Servicio de Neurología/Neuroinmunología, Hospital Universitario Vall de Hebrón, Barcelona, España
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Martín-Aguilar L, Presas-Rodriguez S, Rovira À, Capellades J, Massuet-Vilamajó A, Ramió-Torrentà L, Tintoré M, Brieva-Ruiz L, Moral E, Cano-Orgaz A, Blanco Y, Batlle-Nadal J, Carmona O, Gea M, Hervás-García J, Ramo-Tello C. Gadolinium-enhanced brain lesions in multiple sclerosis relapse. Neurología (English Edition) 2022; 37:557-563. [DOI: 10.1016/j.nrleng.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 10/14/2022] Open
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21
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Boaventura M, Sastre-Garriga J, Garcia-Vidal A, Vidal-Jordana A, Quartana D, Carvajal R, Auger C, Alberich M, Tintoré M, Rovira À, Montalban X, Pareto D. T1/T2-weighted ratio in multiple sclerosis: A longitudinal study with clinical associations. Neuroimage Clin 2022; 34:102967. [PMID: 35202997 PMCID: PMC8866895 DOI: 10.1016/j.nicl.2022.102967] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
Alterations in T1-w/T2-w ratio precede lesion formation in CIS patients. Longitudinal decreases in T1-w/T2-w were associated with disease activity in CIS. Lower T1-w/T2-w was associated with longer disease duration and higher EDSS in MS.
Background T1w/T2-w ratio has been proposed as a clinically feasible MRI biomarker to assess tissue integrity in multiple sclerosis. However, no data is available in the earliest stages of the disease and longitudinal studies analysing clinical associations are scarce. Objective To describe longitudinal changes in T1-w/T2-w in patients with clinically isolated syndrome (CIS) and multiple sclerosis, and to investigate their clinical associations. Methods T1-w/T2-w images were generated and the mean value obtained in the corresponding lesion, normal-appearing grey (NAGM) and white matter (NAWM) masks. By co-registering baseline to follow-up MRI, evolved lesions were assessed; and by placing the mask of new lesions to the baseline study, the pre-lesional tissue integrity was measured. Results We included 171 CIS patients and 22 established multiple sclerosis patients. In CIS, evolved lesions showed significant T1-w/T2-w increases compared to baseline (+7.6%, P < 0.001). T1-w/T2-w values in new lesions were lower than in pre-lesional tissue (-28.2%, P < 0.001), and pre-lesional tissue was already lower than baseline NAWM (-7.8%, P < 0.001). In CIS at baseline, higher NAGM T1-w/T2-w was associated with multiple sclerosis diagnosis, and longitudinal decreases in NAGM and NAWM T1-w/T2-w were associated with disease activity. In established multiple sclerosis, T1-w/T2-w was inversely correlated with clinical disability and disease duration. Conclusion A decrease in T1-w/T2-w ratio precedes lesion formation. In CIS, higher T1-w/T2-w was associated with multiple sclerosis diagnosis. In established multiple sclerosis, lower T1-w/T2-w values were associated with clinical disability. The possible differential impact of chronic inflammation, iron deposition and demyelination should be considered to interpret these findings.
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Affiliation(s)
- Mateus Boaventura
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - Aran Garcia-Vidal
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Angela Vidal-Jordana
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - Davide Quartana
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - René Carvajal
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manel Alberich
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain.
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22
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Comabella M, Sastre-Garriga J, Carbonell-Mirabent P, Fissolo N, Tur C, Malhotra S, Pareto D, Aymerich FX, Río J, Rovira A, Tintoré M, Montalban X. Serum neurofilament light chain levels predict long-term disability progression in patients with progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329020. [PMID: 35487685 DOI: 10.1136/jnnp-2022-329020] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/15/2022] [Indexed: 12/22/2022]
Abstract
ObjectiveThere is a lack of sensitive and specific biomarkers for use in progressive multiple sclerosis (MS). The study aimed to assess the potential of serum neurofilament light chain (sNfL) levels as biomarker of disability progression in patients with progressive MS. METHODS We performed a prospective observational cohort study in 51 patients with progressive MS who participated in a 2-year phase II single-centre, randomised, double-blind, placebo-controlled trial of interferon-beta. Mean (SD) follow-up duration was 13.9 (6.2) years. Levels of sNfL were measured using a single molecule array immunoassay at baseline, 1, 2 and 6 years. Univariable and multivariable analyses were carried out to evaluate associations between sNfL levels and disability progression at short term (2 years), medium term (6 years) and long term (at the time of the last follow-up). RESULTS A sNfL cut-off value of 10.2 pg/mL at baseline discriminated between long-term progressors and non-progressors with a 75% sensitivity and 67% specificity (adjusted OR 7.8; 95% CI 1.8 to 46.4; p=0.01). Similar performance to discriminate between long-term progressors and non-progressors was observed using age/body mass index-adjusted sNfL Z-scores derived from a normative database of healthy controls. A cut-off increase of 5.1 pg/mL in sNfL levels between baseline and 6 years also discriminated between long-term progressors and non-progressors with a 71% sensitivity and 86% specificity (adjusted OR 49.4; 95% CI 4.4 to 2×103; p=0.008). CONCLUSIONS sNfL can be considered a prognostic biomarker of future long-term disability progression in patients with progressive MS. These data expand the little knowledge existing on the role of sNfL as long-term prognostic biomarker in patients with progressive MS.
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Affiliation(s)
- Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nicolás Fissolo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sunny Malhotra
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc X Aymerich
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Zabalza A, Arrambide G, Otero-Romero S, Pappolla A, Tagliani P, López-Maza S, Cárdenas-Robledo S, Esperalba J, Fernández-Naval C, Martínez-Gallo M, Castillo M, Bonastre M, Resina-Salles M, Bertran J, Rodriguez-Barranco M, Carbonell-Mirabent P, Gonzalez M, Merchan M, Quiroga-Varela A, Miguela A, Gómez I, Álvarez G, Robles R, Perez Del Campo D, Queralt X, Soler MJ, Agraz I, Martinez-Valle F, Rodríguez-Acevedo B, Midaglia L, Vidal-Jordana Á, Cobo-Calvo Á, Tur C, Galan I, Castillo J, Río J, Espejo C, Comabella M, Nos C, Sastre-Garriga J, Ramió-Torrentà L, Tintoré M, Montalban X. Is humoral and cellular response to SARS-CoV-2 vaccine modified by DMT in patients with multiple sclerosis and other autoimmune diseases? Mult Scler 2022; 28:1138-1145. [PMID: 35475363 DOI: 10.1177/13524585221089540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effect of disease-modifying therapies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine response is unclear. OBJECTIVES We aim to determine the immunological responses to SARS-CoV-2 in multiple sclerosis (MS) and anti-CD20-treated patients with other autoimmune diseases (AID). METHODS Humoral and cellular responses we determined before and 30-90 days after vaccination in patients with MS and anti-CD20-treated patients with other AID in two Catalan centers. RESULTS 457 patients were enrolled. Findings showed that humoral response decreased under anti-CD20s or sphingosine 1-phosphate receptor modulators (S1PRM) and with longer treatment duration and increased after 4.5 months from the last anti-CD20 infusion. Cellular response decreased in S1PRM-treated. Patients on anti-CD20 can present cellular responses even in the absence of antibodies. CONCLUSION Anti-CD20s and S1PRM modify the immunological responses to SARS-CoV-2 vaccines.
