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Ponzio M, Tacchino A, Verri A, Battaglia MA, Brichetto G, Podda J. Profile and burden of the family caregiver: the caring experience in multiple sclerosis. An observational study. BMC Psychol 2024; 12:173. [PMID: 38528601 DOI: 10.1186/s40359-024-01678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The broad implications of caring for a family member with a chronic medical condition, such as MS, can lead caregivers to experience a high burden of care. The aim of the study was to describe profile of MS caregivers and their burden and to explore potential factors influencing this burden. METHODS 200 family caregivers of a person with MS completed survey questionnaires across a cross-sectional study. Many information were collected: caregiver socio-demographic and health-related data, caregiving activities, knowledge of MS, coping strategies, mood, social support received and care recipient information. Caregiving burden was measured by the ZBI (Zarit Burden Interview). The extent to which the variables explained caregiver burden was analyzed using a hierarchical approach. RESULTS 68% of the caregivers reported a perceived burden of care (ZBI score > 20). Our results show that physical and mental related-health variables are important predictive factors of the care burden, explaining much of the observed variance (40.9%). CONCLUSION Family caregivers in MS continue to make up the shortfall produce by national health and welfare systems. We highlighted the importance of good physical and mental health in decreasing perceived burden. Working to alleviate psychological distress through mechanisms focus on reducing worries and perceived burden may be a valid approach.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy.
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
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Tacchino A, Di Giovanni R, Grange E, Spirito MM, Ponzio M, Battaglia MA, Brichetto G, Solaro CM. The administration of the paper and electronic versions of the Manual Ability Measure-36 (MAM-36) and Fatigue Severity Scale (FSS) is equivalent in people with multiple sclerosis. Neurol Sci 2024; 45:1155-1162. [PMID: 37828384 DOI: 10.1007/s10072-023-07103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The mobile device diffusion has increasingly highlighted the opportunity to collect patient-reported outcomes (PROs) through electronic patient-reported outcomes measurements (ePROMs) during the clinical routine. Despite the ePROMs promises and advantages, the equivalence when a PRO measure is moved from the original paper-and-pencil to the electronic version is still little investigated. This study aims at evaluating equivalence between PROMs and ePROMs self-administration in people with multiple sclerosis (PwMS); in addition, preference of self-administration type was evaluated. METHODS The Manual Ability Measure-36 (MAM-36) and Fatigue Severity Scale (FSS) were selected for the equivalence test. The app ABOUTCOME was developed through a user-centered design approach to administer the questionnaires on tablet. Both paper-and-pencil and electronic versions were randomly self-administered. Intrarater reliability between both versions was evaluated through the intraclass correlation coefficient (ICC, excellent for values ≥ 0.75). RESULTS Fifty PwMS (35 females) participated to the study (mean age: 54.7±11.0 years, disease course: 27 relapsing-remitting and 23 progressive; mean EDSS: 4.7±1.9; mean disease duration: 13.3±9.5 years). No statistically significant differences were found for the means total scores of MAM-36 (p = 0.61) and FSS (p = 0.78). The ICC value for MAM-36 and FSS was excellent (0.98 and 0.94, respectively). Most of participants preferred the tablet version (84%). CONCLUSION The results of the study provide evidence about the equivalence between the paper-and-pencil and electronic versions of PROs administration. In addition, PwMS prefer electronic methods rather than paper because the information can be provided more efficiently and accurately. The results could be easily extended to other MS PROs.
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Affiliation(s)
- Andrea Tacchino
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy.
| | | | - Erica Grange
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy
| | - Maria Marcella Spirito
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy
| | - Michela Ponzio
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy
| | | | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy
- Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Liguria, Genoa, Italy
| | - Claudio Marcello Solaro
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
- Galliera Hospital, Neurology Unit, Genoa, Italy
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Tacchino A, Ponzio M, Confalonieri P, Leocani L, Inglese M, Centonze D, Cocco E, Gallo P, Paolicelli D, Rovaris M, Sabattini L, Tedeschi G, Prosperini L, Patti F, Bramanti P, Pedrazzoli E, Battaglia MA, Brichetto G. An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study. JMIR Serious Games 2023; 11:e41371. [PMID: 37938895 PMCID: PMC10666018 DOI: 10.2196/41371] [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: 07/23/2022] [Revised: 01/30/2023] [Accepted: 07/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. OBJECTIVE In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. METHODS MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. RESULTS A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. CONCLUSIONS The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Center, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Letizia Leocani
- Vita-Salute University & Hospital San Raffaele, Milan, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Hospital, Genoa, Italy
| | | | - Eleonora Cocco
- Department of Medical Science and Public health, University of Cagliari, Cagliari, Italy
| | - Paolo Gallo
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Don Carlo Gnocchi Foundation, Milan, Italy
| | - Loredana Sabattini
- Uosi Multiple Sclerosis Rehabilitation, IRCCS Istituto delle Scienze Neurologiche of Bologna, Bologna, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | | | | | | | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, Genoa, Italy
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Ponzio M, Podda J, Pignattelli E, Verri A, Persechino B, Vitturi BK, Bandiera P, Manacorda T, Inglese M, Durando P, Battaglia MA. Work Difficulties in People with Multiple Sclerosis. J Occup Rehabil 2023:10.1007/s10926-023-10149-9. [PMID: 37921967 DOI: 10.1007/s10926-023-10149-9] [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] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE This study identifies potential predictors of unemployment and describes specific work difficulties and their determinants in a subgroup of employed people with multiple sclerosis (PwMS). The specific work difficulties were evaluated using a validated tool that measures the impact of respondents' symptoms and of workplace features. METHODS A cross-sectional study was carried out in Italy during 2021-2022. The subjects included were adults (18-65 years) with a diagnosis of MS, currently employed or unemployed. Logistic regression models were used to determine the association between each potential determinant and employment status, while linear regression models were used to determine the association between determinants and specific work difficulties. RESULTS The main risk factors associated with a higher risk of being unemployed were being older, living in the South of Italy/islands, and having a higher disability level, while protective factors against unemployment were having a high level of education and 'stable' employment (an open-ended contract). Fatigue was found to be associated with all work difficulties analyzed; mood disorders emerged as the main predictors of mental health-related work difficulties; level of disability and comorbidity significantly impacted physical health-related ones, and a good quality of life was found to improve both workplace-related and mental health-related difficulties at work. CONCLUSION Identifying the most significant difficulties is a crucial step in the development of vocational rehabilitation interventions tailored to maximize the ability of PwMS to handle their job-related duties and demands.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
- Department of Research, Italian Multiple Sclerosis Foundation, via Operai 40, 16149, Genoa, Italy.