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Affiliation(s)
- Ana Zabalza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Preventive Medicine and Epidemiology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Agustín Pappolla
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Paula Tagliani
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Samuel López-Maza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Juliana Esperalba
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Candela Fernández-Naval
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monica Martínez-Gallo
- Immunology Division, Hospital Universitari Vall d'Hebron and Diagnostic Immunology Research Group, Valld'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Mireia Castillo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Mercè Bonastre
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Mireia Resina-Salles
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Jordina Bertran
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Marta Rodriguez-Barranco
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Marina Gonzalez
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - Miguel Merchan
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - Ana Quiroga-Varela
- Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Albert Miguela
- Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - Imma Gómez
- Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - Gary Álvarez
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - René Robles
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain Medical Sciences Department, University of Girona, Girona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Dúnia Perez Del Campo
- Girona Clinical Laboratory, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Xavier Queralt
- Girona Clinical Laboratory, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Maria José Soler
- Department of Nephrology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Agraz
- Department of Nephrology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Martinez-Valle
- Department of Internal Medicine, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Ángela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Ingrid Galan
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Joaquín Castillo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Carmen Espejo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain Medical Sciences Department, University of Girona, Girona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
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24
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Tur C, Dubessy AL, Otero-Romero S, Amato MP, Derfuss T, Di Pauli F, Iacobaeus E, Mycko M, Abboud H, Achiron A, Bellinvia A, Boyko A, Casanova JL, Clifford D, Dobson R, Farez MF, Filippi M, Fitzgerald KC, Fonderico M, Gouider R, Hacohen Y, Hellwig K, Hemmer B, Kappos L, Ladeira F, Lebrun-Frénay C, Louapre C, Magyari M, Mehling M, Oreja-Guevara C, Pandit L, Papeix C, Piehl F, Portaccio E, Ruiz-Camps I, Selmaj K, Simpson-Yap S, Siva A, Sorensen PS, Sormani MP, Trojano M, Vaknin-Dembinsky A, Vukusic S, Weinshenker B, Wiendl H, Winkelmann A, Zuluaga Rodas MI, Tintoré M, Stankoff B. The risk of infections for multiple sclerosis and neuromyelitis optica spectrum disorder disease-modifying treatments: Eighth European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop Review. April 2021. Mult Scler 2022; 28:1424-1456. [PMID: 35196927 DOI: 10.1177/13524585211069068] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the recent years, the treatment of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) has evolved very rapidly and a large number of disease-modifying treatments (DMTs) are now available. However, most DMTs are associated with adverse events, the most frequent of which being infections. Consideration of all DMT-associated risks facilitates development of risk mitigation strategies. An international focused workshop with expert-led discussions was sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and was held in April 2021 to review our current knowledge about the risk of infections associated with the use of DMTs for people with MS and NMOSD and corresponding risk mitigation strategies. The workshop addressed DMT-associated infections in specific populations, such as children and pregnant women with MS, or people with MS who have other comorbidities or live in regions with an exceptionally high infection burden. Finally, we reviewed the topic of DMT-associated infectious risks in the context of the current SARS-CoV-2 pandemic. Herein, we summarize available evidence and identify gaps in knowledge which justify further research.
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Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Anne-Laure Dubessy
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France
| | - Susana Otero-Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Tobias Derfuss
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Franziska Di Pauli
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ellen Iacobaeus
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marcin Mycko
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland Medical Center, Cleveland, OH, USA
| | - Anat Achiron
- Sheba Medical Center at Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Angelo Bellinvia
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia/Institute of Clinical Neurology and Department of Neuroimmunology, Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - David Clifford
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK/Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Mauricio F Farez
- Center for Research on Neuroimmunological Diseases, FLENI, Buenos Aires, Argentina
| | - Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Kathryn C Fitzgerald
- Department of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mattia Fonderico
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Tunis, Tunisia
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Filipa Ladeira
- Neurology Department, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Christine Lebrun-Frénay
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, UR2CA-URRIS, Université Nice Côte d'Azur, Nice, France
| | - Céline Louapre
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute-ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthias Mehling
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico San Carlos, Idissc, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | - Caroline Papeix
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute-ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France
| | - Fredrik Piehl
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Isabel Ruiz-Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Krzysztof Selmaj
- Collegium Medicum, Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland/Center of Neurology, Lodz, Poland
| | - Steve Simpson-Yap
- Clinical Outcomes Research Unit, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Per Soelberg Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Adi Vaknin-Dembinsky
- Hadassah-Hebrew University Medical Center, Department of Neurology, The Agnes-Ginges Center for Neurogenetics Jerusalem, Jerusalem, Israel
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France/Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, Lyon, France
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Münster, Germany
| | | | | | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Bruno Stankoff
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France
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25
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Cobo-Calvo A, Zabalza A, Río J, Arrambide G, Otero-Romero S, Tagliani P, Cárdenas-Robledo S, Castillo M, Espejo C, Rodriguez M, Carbonell P, Rodríguez B, Midaglia L, Vidal-Jordana Á, Tur C, Galan I, Castillo J, Comabella M, Nos C, Auger C, Tintoré M, Rovira À, Montalban X, Sastre-Garriga J. Correction to: Impact of COVID-19 pandemic on frequency of clinical visits, performance of MRI studies, and therapeutic choices in a multiple sclerosis referral centre. J Neurol 2022; 269:1773. [PMID: 35192034 PMCID: PMC8861609 DOI: 10.1007/s00415-022-11019-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Alvaro Cobo-Calvo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Ana Zabalza
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Río
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Georgina Arrambide
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Susana Otero-Romero
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Paula Tagliani
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Mireia Castillo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Carmen Espejo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marta Rodriguez
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Pere Carbonell
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Breogán Rodríguez
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Luciana Midaglia
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Carmen Tur
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Ingrid Galan
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joaquín Castillo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Manuel Comabella
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Carlos Nos
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Edifici Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Catalá E, Iacoboni G, Vidal-Jordana Á, Oristrell G, Carpio C, Vilaseca A, Cabirta A, Bosch F, Tintoré M, Barba P. Neurotoxicity-associated sinus bradycardia after chimeric antigen receptor T-cell therapy. Hematol Oncol 2022; 40:482-487. [PMID: 35139240 DOI: 10.1002/hon.2976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The advent of chimeric antigen receptor (CAR) T-cell therapy has changed the therapeutic landscape of relapsed/refractory aggressive B-cell lymphomas. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are the typical adverse events associated with this therapy. Cardiovascular toxicities have also been reported in this setting. However, there is scarce data regarding the development of sinus bradycardia after CAR T-cell therapy. Here, we detail the clinical course of 4 patients with aggressive B-cell malignancies who received CAR T-cells and developed transient and reversible sinus bradycardia in the context of ICANS. We also discuss several hypotheses behind the pathophysiology of this potential new adverse event.
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Affiliation(s)
- Eva Catalá
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de, Barcelona, 08193, Bellaterra, Spain
| | - Ángela Vidal-Jordana
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gerard Oristrell
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Cecilia Carpio
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de, Barcelona, 08193, Bellaterra, Spain
| | - Andreu Vilaseca
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alba Cabirta
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesc Bosch
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de, Barcelona, 08193, Bellaterra, Spain
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pere Barba
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de, Barcelona, 08193, Bellaterra, Spain
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27
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Pareto D, Garcia-Vidal A, Groppa S, Gonzalez-Escamilla G, Rocca M, Filippi M, Enzinger C, Khalil M, Llufriu S, Tintoré M, Sastre-Garriga J, Rovira À. Prognosis of a second clinical event from baseline MRI in patients with a CIS: a multicenter study using a machine learning approach. Neuroradiology 2022; 64:1383-1390. [PMID: 35048162 DOI: 10.1007/s00234-021-02885-7] [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: 08/27/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To predict the occurrence of a second clinical event in patients with a CIS suggestive of MS, from baseline magnetic resonance imaging (MRI), by means of a pattern recognition approach. METHODS Two hundred sixty-six patients with a CIS were recruited from four participating centers. Over a follow-up of 3 years, 130 patients had a second clinical episode and 136 did not. Grey matter and white matter T1-hypointensities masks segmented from 3D T1-weighted images acquired on 3 T scanners were used as features for the classification approach. Differences between CIS that remained CIS and those that developed a second event were assessed at a global level and at a regional level, arranging the regions according to their contribution to the classification model. RESULTS All classification metrics were around or even below 50% for both global and regional approaches. Accuracies did not change when T1-hypointensity maps were added to the model; just the specificity was increased up to 80%. Among the 30 regions with the largest contribution, 26 were grey matter and 4 were white matter regions. For grey matter, regions contributing showed either a larger or a smaller volume in the group of patients that remained CIS, compared to those with a second event. The volume of T1-hypointensities was always larger for the group that presented a second event. CONCLUSIONS Prediction of a second clinical event in CIS patients from baseline MRI seems to present a highly heterogeneous pattern, leading to very low classification accuracies. Adding the T1-hypointensity maps does not seem to improve the accuracy of the classification model.
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Affiliation(s)
- Deborah Pareto
- Department of Radiology (IDI), Neuroradiology Section, Hospital Universitari Vall d'Hebron and Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Aran Garcia-Vidal
- Department of Radiology (IDI), Neuroradiology Section, Hospital Universitari Vall d'Hebron and Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergiu Groppa
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mara Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Sara Llufriu
- Center of Neuroimmunology, Advanced Imaging in Neuroimmunological Diseases (ImaginEM) Group, Hospital Clinic, IDIBAPS and Universitat de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Department of Radiology (IDI), Neuroradiology Section, Hospital Universitari Vall d'Hebron and Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Ramos-Pla A, Tintoré M, del Arco I. Leadership in times of crisis. School principals facing COVID-19. Heliyon 2021; 7:e08443. [PMID: 34869931 PMCID: PMC8629830 DOI: 10.1016/j.heliyon.2021.e08443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/21/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
This article analyzes the personal leadership resources utilized by a sample of school principals in Catalonia (Spain) during the confinement and post-confinement periods due to the COVID-19 crisis. A questionnaire was designed, validated, and provided to the principals from Primary Education schools to carry out the study. The questionnaire analyzed personal leadership resources used by the principals during the confinement and post-confinement periods, compared to a former ¨normal situation¨. The data analysis results confirmed that the role of the principals was crucial in redirecting the situation and completing the academic course satisfactorily. The principals scored their leadership resources remarkably high in the former normality and maintained proactivity at a similar level during the crisis. However, other resources scored lower during the same period. As a direct result, there was a high degree of adaptation to this situation from the principals. The results indicate that principals do not lead in the same manner in times of crisis as in normal times. Age, experience, and type of school influence the results only in former normal situations but not in times of crisis.
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Affiliation(s)
- A. Ramos-Pla
- University of Lleida, Spain
- Corresponding author.
| | - M. Tintoré
- International University of Catalunya, Spain
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29
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Rovira A, Corral JF, Auger C, Valverde S, Vidal-Jordana A, Oliver A, de Barros A, Ng Wong YK, Tintoré M, Pareto D, Aymerich FX, Montalban X, Lladó X, Alonso J. Assessment of automatic decision-support systems for detecting active T2 lesions in multiple sclerosis patients. Mult Scler 2021; 28:1209-1218. [PMID: 34859704 DOI: 10.1177/13524585211061339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Active (new/enlarging) T2 lesion counts are routinely used in the clinical management of multiple sclerosis. Thus, automated tools able to accurately identify active T2 lesions would be of high interest to neuroradiologists for assisting in their clinical activity. OBJECTIVE To compare the accuracy in detecting active T2 lesions and of radiologically active patients based on different visual and automated methods. METHODS One hundred multiple sclerosis patients underwent two magnetic resonance imaging examinations within 12 months. Four approaches were assessed for detecting active T2 lesions: (1) conventional neuroradiological reports; (2) prospective visual analyses performed by an expert; (3) automated unsupervised tool; and (4) supervised convolutional neural network. As a gold standard, a reference outcome was created by the consensus of two observers. RESULTS The automated methods detected a higher number of active T2 lesions, and a higher number of active patients, but a higher number of false-positive active patients than visual methods. The convolutional neural network model was more sensitive in detecting active T2 lesions and active patients than the other automated method. CONCLUSION Automated convolutional neural network models show potential as an aid to neuroradiological assessment in clinical practice, although visual supervision of the outcomes is still required.
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Affiliation(s)
- Alex Rovira
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Francisco Corral
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Cristina Auger
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Valverde
- TensorMedical, Girona, Spain/Department of Computer Architecture and Technology, University of Girona, Girona, Spain
| | - Angela Vidal-Jordana
- Department of Neurology and Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain/Clinical Neuroimmunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Oliver
- Department of Computer Architecture and Technology, University of Girona, Girona, Spain
| | - Andrea de Barros
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Yiken Karelys Ng Wong
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology and Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain/Clinical Neuroimmunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Francesc Xavier Aymerich
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain/Automatic Control Department, Universitat Politècnica de Catalunya BarcelonaTech, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology and Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain/Clinical Neuroimmunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Lladó
- Department of Computer Architecture and Technology, University of Girona, Girona, Spain
| | - Juli Alonso
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
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30
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Otero-Romero S, Carbonell-Mirabent P, Midaglia L, Zuluaga M, Galán I, Cobo-Calvo A, Rio J, Arrambide G, Vidal-Jordana A, Castillo J, Rodríguez-Acevedo B, Comabella M, Rodríguez M, Tur C, Auger C, Rovira A, Sastre-Garriga J, Montalban X, Tintoré M. Oral contraceptives do not modify the risk of a second attack and disability accrual in a prospective cohort of women with a clinically isolated syndrome and early multiple sclerosis. Mult Scler 2021; 28:950-957. [PMID: 34841948 PMCID: PMC9024022 DOI: 10.1177/13524585211053001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: To evaluate whether oral contraceptive (OC) use is associated with the risk of a second attack and disability accrual in women with a clinically isolated syndrome (CIS) and early multiple sclerosis (MS). Methods: Reproductive information from women included in the Barcelona CIS prospective cohort was collected through a self-reported cross-sectional survey. We examined the relationship of OC exposure with the risk of a second attack and confirmed Expanded Disability Status Scale of 3.0 using multivariate Cox regression models, adjusted by age, topography of CIS, oligoclonal bands, baseline brain T2 lesions, body size at menarche, smoking, and disease-modifying treatment (DMT). OC and DMT exposures were considered as time-varying variables. Findings were confirmed with sensitivity analyses using propensity score models. Results: A total of 495 women were included, 389 (78.6%) referred to ever use OC and 341 (68.9%) started OC before the CIS. Exposure to OC was not associated with a second attack (adjusted hazard ratio (aHR) = 0.73, 95% confidence interval (CI) = 0.33–1.61) or disability accrual (aHR = 0.81, 95% CI = 0.17–3.76). Sensitivity analyses confirmed these results. Conclusion: OC use does not modify the risk of second attack or disability accrual in patients with CIS and early MS, once considered as a time-dependent exposure and adjusted by other potential confounders.