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Elena Pignattelli
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | | | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
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Mosconi P, Guerra T, Paletta P, D'Ettorre A, Ponzio M, Battaglia MA, Amato MP, Bergamaschi R, Capobianco M, Comi G, Gasperini C, Patti F, Pugliatti M, Ulivelli M, Trojano M, Lepore V. Data monitoring roadmap. The experience of the Italian Multiple Sclerosis and Related Disorders Register. Neurol Sci 2023; 44:4001-4011. [PMID: 37311951 PMCID: PMC10264214 DOI: 10.1007/s10072-023-06876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Over the years, disease registers have been increasingly considered a source of reliable and valuable population studies. However, the validity and reliability of data from registers may be limited by missing data, selection bias or data quality not adequately evaluated or checked. This study reports the analysis of the consistency and completeness of the data in the Italian Multiple Sclerosis and Related Disorders Register. METHODS The Register collects, through a standardized Web-based Application, unique patients. Data are exported bimonthly and evaluated to assess the updating and completeness, and to check the quality and consistency. Eight clinical indicators are evaluated. RESULTS The Register counts 77,628 patients registered by 126 centres. The number of centres has increased over time, as their capacity to collect patients. The percentages of updated patients (with at least one visit in the last 24 months) have increased from 33% (enrolment period 2000-2015) to 60% (enrolment period 2016-2022). In the cohort of patients registered after 2016, there were ≥ 75% updated patients in 30% of the small centres (33), in 9% of the medium centres (11), and in all the large centres (2). Clinical indicators show significant improvement for the active patients, expanded disability status scale every 6 months or once every 12 months, visits every 6 months, first visit within 1 year and MRI every 12 months. CONCLUSIONS Data from disease registers provide guidance for evidence-based health policies and research, so methods and strategies ensuring their quality and reliability are crucial and have several potential applications.
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Affiliation(s)
- Paola Mosconi
- Laboratorio di Ricerca per il Coinvolgimento dei Cittadini in Sanità, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy.
| | - Tommaso Guerra
- Dipartimento Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Università degli Studi Aldo Moro, Bari, Italy
| | - Pasquale Paletta
- Laboratorio di Ricerca per il Coinvolgimento dei Cittadini in Sanità, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy
| | - Antonio D'Ettorre
- Laboratorio di Ricerca per il Coinvolgimento dei Cittadini in Sanità, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | | | - Roberto Bergamaschi
- Centro Interdipartimentale Sclerosi Multipla, Fondazione Istituto Neurologico C. Mondino, Pavia, Italy
| | - Marco Capobianco
- Centro Sclerosi Multipla, SC Neurologia, AO Santa Croce E Carle, Cuneo, Italy
| | - Giancarlo Comi
- Casa di Cura del Policlinico, Università Vita Salute San Raffaele, Milan, Italy
| | - Claudio Gasperini
- UOC di Neurologia e Neurofisiopatologia Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | - Francesco Patti
- Centro Sclerosi Multipla AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - Maura Pugliatti
- Centro di Servizio e Ricerca sulla Sclerosi Multipla, AOU di Ferrara, Ferrara, Italy
| | - Monica Ulivelli
- Dipartimento di Scienze Mediche Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | - Maria Trojano
- Dipartimento Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Università degli Studi Aldo Moro, Bari, Italy
| | - Vito Lepore
- Laboratorio di Ricerca per il Coinvolgimento dei Cittadini in Sanità, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy
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Tacchino A, Pedullà L, Podda J, Monti Bragadin M, Battaglia MA, Bisio A, Bove M, Brichetto G. Motor imagery has a priming effect on motor execution in people with multiple sclerosis. Front Hum Neurosci 2023; 17:1179789. [PMID: 37746058 PMCID: PMC10512728 DOI: 10.3389/fnhum.2023.1179789] [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: 03/04/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Priming is a learning process that refers to behavioral changes caused by previous exposure to a similar stimulus. Motor imagery (MI), which involves the mental rehearsal of action representations in working memory without engaging in actual execution, could be a strategy for priming the motor system. This study investigates whether MI primes action execution in Multiple Sclerosis (MS). Here, 17 people with MS (PwMS) and 19 healthy subjects (HS), all right-handed and good imaginers, performed as accurately and quickly as possible, with a pencil, actual or mental pointing movements between targets of small (1.0 × 1.0 cm) or large (1.5 × 1.5 cm) size. In actual trials, they completed five pointing cycles between the left and right targets, whereas in mental trials, the first 4 cycles were imagined while the fifth was actually executed. The fifth cycle was introduced to assess the MI priming effect on actual execution. All conditions, presented randomly, were performed with both dominant (i.e., right) and non-dominant arms. Analysis of the duration of the first 4 cycles in both actual and mental trials confirmed previous findings, showing isochrony in HS with both arms and significantly faster mental than actual movements (anisochrony) in PwMS (p < 0.01) [time (s); HS right: actual: 4.23 ± 0.15, mental: 4.36 ± 0.16; left: actual: 4.32 ± 0.15, mental: 4.43 ± 0.18; PwMS right: actual: 5.85 ± 0.16, mental: 5.99 ± 0.21; left: actual: 6.68 ± 0.20, mental: 5.94 ± 0.23]; anisochrony in PwMS was present when the task was performed with the non-dominant arm. Of note, temporal analysis of the fifth actual cycle showed no differences between actual and mental trials for HS with both arms, whereas in PwMS the fifth actual cycle was significantly faster after the four actual cycles for the non-dominant arm (p < 0.05) [time (s); HS right: actual: 1.03 ± 0.04, mental: 1.03 ± 0.03; left: actual: 1.08 ± 0.04, mental: 1.05 ± 0.03; PwMS right: actual: 1.48 ± 0.04, mental: 1.48 ± 0.06; left: actual: 1.66 ± 0.05, mental: 1.48 ± 0.06]. These results seem to suggest that a few mental repetitions of an action might be sufficient to exert a priming effect on the actual execution of the same action in PwMS. This would indicate further investigation of the potential use of MI as a new motor-cognitive tool for MS neurorehabilitation.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine, and Public Health, University of Siena, Siena, Italy
| | - Ambra Bisio
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Marco Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Ponzio M, Battaglia MA, Brichetto G, Inglese M, Persechino B, Durando P. Work Barriers and Job Adjustments of People with Multiple Sclerosis: A Systematic Review. J Occup Rehabil 2023; 33:450-462. [PMID: 36399281 DOI: 10.1007/s10926-022-10084-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Purpose The aim was to carry out a systematic review dedicated to describing the work barriers and the job adjustments that are particularly sensitive to people with Multiple Sclerosis (PwMS). Methods Four electronic databases (PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science) were searched for peer-reviewed original articles reporting the barriers at work and/or the job adjustments used by PwMS. MS must have been diagnosed according to accepted international criteria at the time of the study and/or confirmed by a doctor. No time limits were set for the search. Articles that were published in English, Italian, Spanish, French, and Portuguese were accepted. Each article was screened by three experienced and trained investigators. The protocol was registered in PROSPERO (CRD42022299994). Results The initial systematic search yielded 104,228 results, of which 49 articles provided sufficient information and were considered suitable for inclusion in the study. Overall, the studies included 30283 participants with MS. Thirteen (27.1%) studies reported on barriers to work, 14 (29.2%) addressed reasonable adjustments and 21 (43.7%) assessed both outcomes. Job characteristics are the most important barriers for PwMS. Other reported barriers concern the work environment, social relationships at work, negative work events and lack of information. PwMS are more vulnerable to the need for adjustments at the workplace, being the management of the workload the most commonly used one. Conclusions PwMS are exposed to a wide variety of work barriers and job adjustments. Future studies are still highly encouraged on the topic.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy.