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Affiliation(s)
- Susana Otero-Romero
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain/Servicio de Medicina Preventiva y Epidemiología, Antigua Escuela de Enfermeria, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Zuluaga
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro Cobo-Calvo
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Rio
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castillo
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodríguez
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Tur
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Sección de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Sección de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Filippi M, Danesi R, Derfuss T, Duddy M, Gallo P, Gold R, Havrdová EK, Kornek B, Saccà F, Tintoré M, Weber J, Trojano M. Early and unrestricted access to high-efficacy disease-modifying therapies: a consensus to optimize benefits for people living with multiple sclerosis. J Neurol 2021; 269:1670-1677. [PMID: 34626224 PMCID: PMC8501364 DOI: 10.1007/s00415-021-10836-8] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 02/05/2023]
Abstract
Early intervention with high-efficacy disease-modifying therapy (HE DMT) may be the best strategy to delay irreversible neurological damage and progression of multiple sclerosis (MS). In European healthcare systems, however, patient access to HE DMTs in MS is often restricted to later stages of the disease due to restrictions in reimbursement despite broader regulatory labels. Although not every patient should be treated with HE DMTs at the initial stages of the disease, early and unrestricted access to HE DMTs with a positive benefit-risk profile and a reasonable value proposition will provide the freedom of choice for an appropriate treatment based on a shared decision between expert physicians and patients. This will further optimize outcomes and facilitate efficient resource allocation and sustainability in healthcare systems and society.
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Affiliation(s)
- Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | | | | | - Martin Duddy
- The Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, UK
| | | | - Ralf Gold
- Ruhr-Universität Bochum, Bochum, Germany
| | - Eva Kubala Havrdová
- Department of Neurology, First Medical Faculty, Charles University, Prague, Czech Republic
| | | | - Francesco Saccà
- Università Degli Studi Di Napoli 'Federico II', Naples, Italy
| | - Mar Tintoré
- MS Centre of Catalonia at the Hospital Vall d'Hebron, Barcelona, Spain
| | - Jörg Weber
- Klinikum Klagenfurt,, Klagenfurt am Wörthersee, Austria
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Filippi M, Wattjes M, Ciccarelli O, Reich D, Banwell B, De Stefano N, Enzinger C, Fazekas F, Frederiksen J, Gasperini C, Hacohen Y, Kappos L, Li D, Mankad K, Montalban X, Newsome S, Oh J, Palace J, Rocca M, Sastre-Garriga J, Tintoré M, Traboulsee A, Vrenken H, Yousry T, Barkhof F, Rovira A. International magnims-CMSC-NAIMS consensus recommendations on the use of standardized MRI in MS. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tintoré M. Classification of disease courses: Implications for treatments. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117902] [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: 11/26/2022]
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Cárdenas-Robledo S, Otero-Romero S, Passarell-Bacardit MA, Carbonell-Mirabent P, Sastre-Garriga J, Montalban X, Tintoré M. Multiple sclerosis is associated with higher comorbidity and health care resource use: A population-based, case-control study in a western Mediterranean region. Eur J Neurol 2021; 28:4124-4134. [PMID: 34293826 DOI: 10.1111/ene.15030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Comorbidities are common in multiple sclerosis (MS), and have been associated with worse outcomes and increased health care resource usage. We studied the frequency of comorbidities and adverse health behaviors (AHBs) in MS patients in the Mediterranean region of Catalonia. METHODS This population-based, case-control study used primary health care information covering 80% of Catalonia's population. Cases were matched by age/sex with randomly chosen controls (ratio = 1:5). Demographic information, comorbidities, AHBs, annual visits, sick leave days, and medication dispensing were studied. The association of comorbidities with MS and the profile of comorbidities according to sex within MS cases were assessed with multivariate logistic regression models, after adjusting for confounding variables. Health care resource usage was analyzed in MS cases compared to controls, and within MS cases in those with compared to those without comorbidities. RESULTS Five thousand five hundred forty-eight MS cases and 27,710 controls (70% female, mean age = 48.3 years) were included. Stroke (odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.17-1.99), epilepsy (OR = 2.46, 95% CI = 1.94-3.10), bipolar disorder (OR = 1.67, 95% CI = 1.17-2.36), and depression (OR = 1.83, 95% CI = 1.70-1.98) were more frequent in MS. Cases were more prone to smoking but less to alcohol intake. Among cases, psychiatric comorbidities were more frequent in women, whereas cardiovascular diseases and AHBs were more frequent in men. MS patients, particularly with comorbidities, had higher health care resource usage than controls. CONCLUSIONS Psychiatric comorbidities, stroke, epilepsy, and AHBs are more common in MS patients than in the general population in the western Mediterranean region of Catalonia. The presence of comorbidities increases the health care resource usage in MS patients.
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Affiliation(s)
- Simón Cárdenas-Robledo
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Neurology, Multiple Sclerosis Center (CEMHUN), Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Susana Otero-Romero
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Preventive Medicine and Epidemiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Angels Passarell-Bacardit
- Atención Primaria / IDIAP Jordi Gol Primary Care Research Institute, Institut Catalá de la Salut, Catalunya Central, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Montalban
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mar Tintoré
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Bittner S, Oh J, Havrdová EK, Tintoré M, Zipp F. The potential of serum neurofilament as biomarker for multiple sclerosis. Brain 2021; 144:2954-2963. [PMID: 34180982 PMCID: PMC8634125 DOI: 10.1093/brain/awab241] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
Multiple sclerosis is a highly heterogeneous disease, and the detection of neuroaxonal damage as well as its quantification is a critical step for patients. Blood-based serum neurofilament light chain (sNfL) is currently under close investigation as an easily accessible biomarker of prognosis and treatment response in patients with multiple sclerosis. There is abundant evidence that sNfL levels reflect ongoing inflammatory-driven neuroaxonal damage (e.g. relapses or MRI disease activity) and that sNfL levels predict disease activity over the next few years. In contrast, the association of sNfL with long-term clinical outcomes or its ability to reflect slow, diffuse neurodegenerative damage in multiple sclerosis is less clear. However, early results from real-world cohorts and clinical trials using sNfL as a marker of treatment response in multiple sclerosis are encouraging. Importantly, clinical algorithms should now be developed that incorporate the routine use of sNfL to guide individualized clinical decision-making in people with multiple sclerosis, together with additional fluid biomarkers and clinical and MRI measures. Here, we propose specific clinical scenarios where implementing sNfL measures may be of utility, including, among others: initial diagnosis, first treatment choice, surveillance of subclinical disease activity and guidance of therapy selection.
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Affiliation(s)
- Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eva Kubala Havrdová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mar Tintoré
- Department of Neurology, Hospital General Universitari Vall D'Hebron, Cemcat, Barcelona, Spain
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Wattjes MP, Ciccarelli O, Reich DS, Banwell B, de Stefano N, Enzinger C, Fazekas F, Filippi M, Frederiksen J, Gasperini C, Hacohen Y, Kappos L, Li DKB, Mankad K, Montalban X, Newsome SD, Oh J, Palace J, Rocca MA, Sastre-Garriga J, Tintoré M, Traboulsee A, Vrenken H, Yousry T, Barkhof F, Rovira À. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol 2021; 20:653-670. [PMID: 34139157 DOI: 10.1016/s1474-4422(21)00095-8] [Citation(s) in RCA: 255] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
The 2015 Magnetic Resonance Imaging in Multiple Sclerosis and 2016 Consortium of Multiple Sclerosis Centres guidelines on the use of MRI in diagnosis and monitoring of multiple sclerosis made an important step towards appropriate use of MRI in routine clinical practice. Since their promulgation, there have been substantial relevant advances in knowledge, including the 2017 revisions of the McDonald diagnostic criteria, renewed safety concerns regarding intravenous gadolinium-based contrast agents, and the value of spinal cord MRI for diagnostic, prognostic, and monitoring purposes. These developments suggest a changing role of MRI for the management of patients with multiple sclerosis. This 2021 revision of the previous guidelines on MRI use for patients with multiple sclerosis merges recommendations from the Magnetic Resonance Imaging in Multiple Sclerosis study group, Consortium of Multiple Sclerosis Centres, and North American Imaging in Multiple Sclerosis Cooperative, and translates research findings into clinical practice to improve the use of MRI for diagnosis, prognosis, and monitoring of individuals with multiple sclerosis. We recommend changes in MRI acquisition protocols, such as emphasising the value of three dimensional-fluid-attenuated inversion recovery as the core brain pulse sequence to improve diagnostic accuracy and ability to identify new lesions to monitor treatment effectiveness, and we provide recommendations for the judicious use of gadolinium-based contrast agents for specific clinical purposes. Additionally, we extend the recommendations to the use of MRI in patients with multiple sclerosis in childhood, during pregnancy, and in the post-partum period. Finally, we discuss promising MRI approaches that might deserve introduction into clinical practice in the near future.
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Affiliation(s)
- Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Olga Ciccarelli
- Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicola de Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria; Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jette Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, University Hospital of Copenhagen, Glostrup, Denmark
| | - Claudio Gasperini
- Department of Neurology, San Camillo-Forlanini Hospital, Roma, Italy
| | - Yael Hacohen
- Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Ludwig Kappos
- Department of Neurology and Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital of Basel and University of Basel, Basel, Switzerland
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children, London, UK
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiwon Oh
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, London, UK; Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands; Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Comabella M, Clarke MA, Schaedelin S, Tintoré M, Pareto D, Fissolo N, Pinteac R, Granziera C, Sastre-Garriga J, Benkert P, Auger C, Kuhle J, Montalban X, Rovira A. CSF chitinase 3-like 1 is associated with iron rims in patients with a first demyelinating event. Mult Scler 2021; 28:71-81. [PMID: 33870790 DOI: 10.1177/13524585211010082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chronic active lesions with iron rims have prognostic implications in patients with multiple sclerosis. OBJECTIVE To assess the relationship between iron rims and levels of chitinase 3-like 1 (CHI3L1), neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in patients with a first demyelinating event. METHODS Iron rims were identified using 3T susceptibility-weighted imaging. Serum NfL and GFAP levels were measured by single-molecule array assays. CSF (cerebrospinal fluid) CHI3L1 levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS Sixty-one patients were included in the study. The presence of iron rims was associated with higher T2 lesion volume and higher number of gadolinium-enhancing lesions. In univariable analysis, having ⩾2 iron rims (vs 0) was associated with increased CSF CHI3L1 levels (β = 1.41; 95% confidence interval (CI) = 1.10-1.79; p < 0.01) and serum NfL levels (β = 2.30; 95% CI = 1.47-3.60; p < 0.01). In multivariable analysis, however, only CSF CHI3L1 levels remained significantly associated with the presence of iron rim lesions (β = 1.45; 95% CI = 1.11-1.90; p < 0.01). The presence of ⩾2 iron rims was not associated with increased serum GFAP levels in univariable or multivariable analyses. CONCLUSION These findings support an important contribution of activated microglia/macrophages to the pathophysiology of chronic active lesions with iron rims in patients with a first demyelinating event.
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Affiliation(s)
- Manuel Comabella
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margareta A Clarke
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - Mar Tintoré
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nicolás Fissolo
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rucsanda Pinteac
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Neurology Clinic and Policlinic and RC2NB, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Jaume Sastre-Garriga
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Xavier Montalban
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Gasperini C, Prosperini L, Rovira À, Tintoré M, Sastre-Garriga J, Tortorella C, Haggiag S, Galgani S, Capra R, Pozzilli C, Montalban X, Río J. Scoring the 10-year risk of ambulatory disability in multiple sclerosis: the RoAD score. Eur J Neurol 2021; 28:2533-2542. [PMID: 33786942 DOI: 10.1111/ene.14845] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Both baseline prognostic factors and short-term predictors of treatment response can influence the long-term risk of disability accumulation in patients with relapsing-remitting multiple sclerosis (RRMS). The objective was to develop and validate a scoring system combining baseline prognostic factors and 1-year variables of treatment response into a single numeric score predicting the long-term risk of disability. METHODS We analysed two independent datasets of patients with RRMS who started interferon beta or glatiramer acetate, had an Expanded Disability Status Scale (EDSS) score <4.0 at treatment start and were followed for at least 10 years. The first dataset ('training set') included patients attending three MS centres in Italy and served as a framework to create the so-called RoAD score (Risk of Ambulatory Disability). The second ('validation set') included a cohort of patients followed in Barcelona, Spain, to explore the performance of the RoAD score in predicting the risk of reaching an EDSS score ≥6.0. RESULTS The RoAD score (ranging from 0 to 8) derived from the training set (n = 1225), was based on demographic (age), clinical baseline prognostic factors (disease duration, EDSS) and 1-year predictors of treatment response (number of relapses, presence of gadolinium enhancement and new T2 lesions). The best cut-off score for discriminating patients at higher risk of reaching the disability milestone was ≥4. When applied to the validation set (n = 296), patients with a RoAD score ≥4 had an approximately 4-fold increased risk for reaching the disability milestone (p < 0.001). DISCUSSION The RoAD score is proposed as an useful tool to predict individual prognosis and optimize treatment strategy of patients with RRMS.
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Affiliation(s)
- Claudio Gasperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Àlex Rovira
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carla Tortorella
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Shalom Haggiag
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Simonetta Galgani
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, ASST Spedali Civili di Brescia, P.O. Montichiari, Montichiari, Brescia, Italy
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Xavier Montalban
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
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Otero-Romero S, Midaglia L, Carbonell-Mirabent P, Zuluaga M, Galán I, Río J, Arrambide G, Rodríguez-Barranco M, Vidal-Jordana A, Castillo J, Rodríguez-Acevedo B, Zabalza A, Nos C, Comabella-Lopez M, Mulero P, Auger C, Sastre-Garriga J, Pérez-Hoyos S, Rovira A, Montalban X, Tintoré M. Menopause does not modify disability trajectories in a longitudinal cohort of women with clinically isolated syndrome and multiple sclerosis followed from disease onset. Eur J Neurol 2021; 29:1075-1081. [PMID: 33609298 DOI: 10.1111/ene.14782] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/02/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the effect of menopause on disability accumulation in women followed from their clinically isolated syndrome (CIS). METHODS We examined the longitudinal changes in Expanded Disability Status Scale (EDSS) scores from CIS until the last follow-up in women belonging to the Barcelona CIS prospective cohort, followed through their menopausal transition. The analysis is based on 13,718 EDSS measurements, with an average of 28 EDSS measurements per patient. Differences in EDSS trajectories between menopausal and nonmenopausal women, controlling for age and disease duration, were evaluated. We performed two sensitivity analyses in women with confirmed MS and in those experiencing early menopause. RESULTS From 764 eligible women, 496 (65%) responded to the questionnaire, and 74 (14.9%) reached menopause over the follow-up. We did not find a significant inflection point in EDSS trajectories around menopause (slope change -0.009; 95% CI -0.066; 0.046). The annual increase in EDSS over the complete course of the disease was significantly higher in menopausal women (0.049; 95% CI, 0.026-0.074) versus nonmenopausal (0.019; 95% CI, 0.008-0.031; interaction p value 0.025). This difference was lost when controlling for age and disease duration (EDSS annual increase of 0.059; 95% CI, 0.025-0.094 vs. 0.038; 95% CI, 0.021-0.057, respectively; interaction p value 0.321). No inflection point was detected when the analysis was restricted to women with confirmed MS or with earlier menopause. CONCLUSIONS Menopause is not associated with an increased risk of disability in a CIS population, considering EDSS trajectories throughout the course of the disease together with age and disease duration.