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Neurology Unit, Genoa, Italy
| | | | - Paolo Durando
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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Aprea MG, Schiavetti I, Portaccio E, Ballerini C, Battaglia MA, Bergamaschi R, Brichetto G, Bunul SD, Calabrese M, Capobianco M, Cavalla P, Celani MG, Clerico M, Cocco E, Comi G, Confalonieri P, Conte A, Cordioli C, De Luca G, De Rossi N, Filippi M, Gumes H, Immovilli P, Inglese M, Karabudak R, Landi D, Lanzillo R, L’Episcopo MR, Lorefice L, Mantero V, Marangoni S, Marfia GA, Masciulli C, Milano E, Moiola L, Orlandi R, Patti F, Perini P, Pesci I, Pucci E, Puthenparampil M, Radaelli M, Salvetti M, Sartori A, Scandellari C, Sen S, Siva A, Strumia S, Teatini F, Tedeschi G, Trojano M, Tutuncu M, Vaula G, Sormani MP, Amato MP. Sars-CoV2 infection in pregnant women with multiple sclerosis. Mult Scler 2023; 29:1090-1098. [PMID: 37232279 PMCID: PMC10225808 DOI: 10.1177/13524585231176174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the general population, maternal SARS-CoV-2 infection during pregnancy is associated with worse maternal outcomes; however, only one study so far has evaluated COVID-19 clinical outcomes in pregnant and postpartum women with multiple sclerosis, showing no higher risk for poor COVID-19 outcomes in these patients. OBJECTIVE In this multicenter study, we aimed to evaluate COVID-19 clinical outcomes in pregnant patients with multiple sclerosis. METHODS We recruited 85 pregnant patients with multiple sclerosis who contracted COVID-19 after conception and were prospectively followed-up in Italian and Turkish Centers, in the period 2020-2022. A control group of 1354 women was extracted from the database of the Multiple Sclerosis and COVID-19 (MuSC-19). Univariate and subsequent logistic regression models were fitted to search for risk factors associated with severe COVID-19 course (at least one outcome among hospitalization, intensive care unit [ICU] admission and death). RESULTS In the multivariable analysis, independent predictors of severe COVID-19 were age, body mass index ⩾ 30, treatment with anti-CD20 and recent use of methylprednisolone. Vaccination before infection was a protective factor. Vaccination before infection was a protective factor. Pregnancy was not a risk nor a protective factor for severe COVID-19 course. CONCLUSION Our data show no significant increase of severe COVID-19 outcomes in patients with multiple sclerosis who contracted the infection during pregnancy.
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Affiliation(s)
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Chiara Ballerini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy/Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | - S Destan Bunul
- Kocaeli University School of Medicine, Kocaeli, Kocaeli, Turkey
| | - Massimiliano Calabrese
- The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Marco Capobianco
- Department of Neurology, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science, University Hospital of Turin, Turin, Italy
| | - Maria Grazia Celani
- Servizio Malattie Demielinizzanti, SC di Neurofisiopatologia, AO di Perugia, Perugia, UK
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | | | - Paolo Confalonieri
- Multiple Sclerosis Centre, IRCCS Foundation “Carlo Besta” Neurological Institute, Milan, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Giovanna De Luca
- MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Haluk Gumes
- Selcuk University School of Medicine, Konya, Turkey
| | - Paolo Immovilli
- Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy/Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | | | | | - Vittorio Mantero
- UOC Neurologia—Stroke Unit, Presidio “A. Manzoni,” ASST Lecco, Italy/Department of Neurology, Ospedale Santa Chiara, Trento, Italy
| | - Sabrina Marangoni
- Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, “Tor Vergata” University, Rome, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Eva Milano
- SC Neurologia 1, Ospedale Maria Vittoria, Torino, Italy
| | - Lucia Moiola
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Riccardo Orlandi
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Patti
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Paola Perini
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy
| | | | - Marco Puthenparampil
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Marta Radaelli
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy/Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Arianna Sartori
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Cinzia Scandellari
- IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy
| | - Sedat Sen
- Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Aksel Siva
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Silvia Strumia
- UOC di Neurologia, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Francesco Teatini
- Multiple Sclerosis Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - Melih Tutuncu
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Giovanna Vaula
- Department of Neuroscience, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Podda J, Marchesi G, Squeri V, De Luca A, Bellosta A, Pedullà L, Konrad G, Battaglia MA, Brichetto G, Tacchino A. Standard versus innovative robotic balance assessment for people with multiple sclerosis: a correlational study. Eur J Med Res 2023; 28:254. [PMID: 37491303 PMCID: PMC10369743 DOI: 10.1186/s40001-023-01223-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION Balance disorders are common in people with Multiple Sclerosis (PwMS) and, together with other impairments and disabilities, often prevent PwMS from performing their daily living activities. Besides clinical scales and performance tests, robotic platforms can provide more sensitive, specific, and objective monitoring. Validated technologies have been adopted as gold standard, but innovative robotic solutions would represent an opportunity to detect balance impairment in PwMS. AIM Study's aim was to compare postural assessment of 46 PwMS with a relapsing-remitting form during static tasks performed with the novel robotic platform hunova® and the gold standard EquiTest®, METHODS: Pearson's r was run on Center of Pressure (COP)-related parameters and global static balance measures computed from hunova® and EquiTest® in eyes-open (EO) and eyes-closed (EC) conditions. In addition, agreeableness level toward the use of both devices was tested through numeric rating scale. RESULTS Considering COP-related parameters, correlations were significant for all measures (p < .001). Interestingly, in EO, a strong correlation was shown for sway area (r = .770), while Medio-Lateral (ML) and Anterior-Posterior (AP) oscillation range, path length, ML and AP speed, ML and AP root mean square distance had a relatively strong association (.454 ≤ r ≤ .576). In EC, except for ML oscillation range showing a relatively strong correlation (r = .532), other parameters were strongly associated (.603 ≤ r ≤ .782). Correlations between global balance indexes of hunova® and EquiTest® revealed a relatively strong association between the Somatosensory Score in EquiTest® and the Somatosensory Index in hunova® (r = - .488). While in EO Static Balance Index from hunova® was highly correlated with Equilibrium score of EquiTest® (r = .416), Static Balance Index had a relatively strong association with both the Equilibrium (r = .482) and Strategy Score (r = .583) of EquiTest® in EC. Results from agreeableness rating scale revealed that hunova® was highly appreciated compared to EquiTest® (p = .044). CONCLUSIONS hunova® represents an innovative adjunct to standard robotic balance evaluation for PwMS. This confirms that combining traditional and robotic assessments can more accurately detect balance impairments in MS.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy.
| | | | | | | | - Alice Bellosta
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
| | - Giovanna Konrad
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
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10
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Podda J, Tacchino A, Verri A, Battaglia MA, Brichetto G, Ponzio M. Development and psychometric properties of a self-assessed knowledge questionnaire for caregivers of people with multiple sclerosis (CareKoMS): a cross-sectional study. BMJ Open 2023; 13:e071657. [PMID: 37399437 DOI: 10.1136/bmjopen-2023-071657] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES Knowledge about multiple sclerosis (MS) is crucial for those who provide care and support as caregivers. However, despite the key benefits of acquiring relevant information to properly assume the caregiving role, caregivers' knowledge of MS is poorly investigated. The aim of this study was to develop and validate the Caregivers' Knowledge of Multiple Sclerosis (CareKoMS), a self-assessed questionnaire, to test MS knowledge in caregivers of people with MS. DESIGN Cross-sectional study. SETTING Italy. PARTICIPANTS Two-hundred caregivers (female: 49%) were asked to self-administer the 32-item CareKoMS questionnaire; they had a median age of 60 years (IQR: 51-68 years) and a medium-high educational level (36.5% primary school and 63.5% high school/university). Item analysis using item difficulty index, item discrimination index, Kuder-Richardson-20 coefficient and item-total correlation were assessed. Once excluding less useful items, reliability, floor and ceiling effects and construct validity were calculated on the 21-item CareKoMS final version. RESULTS Psychometric evaluation indicates that the 21-item CareKoMS was a good questionnaire with no ceiling or floor effects registered. Internal consistency was satisfactory and acceptable as indicated by the mean value of 0.74 of Kuder-Richardson-20. No ceiling or floor effects have been observed. Interestingly, educational level and disease duration correlated with MS knowledge. CONCLUSION CareKoMS is a valid self-assessed questionnaire on MS knowledge for caregivers that may be used in clinical practice and research. Assessing knowledge of MS among caregivers is essential to facilitate their caregiving role and thus decrease the burden of disease management.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
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11
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Schiavetti I, Inglese M, Frau J, Signoriello E, Caleri F, Stromillo ML, Ferrò MT, Rilla MT, Gandoglia I, Gazzola P, Brichetto G, Pasquali L, Grimaldi L, Ulivelli M, Marinelli F, Cordera S, Clerico M, Conte A, Salvetti M, Battaglia MA, Franciotta D, Uccelli A, Sormani MP. Antibody response elicited by the SARS-CoV-2 vaccine booster in patients with multiple sclerosis: who gains from it? Eur J Neurol 2023. [PMID: 37154406 DOI: 10.1111/ene.15830] [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: 02/10/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although two doses of Covid-19 vaccine elicited a protective humoral response in most persons with multiple sclerosis (pwMS), a significant group of them treated with immunosuppressive disease modifying therapies (DMTs) showed less efficient responses. METHODS This prospective multiCenter observational study evaluates differences in immune response after a third vaccine dose in pwMS. RESULTS 473 pwMS were analyzed. Compared to untreated patients, there was a 50-fold decrease (95%CI=14.3-100.0, p < 0.001) in serum SARS-CoV-2 antibody levels in those on rituximab, a 20-fold decrease (95%CI=8.3-50.0, p < 0.001) in those on ocrelizumab, and a 2.3-fold decrease (95%CI=1.2-4.6, p = 0.015) in those on fingolimod. As compared to the antibody levels after the second vaccine dose, patients on the anti-CD20 drugs rituximab/ocrelizumab showed a 2.3-fold lower gain (95%CI=1.4-3.8; p = 0.001), whereas, in contrast, those on fingolimod showed a 1.7-fold higher gain (95%CI: 1.1-2.7; p = 0.012), compared to patients treated with other DMTs. Conclusions All pwMS increased their serum SARS-CoV-2 antibodies levels after the third vaccine dose. The mean antibody values of patients treated with ocrelizumab/rituximab remained well below the empirical 'protective threshold' for risk of infection identified in the CovaXiMS study (> 659 BAU/mL), whereas for patients treated with fingolimod this value was significantly closer to the cut-off.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Italy
| | | | - Elisabetta Signoriello
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli, Italy
| | - Francesca Caleri
- MS Center, Department of Neurology, F. Tappeiner Hospital Meran (BZ), Italy
| | - Maria Laura Stromillo
- Clinica Neurologica e Malattie Neurometaboliche, Università degli Studi di Siena, Italy
| | - Maria Teresa Ferrò
- Neuroimmunology, Center for Multiple Sclerosis, Cerobrovascular Department, Neurological Unit, ASST, Crema, Italy
| | | | | | - Paola Gazzola
- Centro Sclerosi Multipla S.C. Neurologia Asl 3 Genovese, Italy
| | | | - Livia Pasquali
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Luigi Grimaldi
- UOC Neurologia e Centro SM Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Monica Ulivelli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Fabiana Marinelli
- Multiple Sclerosis Center, Fabrizio Spaziani Hospital, via Armando Fabi, Frosinone, Italy
| | | | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino Università di Torino, Italy
| | - Antonella Conte
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Marco Salvetti
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Life Sciences, University of Siena, Italy
| | | | - Antonio Uccelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
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12
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Ciani O, Meregaglia M, Battaglia MA, Brichetto G, Conte A, Gasperini C, Sansone V. Patient-reported outcome measures in drugs for neurological conditions approved by European Medicines Agency 2017-2022. Neurol Sci 2023:10.1007/s10072-023-06825-6. [PMID: 37145229 DOI: 10.1007/s10072-023-06825-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Regulatory agencies have been responsive to public demand for inclusion of the patient experience in evaluating and approving therapies. Over the years, patient-reported outcome measures (PROMs) have become increasingly prevalent in clinical trial protocols; however, their influence on regulators, payers, clinicians, and patients' decision-making is not always clear. We recently conducted a cross-sectional study aimed at investigating the use of PROMs in new regulatory approvals of drugs for neurological conditions between 2017 and 2022 in Europe. METHODS We reviewed European Public Assessment Reports (EPARs) and recorded on a predefined data extraction form whether they considered PROMs, their characteristics (e.g., primary/secondary endpoint, generic/specific instrument) and other relevant information (e.g., therapeutic area, generic/biosimilar, orphan status). Results were tabulated and summarized by means of descriptive statistics. RESULTS Of the 500 EPARs related to authorized medicines between January 2017 and December 2022, 42 (8%) concerned neurological indications. Among the EPARs of these products, 24 (57%) reported any use of PROMs, typically considered as secondary (38%) endpoints. In total, 100 PROMs were identified, of which the most common were the EQ-5D (9%), the SF-36 (6%), or its shorter adaptation SF-12, the PedsQL (4%). CONCLUSIONS Compared to other disease areas, neurology is one where the use of patient-reported outcomes evidence is inherently part of the clinical evaluation and for which core outcome sets exist. Better harmonization of the instruments recommended for use would facilitate the consideration of PROMs at all stages in the drug development process.
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Affiliation(s)
- Oriana Ciani
- Government, Health & Not-for-Profit Division, Center for Research On Health and Social Care Management, SDA Bocconi School of Management, Health Economics & HTA, MEO Building, Room W210, II Floor, Via Sarfatti 10, 20136, Milan, Italy.
| | - Michela Meregaglia
- Government, Health & Not-for-Profit Division, Center for Research On Health and Social Care Management, SDA Bocconi School of Management, Health Economics & HTA, MEO Building, Room W210, II Floor, Via Sarfatti 10, 20136, Milan, Italy
| | | | - Gianpaolo Brichetto
- Associazione Italiana Sclerosi Multipla (AISM) Rehabilitation Center, Genoa, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Italian Society of Neurology (SIN), Siena, Italy
| | - Claudio Gasperini
- Italian Society of Neurology (SIN), Siena, Italy
- Department of Neurosciences, S. Camillo Forlanini Hospital, Rome, Italy
| | - Valeria Sansone
- NeMO Clinical Center, Neurorehabilitation Unit, University of Milan, Milan, Italy
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13
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Genchi A, Brambilla E, Sangalli F, Radaelli M, Bacigaluppi M, Furlan R, Andolfo A, Drago D, Magagnotti C, Scotti GM, Greco R, Vezzulli P, Ottoboni L, Bonopane M, Capilupo D, Ruffini F, Belotti D, Cabiati B, Cesana S, Matera G, Leocani L, Martinelli V, Moiola L, Vago L, Panina-Bordignon P, Falini A, Ciceri F, Uglietti A, Sormani MP, Comi G, Battaglia MA, Rocca MA, Storelli L, Pagani E, Gaipa G, Martino G. Neural stem cell transplantation in patients with progressive multiple sclerosis: an open-label, phase 1 study. Nat Med 2023; 29:75-85. [PMID: 36624312 PMCID: PMC9873560 DOI: 10.1038/s41591-022-02097-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 06/01/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2023]
Abstract
Innovative pro-regenerative treatment strategies for progressive multiple sclerosis (PMS), combining neuroprotection and immunomodulation, represent an unmet need. Neural precursor cells (NPCs) transplanted in animal models of multiple sclerosis have shown preclinical efficacy by promoting neuroprotection and remyelination by releasing molecules sustaining trophic support and neural plasticity. Here we present the results of STEMS, a prospective, therapeutic exploratory, non-randomized, open-label, single-dose-finding phase 1 clinical trial ( NCT03269071 , EudraCT 2016-002020-86), performed at San Raffaele Hospital in Milan, Italy, evaluating the feasibility, safety and tolerability of intrathecally transplanted human fetal NPCs (hfNPCs) in 12 patients with PMS (with evidence of disease progression, Expanded Disability Status Scale ≥6.5, age 18-55 years, disease duration 2-20 years, without any alternative approved therapy). The safety primary outcome was reached, with no severe adverse reactions related to hfNPCs at 2-year follow-up, clearly demonstrating that hfNPC therapy in PMS is feasible, safe and tolerable. Exploratory secondary analyses showed a lower rate of brain atrophy in patients receiving the highest dosage of hfNPCs and increased cerebrospinal fluid levels of anti-inflammatory and neuroprotective molecules. Although preliminary, these results support the rationale and value of future clinical studies with the highest dose of hfNPCs in a larger cohort of patients.