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Affiliation(s)
- Susana Otero-Romero
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain.,Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Zuluaga
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodríguez-Barranco
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquin Castillo
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella-Lopez
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Mulero
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Statistics and bioinformatics unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
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Midaglia L, Sastre-Garriga J, Pappolla A, Quibus L, Carvajal R, Vidal-Jordana A, Arrambide G, Río J, Comabella M, Nos C, Castilló J, Galan I, Rodríguez-Acevedo B, Auger C, Tintoré M, Montalban X, Rovira À. The frequency and characteristics of MS misdiagnosis in patients referred to the multiple sclerosis centre of Catalonia. Mult Scler 2021; 27:913-921. [DOI: 10.1177/1352458520988148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Multiple sclerosis (MS) misdiagnosis may cause physical and emotional damage to patients. Objectives: The objective of this study is to determine the frequency and characteristics of MS misdiagnosis in patients referred to the Multiple Sclerosis Centre of Catalonia. Methods: We designed a prospective study including all new consecutive patients referred to our centre between July 2017 and June 2018. Instances of misdiagnosis were identified, and referral diagnosis and final diagnosis were compared after 1 year of follow-up. Association of misdiagnosis with magnetic resonance imaging (MRI) findings, presence of comorbidities and family history of autoimmunity were assessed. Results: A total of 354 patients were referred to our centre within the study period, 112 (31.8%) with ‘established MS’. Misdiagnosis was identified in eight out of 112 cases (7.1%). MRI identified multifocal white matter lesions, deemed non-specific or not suggestive of MS in all misdiagnosed cases. Patients with MS misdiagnosis had more comorbidities in general than patients with MS ( p = 0.026) as well as a personal history of autoimmunity ( p < 0.001). Conclusion: A low frequency of MS misdiagnosis was found in our clinical setting. Multifocal non-specific white matter lesions in referral MRI examinations and the presence of comorbidities, including a personal history of autoimmunity, seem to be contributing factors to misdiagnosis.
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Affiliation(s)
- Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Agustín Pappolla
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Quibus
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - René Carvajal
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquin Castilló
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galan
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogan Rodríguez-Acevedo
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Radiology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Radiology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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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
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Vidal-Jordana A, Rovira A, Arrambide G, Otero-Romero S, Río J, Comabella M, Nos C, Castilló J, Galan I, Cabello S, Moncho D, Rahnama K, Thonon V, Rodríguez-Acevedo B, Zabalza A, Midaglia L, Auger C, Sastre-Garriga J, Montalban X, Tintoré M. Optic Nerve Topography in Multiple Sclerosis Diagnosis: The Utility of Visual Evoked Potentials. Neurology 2020; 96:e482-e490. [PMID: 33328323 PMCID: PMC7905792 DOI: 10.1212/wnl.0000000000011339] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria. Methods From the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and dissemination in time at baseline (n = 388) were selected. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 10 years of follow-up or a second attack occurring within 10 years (n = 151) were selected to assess the diagnostic performance. The analyses were also performed according to CIS topography (optic neuritis vs non–optic neuritis). Results The addition of the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non–optic neuritis CIS. Conclusion The addition of the optic nerve, assessed by VEP, as a fifth region in the current DIS criteria slightly improves the diagnostic performance because it increases sensitivity without losing specificity.
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Affiliation(s)
- Angela Vidal-Jordana
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada.
| | - Alex Rovira
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Georgina Arrambide
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Susana Otero-Romero
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Jordi Río
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Manuel Comabella
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Carlos Nos
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Joaquin Castilló
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Ingrid Galan
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Sergio Cabello
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Dulce Moncho
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Kimia Rahnama
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Vanessa Thonon
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Breogan Rodríguez-Acevedo
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Ana Zabalza
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Luciana Midaglia
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Cristina Auger
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Jaume Sastre-Garriga
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Xavier Montalban
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Mar Tintoré
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
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Pérez-Miralles FC, Río J, Pareto D, Vidal-Jordana À, Auger C, Arrambide G, Castilló J, Tintoré M, Rovira À, Montalban X, Sastre-Garriga J. Adding brain volume measures into response criteria in multiple sclerosis: the Río-4 score. Neuroradiology 2020; 63:1031-1041. [PMID: 33237430 DOI: 10.1007/s00234-020-02604-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Brain volume changes (BVC) on therapy in MS are being considered as predictor for treatment response at an individual level. We ought to assess whether adding BVC as a factor to monitor interferon-beta response improves the predictive ability of the (no) evidence of disease activity (EDA-3) and Río score (RS-3) criteria for confirmed disability progression in a historical cohort. METHODS One hundred one patients from an observational cohort treated with interferon-beta were assessed for different cutoff points of BVC (ranged 0.2-1.2%), presence of active lesions (≥ 1 for EDA/≥ 3 for RS), relapses, and 6-month confirmed disability progression (CDP), measured by the Expanded Disability Status Scale, after 1 year. Sensitivity, specificity, and positive and negative predictive values for predicting confirmed disability progression at 4 years in original EDA (EDA-3) and RS (RS-3) as well as EDA and RS including BVC (EDA-4 and RS-4) were compared. RESULTS Adding BVC to EDA slightly increased sensitivity, but not specificity or predictive values, nor the OR for predicting CDP; only EDA-3 showed a trend for predicting CDP (OR 3.701, p = 0.050). Adding BVC to RS-3 (defined as ≥ 2 criteria) helped to improve sensitivity and negative predictive value, and increased OR for predicting CDP using a cutoff of ≤ - 0.86% (RS-3 OR 23.528, p < 0.001; RS-4 for all cutoffs ranged from 15.06 to 32, p < 0.001). RS-4 showed areas under the curve larger than RS-3 for prediction of disability at 4 years. CONCLUSION Addition of BVC to RS improves its prediction of response to interferon-beta.