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Affiliation(s)
- Angela Genchi
- grid.18887.3e0000000417581884Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy ,grid.18887.3e0000000417581884Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy ,grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy
| | - Elena Brambilla
- grid.18887.3e0000000417581884Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Sangalli
- grid.18887.3e0000000417581884Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Radaelli
- grid.18887.3e0000000417581884Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Bacigaluppi
- grid.18887.3e0000000417581884Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy ,grid.18887.3e0000000417581884Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy ,grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy
| | - Roberto Furlan
- grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy ,grid.18887.3e0000000417581884Clinical Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Annapaola Andolfo
- grid.18887.3e0000000417581884ProMeFa, Proteomics and Metabolomics Facility, Center for Omics Sciences (COSR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Denise Drago
- grid.18887.3e0000000417581884ProMeFa, Proteomics and Metabolomics Facility, Center for Omics Sciences (COSR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cinzia Magagnotti
- grid.18887.3e0000000417581884ProMeFa, Proteomics and Metabolomics Facility, Center for Omics Sciences (COSR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Maria Scotti
- grid.18887.3e0000000417581884Center for Omics Sciences (COSR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Greco
- grid.18887.3e0000000417581884Haematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Vezzulli
- grid.18887.3e0000000417581884Department of Neuroradiology and CERMAC, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Linda Ottoboni
- grid.18887.3e0000000417581884Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Bonopane
- grid.18887.3e0000000417581884Clinical Trial Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Capilupo
- grid.18887.3e0000000417581884Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ruffini
- grid.18887.3e0000000417581884Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Belotti
- grid.415025.70000 0004 1756 8604M. Tettamanti Research Center, Pediatric Clinic University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy ,grid.415025.70000 0004 1756 8604Laboratorio di Terapia Cellulare e Genica Stefano Verri, ASST-Monza, Ospedale San Gerardo, Monza, Italy
| | - Benedetta Cabiati
- grid.415025.70000 0004 1756 8604M. Tettamanti Research Center, Pediatric Clinic University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy ,grid.415025.70000 0004 1756 8604Laboratorio di Terapia Cellulare e Genica Stefano Verri, ASST-Monza, Ospedale San Gerardo, Monza, Italy
| | - Stefania Cesana
- grid.415025.70000 0004 1756 8604M. Tettamanti Research Center, Pediatric Clinic University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy ,grid.415025.70000 0004 1756 8604Laboratorio di Terapia Cellulare e Genica Stefano Verri, ASST-Monza, Ospedale San Gerardo, Monza, Italy
| | - Giada Matera
- grid.415025.70000 0004 1756 8604M. Tettamanti Research Center, Pediatric Clinic University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy ,grid.415025.70000 0004 1756 8604Laboratorio di Terapia Cellulare e Genica Stefano Verri, ASST-Monza, Ospedale San Gerardo, Monza, Italy
| | - Letizia Leocani
- grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy
| | - Vittorio Martinelli
- grid.18887.3e0000000417581884Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- grid.18887.3e0000000417581884Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Vago
- grid.18887.3e0000000417581884Haematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Panina-Bordignon
- grid.18887.3e0000000417581884Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy ,grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Falini
- grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy ,grid.18887.3e0000000417581884Department of Neuroradiology and CERMAC, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy ,grid.18887.3e0000000417581884Haematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Uglietti
- grid.414818.00000 0004 1757 8749Department of Gynaecology, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Pia Sormani
- grid.5606.50000 0001 2151 3065Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Giancarlo Comi
- grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy
| | | | - Maria A. Rocca
- grid.18887.3e0000000417581884Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy ,grid.15496.3f0000 0001 0439 0892University Vita-Salute San Raffaele, Milan, Italy ,grid.18887.3e0000000417581884Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Loredana Storelli
- grid.18887.3e0000000417581884Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- grid.18887.3e0000000417581884Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Gaipa
- grid.415025.70000 0004 1756 8604M. Tettamanti Research Center, Pediatric Clinic University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy ,grid.415025.70000 0004 1756 8604Laboratorio di Terapia Cellulare e Genica Stefano Verri, ASST-Monza, Ospedale San Gerardo, Monza, Italy
| | - Gianvito Martino
- Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,University Vita-Salute San Raffaele, Milan, Italy.
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14
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Schiavetti I, Carmisciano L, Ponzano M, Cordioli C, Cocco E, Marfia GA, Inglese M, Filippi M, Radaelli M, Bergamaschi R, Immovilli P, Capobianco M, De Rossi N, Brichetto G, Scandellari C, Cavalla P, Pesci I, Confalonieri P, Perini P, Trojano M, Lanzillo R, Tedeschi G, Comi G, Battaglia MA, Patti F, Salvetti M, Sormani MP. Signs and symptoms of Covid‐19 in patients with multiple sclerosis. Eur J Neurol 2022; 29:3728-3736. [PMID: 36086905 PMCID: PMC9538224 DOI: 10.1111/ene.15554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID‐19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID‐19 in MS patients and identify all factors associated with their manifestation. Method Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID‐19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p = 0.005) and more in smoker patients (OR 1.39; p = 0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p = 0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p = 0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p = 0.008). Some disease‐modifying therapies were associated with greater frequencies of certain COVID‐19 symptoms (association between anti‐CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p = 0.05). Differences in frequencies between the three waves were found for flu‐like symptoms (G1, p = 0.024), joint or muscle pain (G2, p = 0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID‐19 symptoms.
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Affiliation(s)
| | | | - Marta Ponzano
- Department of Health Sciences University of Genova Genova Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla, ATS Sardegna Cagliari Italy
- Dipartimento Scienze Mediche e Sanità Pubblica, Università di Cagliari Cagliari Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine Tor Vergata University Rome Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Massimo Filippi
- Neurology Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neurorehabilitation Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neurophysiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
- Vita‐Salute San Raffaele University Milan Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST ‘Papa Giovanni XXIII’ Bergamo Italy
| | | | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto Piacenza Italy
| | - Marco Capobianco
- Regional Referral Multiple Sclerosis Centre, Department of Neurology University Hospital San Luigi Orbassano (Torino) Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari Italy
| | | | - Cinzia Scandellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla Bologna Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience City of Health and Science University Hospital of Turin Turin Italy
| | - Ilaria Pesci
- Centro SM UOC Neurologia, Fidenza, AUSL PR, Fidenza Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Neuroimmunology Department ‘Carlo Besta’ Neurological Institute Milan Italy
| | - Paola Perini
- Department of Neurology Multiple Sclerosis Center University of Padua Padova Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs University of Bari Bari Italy
| | | | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences University of Campania Napoli Italy
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Casa di Cura Privata del Policlinico Milan Italy
| | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation Genoa Italy
- Department of Life Sciences University of Siena Siena Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia University of Catania Catania Italy
- Centro Sclerosi Multipla, Policlinico Catania University of Catania Catania Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs Sapienza University of Rome Rome Italy
- Unit of Neurology, IRCCS Neuromed Pozzilli Italy
| | - Maria Pia Sormani
- Department of Health Sciences University of Genova Genova Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
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15
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Bezzini D, Gualdani E, Razzanelli M, Battaglia MA, Cortese R, Francesconi P, Ulivelli M. Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy). Neurol Sci 2022; 43:6407-6414. [PMID: 35978257 PMCID: PMC9616752 DOI: 10.1007/s10072-022-06345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
Objective Chronic comorbidities are common in people with multiple sclerosis (PwMS), thus worsening their prognosis and quality of life, and increasing disease burden. The aim of the present study was to evaluate the prevalence of common comorbidities in PwMS in Tuscany (Central Italy) and to compare it with the general population. Methods The prevalence of comorbidities, including diabetes, chronic obstructive pulmonary disease (COPD), hypertension, stroke, heart failure (HF), cardiac infarction and ischemic heart disease (IHD), was assessed in PwMS and in general population resident in Tuscany, aged > 20 years, using administrative data. Results In total, we identified 8,274 PwMS. Among them, 34% had at least one comorbidity, with hypertension being the most common (28.5%). Comparing PwMS with the general population, PwMS had a higher frequency of hypertension and stroke when considering the whole group, and of diabetes, COPD, and IHD when considering sex and age subgroups. This increased risk was especially evident in the young and intermediate age groups, where multiple sclerosis may play an important role as risk factor for some comorbidities. In PwMS, as well as in the general population, prevalence of chronic diseases was higher in males and increased with age. Conclusions Comorbidities frequently coexist with multiple sclerosis and they may have an impact on this complex disease, from the health, clinical, and socioeconomic points of view. Therefore, a routine screening of chronic comorbidities should be a crucial step in clinical practice, as well as the promotion of healthy lifestyles to prevent the onset and to reduce their burden.
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Affiliation(s)
- Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy.
| | - Elisa Gualdani
- Agenzia Regionale Di Sanità Della Toscana, Florence, Italy
| | | | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | | | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
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16
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Battaglia MA, Manacorda T, Persechino B, Buresti G, Ponzio M, Inglese M, Durando P. Spatial and temporal distribution of the prevalence of unemployment and early retirement in people with multiple sclerosis: A systematic review with meta-analysis. PLoS One 2022; 17:e0272156. [PMID: 35901070 PMCID: PMC9333213 DOI: 10.1371/journal.pone.0272156] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to summarise the prevalence of unemployment and early retirement among people with MS and analyze data according to a spatio-temporal perspective. Methods We undertook a systematic search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science. We included any peer-reviewed original article reporting the prevalence of unemployment and early retirement in the working-age population with MS. We excluded articles off-topic, with other study designs, whose study sample were unlikely to be representative of the MS population and in case of unavailability of the full text or essential information. A random-effects meta-analysis was used to measure overall prevalence estimates of unemployment and early retirement. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. Results Our research identified 153 studies across 29 countries encompassing 188436 subjects with MS. The pooled overall effect size for unemployment and early retirement was 35.6% (95% CI 32.8–38.4; I2 = 99.31) and 17.2% (95% CI 14.6–20.2; I2 = 99.13), respectively. The prevalence of unemployment varied according to the year of publication (p < 0.001) and there was a statistically significant decrease in the prevalence of unemployment over time (p = 0.042). Regarding early retirement, only seven (31.8%) estimates obtained from studies that were published before 2010 were below the overall effect size in comparison to 27 (60.0%) estimates extracted from data published between 2010 and 2021 (p = 0.039). There was a significant difference in prevalence according to countries (p < 0.001). Psychiatric illness was an important clinical feature responsible for patients leaving the workforce in regions with a high MS prevalence. Conclusions Unemployment and early retirement due to MS remain highly prevalent, despite a slight decline in the last decade. The prevalence of unemployment and early retirement varies globally.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
| | - Tommaso Manacorda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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17
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Sbragia E, Bandiera P, Ponzio M, Battaglia MA, Manacorda T, Persechino B, Buresti G, Inglese M, Durando P. Occupational outcomes of people with multiple sclerosis: a scoping review. BMJ Open 2022; 12:e058948. [PMID: 35777874 PMCID: PMC9252209 DOI: 10.1136/bmjopen-2021-058948] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To update the knowledge on the occupational outcomes associated with multiple sclerosis (MS), systematically examine the extent, scope and nature of the pre-existing literature and identify research gaps in the existing literature. DESIGN Scoping review. DATA SOURCES A comprehensive database search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect and Web of Science was performed. There were no time limits. ELIGIBILITY CRITERIA We included any peer-reviewed original article reporting the occupational outcomes of people with MS between the ages of 18 and 65 years. We excluded those off-topic and with insufficient information. METHODS This review was conducted following the Joanna Briggs Institute recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review checklist. Screening, reading of full-texts and data extraction was performed in a standardised way by expert reviewers from 14 July 2021 to 31 October 2021. We provided a narrative synthesis and an overview of findings. RESULTS The initial systematic search yielded 104 228 results. After removing duplicates and applying the exclusion criteria, 403 articles were included in the review. In total, the studies evaluated 492 062 subjects with MS. One hundred fifty-four (38.2%) articles were published in the last 5 years, mostly from Europe and North America (50.9% and 33.0%, respectively). Concerning the occupational outcomes, studies mostly addressed unemployment (311, 77.2%), early retirement (120, 29.8%), disability pension (117, 29.0%), sick leave (77, 19.1%), the indirect cost of MS (74, 18.4%) and work characteristics (57, 14.1%). The results were categorised into seven subtopics: 'Changes in work and occupational status due to MS', 'work-related socio-economic consequences of MS', 'risk factors for unfavourable occupational outcomes', 'reported barriers to employment', 'reported job accommodations and vocational rehabilitation strategies', 'job satisfaction, stigma, and disclosing the diagnosis in the workplace' and 'rating clinical scales'. CONCLUSIONS There are several issues that deserve further in-depth study by the scientific community in order to improve the occupational outcomes of people with MS.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicoletta Debarbieri
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elvira Sbragia
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Michela Ponzio
- Research Area, Italian Multiple Sclerosis Association, Genoa, Italy
| | - Mario Alberto Battaglia
- Research Area, Italian Multiple Sclerosis Association, Genoa, Italy
- Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
- Department of Life Science, University of Siena, Siena, Italy
| | | | | | | | - Matilde Inglese
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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18
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Podda J, Uccelli MM, Tacchino A, Pedullà L, Monti Bragadin M, Alberto Battaglia M, Brichetto G, Ponzio M. Predictors of Mood Disorders in Parents With Multiple Sclerosis: The Role of Disability Level, Coping Techniques, and Perceived Social Support. Int J MS Care 2022; 24:224-229. [DOI: 10.7224/1537-2073.2021-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background:
Being a parent can be demanding and stressful, especially for people with chronic diseases such as multiple sclerosis (MS). Parenting can be disrupted by flare-ups, disease worsening, and other MS symptoms, including mobility problems, pain, fatigue, and cognitive impairment. Mood disorders, such as depression and anxiety, have been found to occur at much higher rates in people with MS than in the general population. Surprisingly, less is known about which factors may predict mood disorders in parents with MS. This study aims to identify potential demographic, clinical, and self-reported predictors that contribute to mood disorders measured by the Hospital Anxiety and Depression Scale.