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Affiliation(s)
- Francisco Carlos Pérez-Miralles
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Deborah Pareto
- Unitat de Ressonància Magnètica (Servei de Radiologia), Hospital universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àngela Vidal-Jordana
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Auger
- Unitat de Ressonància Magnètica (Servei de Radiologia), Hospital universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joaquín Castilló
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Àlex Rovira
- Unitat de Ressonància Magnètica (Servei de Radiologia), Hospital universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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Cobo-Calvo A, Ruiz A, Rollot F, Arrambide G, Deschamps R, Maillart E, Papeix C, Audoin B, Lépine AF, Maurey H, Zephir H, Biotti D, Ciron J, Durand-Dubief F, Collongues N, Ayrignac X, Labauge P, Meyer P, Thouvenot E, Bourre B, Montcuquet A, Cohen M, Horello P, Tintoré M, De Seze J, Vukusic S, Deiva K, Marignier R. Clinical Features and Risk of Relapse in Children and Adults with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Ann Neurol 2020; 89:30-41. [PMID: 32959427 DOI: 10.1002/ana.25909] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The main objective was to compare clinical features, disease course, and myelin oligodendrocyte glycoprotein (MOG) antibody (Ab) dynamics between children and adults with MOG-Ab-associated disease (MOGAD). METHODS This retrospective multicentric, national study included 98 children and 268 adults with MOGAD between January 2014 and September 2019. Cox regression model for recurrent time-to-event data and Kaplan-Meier curves for time to antibody negativity were performed for the objectives. RESULTS Isolated optic neuritis was the most frequent clinical presentation in both children (40.8%) and adults (55.9%, p = 0.013), and acute disseminated encephalomyelitis syndrome was more frequent in children (36.7% vs 5.6%, p < 0.001). Compared to adults, children displayed better recovery (Expanded Disability Status Scale ≥ 3.0 at last follow-up reached only by 10 of 97 [10.3%] vs 66/247 [26.7%], p < 0.001). In the multivariate analysis, adults were at higher risk of relapse than children (hazard ratio = 1.41, 95% confidence interval [CI] = 1.12-1.78, p = 0.003). At 2 years, 64.2% (95% CI = 40.9-86.5) of nonrelapsing children became MOG-Ab negative compared to 14.1% (95% CI = 4.7-38.3) of relapsing children (log-rank p < 0.001), with no differences observed in adults (log-rank p = 0.280). INTERPRETATION MOGAD patients differ in the clinical presentation at onset, showing an age-related shift in the clinical features across age groups. Compared to children, adults have a higher risk of relapse and worse functional recovery. Finally, children with monophasic disease become MOG-Ab negative earlier than relapsing children, but this is not true in adults. Considering these differences, management and treatment guidelines should be considered independently in children and adults. ANN NEUROL 2021;89:30-41.
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Affiliation(s)
- Alvaro Cobo-Calvo
- Department of Neurology, Multiple Sclerosis and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Lyon Civil Hospices, Lyon, France.,Department of Neurology-Neuroimmunology, Multiple Sclerosis Center Catalonia, Vall d'Hebron Institute of Research, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France
| | - Anne Ruiz
- Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France
| | - Fabien Rollot
- University of Lyon, Claude Bernard University Lyon 1, Lyon Civil Hospices, EDMUS Foundation, OFSEP, Lyon Neuroscience Research Center, Lyon, France
| | - Georgina Arrambide
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Center Catalonia, Vall d'Hebron Institute of Research, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Romain Deschamps
- Department of Neurology, Adolphe de Rothschild Hospital Foundation, Paris, France
| | - Elisabeth Maillart
- Department of Neurology and Reference Center for Rare Inflammatory Diseases of the Brain and Bone, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | - Caroline Papeix
- Department of Neurology and Reference Center for Rare Inflammatory Diseases of the Brain and Bone, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | - Bertrand Audoin
- Aix-Marseille University, Public Assistance Hospitals of Marseille, Timone Hospital, Clinical Neuroscience Center, Neurology Department, Marseille, France
| | - Anne Fabienne Lépine
- Pediatric Neurology Department, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France
| | - Hélène Maurey
- National Referral Center for Neuroinflammatory Diseases and Pediatric Neurology Department, Public Hospital Network of Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Department of Neuropediatrics, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Helene Zephir
- University Lille, INSERM, CHU Lille, U1172-Laboratory of Neuroinflammation and Multiple Sclerosis, Lille Neuroscience & Cognition, Lille, France.,Department of Neurology, SEP Resource and Competence Center, Lille, France
| | - Damien Biotti
- Department of Neurology, CRC-SEP, Toulouse University Hospital, Toulouse, France
| | - Jonathan Ciron
- Department of Neurology, CRC-SEP, Toulouse University Hospital, Toulouse, France
| | - Francoise Durand-Dubief
- Department of Neurology, Multiple Sclerosis and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Lyon Civil Hospices, Lyon, France
| | - Nicolas Collongues
- Department of Neurology and Clinical Investigation Center, INSERM 1434, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Ayrignac
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Pierre Labauge
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - Pierre Meyer
- Department of Pediatric Neurology, CHU Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Carémeau Hospital, Nimes University Hospital, Nimes, France
| | - Bertrand Bourre
- Department of Neurology, Rouen University Hospital, Rouen, France
| | | | - Mikael Cohen
- Department of Neurology, CRCSEP, Cote d'Azur Clinical Research Unit, Pasteur University Hospital Center 2, Nice, France
| | - Philippe Horello
- Division of Immunovirology, INSERM, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, University of Paris-Sud 11, CEA, DSV/iMETI, IDMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Center Catalonia, Vall d'Hebron Institute of Research, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Jerome De Seze
- Department of Neurology and Clinical Investigation Center, INSERM 1434, Strasbourg University Hospital, Strasbourg, France
| | - Sandra Vukusic
- Department of Neurology, Multiple Sclerosis and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Lyon Civil Hospices, Lyon, France.,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France.,University of Lyon, Claude Bernard University Lyon 1, Lyon Civil Hospices, EDMUS Foundation, OFSEP, Lyon Neuroscience Research Center, Lyon, France
| | - Kumaran Deiva
- Pediatric Neurology Department, National Referral Center for Rare Inflammatory Brain and Spinal Diseases, Public Hospital Network of Paris, University of Paris-Sud Hospitals, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Center for Immunology of Viral Infections and Autoimmune Diseases, University of Paris-Sud, UMR 1184-CEA-IDMIT, Le Kremlin-Bicêtre, France
| | - Romain Marignier
- Department of Neurology, Multiple Sclerosis and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Lyon Civil Hospices, Lyon, France.,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France
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Midaglia L, Otero S, Baró F, Montalban X, Tintoré M. Menopause and multiple sclerosis: Influence on prognosis and role of disease-modifying drugs and hormonal replacement therapy. Mult Scler 2020; 28:173-182. [DOI: 10.1177/1352458520952022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background:Sex hormones play a role in both the risk and the prognosis of multiple sclerosis (MS). Considering all stages of women’s reproductive life, data regarding the influence of menopause on MS and vice versa are scarce.Objective:The aim of this study was to review the evidence addressing the relationship between menopause and MS.Methods:A literature search through PubMed was conducted, selecting studies that assessed (1) the influence of menopause in the MS course, (2) the influence of MS and disease-modifying drugs (DMD) on the development of menopause and (3) the effect of hormone replacement therapy (HRT) on symptoms of menopausal MS patients.Results:(1) Most studies suggest menopause may transitorily aggravate MS symptoms. Two studies found an inflexion point on the Expanding Disability Status Scale (EDSS) with clinical worsening during the menopausal transition. Another study considering full EDSS trajectories from clinically isolated syndrome to postmenopause did not find such an EDSS inflection; (2) MS and DMD do not seem to alter the age of menopause onset; and (3) HRT in menopausal MS patients has not shown consistent benefits.Conclusion:Menopause seems to be associated with transient symptom worsening, but the existence of an inflection in disability progression is still controversial. Properly designed studies are necessary to achieve conclusive results.