Methods:
A total of 285 parents with MS completed an anonymous online questionnaire combining sociodemographic, clinical, and family characteristics and scales, validated in Italian, related to coping strategies and social support. Associations between each variable and mood disorders were assessed using univariate and multivariate logistic regression analyses.
Results:
Disability level, emotional and dysfunctional coping strategies, and perceived social support were significant predictors of mood disorders in parents with MS.
Conclusions:
These findings confirm the importance of identifying risk factors for mood disorders in parents with MS so that early intervention can minimize mood disruptions caused by the disease.
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Affiliation(s)
- Jessica Podda
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michele Messmer Uccelli
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Andrea Tacchino
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margherita Monti Bragadin
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP) and AISM Rehabilitation Service (MMB, GB), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Mario Alberto Battaglia
- The Department of Physiopathology, Experimental Medicine, and Public Health, University of Siena, Siena, Italy (MAB)
| | - Giampaolo Brichetto
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP) and AISM Rehabilitation Service (MMB, GB), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michela Ponzio
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
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19
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Sormani MP, Schiavetti I, Inglese M, Carmisciano L, Laroni A, Lapucci C, Visconti V, Serrati C, Gandoglia I, Tassinari T, Perego G, Brichetto G, Gazzola P, Mannironi A, Stromillo ML, Cordioli C, Landi D, Clerico M, Signoriello E, Cocco E, Frau J, Ferrò MT, Di Sapio A, Pasquali L, Ulivelli M, Marinelli F, Pizzorno M, Callari G, Iodice R, Liberatore G, Caleri F, Repice AM, Cordera S, Battaglia MA, Salvetti M, Franciotta D, Uccelli A. Breakthrough SARS-CoV-2 infections after COVID-19 mRNA vaccination in MS patients on disease modifying therapies during the Delta and the Omicron waves in Italy. EBioMedicine 2022; 80:104042. [PMID: 35526306 PMCID: PMC9069178 DOI: 10.1016/j.ebiom.2022.104042] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [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: 02/23/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In this study we aimed to monitor the risk of breakthrough SARS-CoV-2 infection in patients with MS (pwMS) under different DMTs and to identify correlates of reduced protection. METHODS This is a prospective Italian multicenter cohort study, long-term clinical follow-up of the CovaXiMS (Covid-19 vaccine in Multiple Sclerosis) study. 1855 pwMS scheduled for SARS-CoV-2 mRNA vaccination were enrolled and followed up to a mean time of 10 months. The cumulative incidence of breakthrough Covid-19 cases in pwMS was calculated before and after December 2021, to separate the Delta from the Omicron waves and to account for the advent of the third vaccine dose. FINDINGS 1705 pwMS received 2 m-RNA vaccine doses, 21/28 days apart. Of them, 1508 (88.5%) had blood assessment 4 weeks after the second vaccine dose and 1154/1266 (92%) received the third dose after a mean interval of 210 days (range 90-342 days) after the second dose. During follow-up, 131 breakthrough Covid-19 infections (33 during the Delta and 98 during the Omicron wave) were observed. The probability to be infected during the Delta wave was associated with SARS-CoV-2 antibody levels measured after 4 weeks from the second vaccine dose (HR=0.57, p < 0.001); the protective role of antibodies was preserved over the whole follow up (HR=0.57, 95%CI=0.43-0.75, p < 0.001), with a significant reduction (HR=1.40, 95%CI=1.01-1.94, p=0.04) for the Omicron cases. The third dose significantly reduced the risk of infection (HR=0.44, 95%CI=0.21-0.90,p=0.025) during the Omicron wave. INTERPRETATION The risk of breakthrough SARS-CoV-2 infections is mainly associated with reduced levels of the virus-specific humoral immune response. FUNDING Supported by FISM - Fondazione Italiana Sclerosi Multipla - cod. 2021/Special-Multi/001 and financed or co-financed with the '5 per mille' public funding.
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Affiliation(s)
- Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Alice Laroni
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Valeria Visconti
- Laboratory Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Serrati
- Department of Neurology, Imperia Hospital, Imperia, Italy
| | | | | | | | | | - Paola Gazzola
- Centro Sclerosi Multipla S.C. Neurologia Asl 3 Genovese, Italy
| | | | - Maria Laura Stromillo
- Clinica Neurologica e Malattie Neurometaboliche, Università degli Studi di Siena, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Rome, Italy
| | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Italy
| | - Elisabetta Signoriello
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari - ATS Sardegna, Università di Cagliari, Italy
| | - Jessica Frau
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari - ATS Sardegna, Università di Cagliari, Italy
| | - Maria Teresa Ferrò
- Neuroimmunology, Center for Multiple Sclerosis, Cerobrovascular Department, Neurological Unit, ASST Crema, Italy
| | - Alessia Di Sapio
- Department of Neurology, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Livia Pasquali
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Fabiana Marinelli
- Multiple Sclerosis Center, Fabrizio Spaziani Hospital, Frosinone, Italy
| | | | - Graziella Callari
- UOC Neurologia e Centro SM Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Rosa Iodice
- Clinica Neurologica, DSNRO Università Federico II di Napoli, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesca Caleri
- MS Center, Department of Neurology, F. Tappeiner Hospital Meran (BZ), Italy
| | - Anna Maria Repice
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | | | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy; Department of Life Sciences, University of Siena, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy; IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Diego Franciotta
- Autoimmunology Laboratory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Uccelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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20
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Ulivelli M, Bezzini D, Kundisova L, Grazi I, Battaglia MA, Nante N, Rossi S. Mortality of Parkinson's disease in Italy from 1980 to 2015. Neurol Sci 2022; 43:3603-3611. [PMID: 35094172 DOI: 10.1007/s10072-021-05854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate mortality for Parkinson's disease (PD) in Italy during a long time period (1980-2015) and to discuss the role of possible general and specific influencing factors. METHODS Based on mortality data provided by the Italian National Institute of Statistics, sex- and age-specific crude mortality rates were computed, for the whole country and for its main geographical sub-areas. Rates were standardized using both direct (annual mortality rates AMRs) and indirect (standardized mortality rates SMRs) methods. SMRs were used to evaluate geographical differences, whereas AMRs and joinpoint linear regression analysis to study mortality trends. RESULTS Considering the entire period, highest mortality rates were observed in males (AMR/100,000: 9.0 in males, 5.25 in females), in North-West and Central Italy (SMR > 100). Overall PD mortality decreased from mid-eighties onwards and then rapidly reversed the trend in the period 1998-2002, rising up to a maximum in 2015, with some differences according to sex and geographical areas. CONCLUSIONS Several factors may have contributed to the rapid inversion of decreasing trend in mortality observed in the last part of XX century. Possible explanations of this rising trend are related to the increasing burden of PD (especially in males and in certain Italian regions), caused by different factors as population aging, physiological prevalence rise due to incidence exceeding mortality, and growing exposure to environmental or occupational risk factors. In addition, the accuracy of death certificate compilation could account for geographical differences and for the temporal trend. The role of levodopa and recently introduced dopaminergic drugs is also discussed.