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Affiliation(s)
- Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Otero
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Baró
- Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sorensen PS, Sellebjerg F, Hartung HP, Montalban X, Comi G, Tintoré M. The apparently milder course of multiple sclerosis: changes in the diagnostic criteria, therapy and natural history. Brain 2020; 143:2637-2652. [DOI: 10.1093/brain/awaa145] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
In the past decade, changes have occurred in the spectrum of multiple sclerosis courses. The natural history of multiple sclerosis appears milder from the first sign of demyelinating disease to the progressive course, probably as a result of an interplay between several factors including changes in the diagnostic criteria, changes in the epidemiology of multiple sclerosis, impact of early and appropriate disease-modifying treatment and improvement of the general state of health in the population. It has been suggested to regard incidental findings of demyelinating lesions in MRI in individuals without any history of clinical symptoms consistent with neurological dysfunction, so-called radiological isolated syndrome, as the initial course of multiple sclerosis. New diagnostic criteria have enabled the multiple sclerosis diagnosis in many patients at the first clinical demyelinating event, clinically isolated syndrome. The remaining patients with clinically isolated syndrome have a more benign prognosis, and for relapsing-remitting multiple sclerosis, the prognosis has become more favourable. Reduced disease activity in patients with relapsing-remitting multiple sclerosis can partly be ascribed to more efficacious new disease-modifying therapies but decrease in disease activity has also be seen in placebo-treated patients in clinical trials. This may be explained by several factors: change in the diagnostic criteria, more explicit inclusion criteria, exclusion of high-risk patients e.g. patients with co-morbidities, and more rigorous definitions of relapses and disease worsening. However, these factors also make the disease course in patients treated with disease-modifying therapies seem more favourable. In addition, change in the therapeutic target to stable disease (no evidence of disease activity = no relapses, no disease worsening and no MRI activity) could by itself change the course in relapsing-remitting multiple sclerosis. The effectiveness of disease-modifying drugs has reduced the transition from relapsing-remitting to secondary progressive multiple sclerosis. The concept of progressive multiple sclerosis has also evolved from two very distinct categories (primary progressive and secondary progressive multiple sclerosis) to a unified category of progressive multiple sclerosis, which can then be split into the categories of active or inactive. Also, an increasing tendency to treat progressive multiple sclerosis with disease-modifying therapies may have contributed to change the course in progressive multiple sclerosis. In conclusion, during the past decade the entire course of multiple sclerosis from the first sign of a demyelinating disorder through the progressive course appears to be milder due to a complex interplay of several factors.
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Affiliation(s)
- Per Soelberg Sorensen
- Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Hans-Peter Hartung
- Department of Neurology, University Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Xavier Montalban
- Department of Neurology, Hospital General Universitari Vall D’Hebron, Cemcat, Barcelona, Spain
- Division of Neurology, University of Toronto, St. Michael’s Hospital, Toronto, Canada
| | - Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mar Tintoré
- Department of Neurology, Hospital General Universitari Vall D’Hebron, Cemcat, Barcelona, Spain
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47
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Affiliation(s)
- Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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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.
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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
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Clarke MA, Pareto D, Pessini-Ferreira L, Arrambide G, Alberich M, Crescenzo F, Cappelle S, Tintoré M, Sastre-Garriga J, Auger C, Montalban X, Evangelou N, Rovira À. Value of 3T Susceptibility-Weighted Imaging in the Diagnosis of Multiple Sclerosis. AJNR Am J Neuroradiol 2020; 41:1001-1008. [PMID: 32439639 DOI: 10.3174/ajnr.a6547] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that the central vein sign and iron rims are specific features of MS lesions. Using 3T SWI, we aimed to compare the frequency of lesions with central veins and iron rims in patients with clinically isolated syndrome and MS-mimicking disorders and test their diagnostic value in predicting conversion from clinically isolated syndrome to MS. MATERIALS AND METHODS For each patient, we calculated the number of brain lesions with central veins and iron rims. We then identified a simple rule involving an absolute number of lesions with central veins and iron rims to predict conversion from clinically isolated syndrome to MS. Additionally, we tested the diagnostic performance of central veins and iron rims when combined with evidence of dissemination in space. RESULTS We included 112 patients with clinically isolated syndrome and 35 patients with MS-mimicking conditions. At follow-up, 94 patients with clinically isolated syndrome developed MS according to the 2017 McDonald criteria. Patients with clinically isolated syndrome had a median of 2 central veins (range, 0-19), while the non-MS group had a median of 1 central vein (range, 0-6). Fifty-six percent of patients who developed MS had ≥1 iron rim, and none of the patients without MS had iron rims. The sensitivity and specificity of finding ≥3 central veins and/or ≥1 iron rim were 70% and 86%, respectively. In combination with evidence of dissemination in space, the 2 imaging markers had higher specificity than dissemination in space and positive findings of oligoclonal bands currently used to support the diagnosis of MS. CONCLUSIONS A single 3T SWI scan offers valuable diagnostic information, which has the potential to prevent MS misdiagnosis.
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Affiliation(s)
- M A Clarke
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain
| | - D Pareto
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Pessini-Ferreira
- Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Arrambide
- Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Alberich
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain
| | - F Crescenzo
- Department of Neurosciences, Biomedicine and Movement Sciences (F.C.), University of Verona, Verona, Italy
| | - S Cappelle
- Division of Radiology (S.C.), University Hospital Leuven, Leuven, Belgium
| | - M Tintoré
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Auger
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - N Evangelou
- Division of Clinical Neuroscience (N.E.), University of Nottingham, Nottingham, UK
| | - À Rovira
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain .,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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50
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Cappelle S, Pareto D, Tintoré M, Vidal-Jordana A, Alyafeai R, Alberich M, Sastre-Garriga J, Auger C, Montalban X, Rovira À. A validation study of manual atrophy measures in patients with Multiple Sclerosis. Neuroradiology 2020; 62:955-964. [PMID: 32246177 DOI: 10.1007/s00234-020-02401-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/10/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Manual measures such as corpus callosum index, normalized corpus callosum area, and width of the third ventricle are potential biomarkers for brain atrophy. In this work, we investigate their suitability to assess the neurodegenerative component of multiple sclerosis (MS) by comparing them to volumetric measures and expanded disability status scale (EDSS). METHODS Fifty-eight patients with a clinically isolated syndrome, 48 MS patients treated with interferon β, and 26 treated with natalizumab underwent a brain MRI at baseline and after 1 year. Manual measures were evaluated by two observers using Jim v.6.0 at both time points. Volumetric tools (SIENA/x and Freesurfer) were used to calculate normalized brain volume, brain parenchymal fraction, annualized percentage of brain volume change, corpus callosum volume, ventricle volume, and volume of the third ventricle. Statistical analyses were performed with SPSS v.13. RESULTS Usage of corpus callosum volume and third ventricle volume to validate normalized corpus callosum area and width of the third ventricle, respectively, showed very good correlations (r = 0.85, r = 0.83; p < 0.01). Width of the third ventricle, corpus callosum index, and normalized corpus callosum area correlations were significant with EDSS in all patients and moderate to strong with normalized brain volume and brain parenchymal fraction in natalizumab-treated patients (respectively r = - 0.54, r = - 0.61; r = 0.55, r = 0.67; and r = 0.58, r = 0.67; with p < 0.05). CONCLUSION Width of the third ventricle and normalized corpus callosum area seem the more robust manual measures regarding correlation with volumetric measures and EDSS, especially in patients with more advanced disease.
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Affiliation(s)
- Sarah Cappelle
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Deborah Pareto
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Mar Tintoré
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rumaiza Alyafeai
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Alberich
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Àlex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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