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Affiliation(s)
- Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy.
| | - Lucia Kundisova
- Postgradual School of Public Health, University of Siena, Siena, Italy
| | - Ilaria Grazi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy.,Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Nicola Nante
- Postgradual School of Public Health, University of Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
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21
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Battaglia MA, Bezzini D, Cecchini I, Cordioli C, Fiorentino F, Manacorda T, Nica M, Ponzio M, Ritrovato D, Vassallo C, Patti F. Patients with multiple sclerosis: a burden and cost of illness study. J Neurol 2022; 269:5127-5135. [PMID: 35604465 PMCID: PMC9124746 DOI: 10.1007/s00415-022-11169-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
Background Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease negatively impacting patients’ physical, psychological and social well-being with a significant economic burden. Objectives The study estimates MS burden and cost of illness in Italy from a societal perspective in 2019. Methods Information on the impact of the disease on daily activities, symptoms, employment, resource utilization and the role of caregivers was collected through questionnaires completed by 944 patients and caregivers. Results were stratified according to both disease severity and payer. Mean costs and overall costs were extrapolated from the sample to the Italian MS population considering published distribution of severity. Results The study showed a great impact of the disease on daily and work activities increasing with the disability. The overwhelming burden of fatigue emerged. Mean annual costs were estimated at €39,307/patient (€29,676, €43,464 and €53,454 in mild, moderate and severe cases, respectively). Direct healthcare costs were the major component (€21,069), followed by indirect costs (€15,004). The overall cost of the disease in Italy was €4.8 billion. The National Healthcare System (NHS) sustained most of the costs (80%), most notably direct healthcare costs, while patients paid almost all non-healthcare expenses. Conclusions This study confirmed that MS carries a substantial burden to patients and society, highlighting the need for awareness of this disease. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11169-w.
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Affiliation(s)
- Mario Alberto Battaglia
- Italian Multiple Sclerosis Foundation (AISM), Genoa, Italy
- The University of Siena, Siena, Italy
| | | | | | - Cinzia Cordioli
- ASST Spedali Civili di Brescia, Multiple Sclerosis Center, Brescia, Italy
| | | | - Tommaso Manacorda
- Italian Multiple Sclerosis Foundation (AISM), Genoa, Italy
- The London School of Hygiene and Tropical Medicine, London, UK
| | | | - Michela Ponzio
- Italian Multiple Sclerosis Foundation (AISM), Genoa, Italy
| | | | | | - Francesco Patti
- Multiple Sclerosis Centre Sicilia Region, University Hospital Catania, Catania, Italy
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22
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Ponzano M, Schiavetti I, Bovis F, Landi D, Carmisciano L, De Rossi N, Cordioli C, Moiola L, Radaelli M, Immovilli P, Capobianco M, Bragadin MM, Cocco E, Scandellari C, Cavalla P, Pesci I, Confalonieri P, Perini P, Bergamaschi R, Inglese M, Petracca M, Trojano M, Tedeschi G, Comi G, Battaglia MA, Patti F, Fragoso YD, Sen S, Siva A, Karabudak R, Efendi H, Furlan R, Salvetti M, Sormani MP. A multiparametric score for assessing the individual risk of severe Covid-19 among patients with Multiple Sclerosis. Mult Scler Relat Disord 2022; 63:103909. [PMID: 35675744 PMCID: PMC9130313 DOI: 10.1016/j.msard.2022.103909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/09/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
Background Many risk factors for the development of severe forms of Covid-19 have been identified, some applying to the general population and others specific to Multiple Sclerosis (MS) patients. However, a score for quantifying the individual risk of severe Covid-19 in patients with MS is not available. The aim of this study was to construct such score and to evaluate its performance. Methods Data on patients with MS infected with Covid-19 in Italy, Turkey and South America were extracted from the Musc-19 platform. After imputation of missing values, data were separated into training data set (70%) and validation data set (30%). Univariable logistic regression models were performed in the training dataset to identify the main risk factors to be included in the multivariable logistic regression analyses. To select the most relevant variables we applied three different approaches: (1) multivariable stepwise, (2) Lasso regression, (3) Bayesian model averaging. Three scores were defined as the linear combination of the coefficients estimated in the models multiplied by the corresponding value of the variables and higher scores were associated to higher risk of severe Covid-19 course. The performances of the three scores were compared in the validation dataset based on the area under the ROC curve (AUC) and an optimal cut-off was calculated in the training dataset for the score with the best performance. The probability of showing a severe Covid-19 course was calculated based on the score with the best performance. Results 3852 patients were included in the study (2696 in the training dataset and 1156 in the validation data set). 17% of the patients required hospitalization and risk factors for severe Covid-19 course were older age, male sex, living in Turkey or South America instead of living in Italy, presence of comorbidities, progressive MS, longer disease duration, higher Expanded Disability Status Scale, Methylprednisolone use and anti-CD20 treatment. The score with the best performance was the one derived using the Lasso selection approach (AUC= 0.72) and it was built with the following variables: age, sex, country, BMI, presence of comorbidities, EDSS, methylprednisolone use, treatment. An excel spreadsheet to calculate the score and the probability of severe Covid-19 is available at the following link: https://osf.io/ac47u/?view_only=691814d57b564a34b3596e4fcdcf8580. Conclusions The originality of this study consists in building a useful tool to quantify the individual risk for Covid-19 severity based on patient's characteristics. Due to the modest predictive ability and to the need of external validation, this tool is not ready for being fully used in clinical practice to make important decisions or interventions. However, it can be used as an additional instrument to identify high-risk patients and persuade them to take important measures to prevent Covid-19 infection (i.e. getting vaccinated against Covid-19, adhering to social distancing, and using of personal protection equipment).
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23
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Iaffaldano P, Lucisano G, Manni A, Paolicelli D, Patti F, Capobianco M, Brescia Morra V, Sola P, Pesci I, Lus G, De Luca G, Lugaresi A, Cavalla P, Montepietra S, Maniscalco GT, Granella F, Ragonese P, Vianello M, Brambilla L, Totaro R, Toscano S, Malucchi S, Petracca M, Moiola L, Ferraro D, Lepore V, Mosconi P, Ponzio M, Tedeschi G, Comi G, Battaglia MA, Filippi M, Amato MP, Trojano M. Risk of Getting COVID-19 in People With Multiple Sclerosis: A Case-Control Study. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/2/e1141. [PMID: 35046084 PMCID: PMC8771668 DOI: 10.1212/nxi.0000000000001141] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
Background and Objectives Several studies have assessed risk factors associated with the severity of COVID-19 outcomes in people with multiple sclerosis (PwMS). The potential role of disease-modifying therapies (DMTs) and demographic and clinical factors on the risk of acquiring SARS-CoV-2 infection has not been evaluated so far. The objective of this study was to assess risk factors of contracting SARS-CoV-2 infection in PwMS by using data collected in the Italian MS Register (IMSR). Methods A case-control (1:2) study was set up. Cases included PwMS with a confirmed diagnosis of COVID-19, and controls included PwMS without a confirmed diagnosis of COVID-19. Both groups were propensity score–matched by the date of COVID-19 diagnosis, the date of last visit, and the region of residence. No healthy controls were included in this study. COVID-19 risk was estimated by multivariable logistic regression models including demographic and clinical covariates. The impact of DMTs was assessed in 3 independent logistic regression models including one of the following covariates: last administered DMT, previous DMT sequences, or the place where the last treatment was administered. Results A total of 779 PwMS with confirmed COVID-19 (cases) were matched to 1,558 PwMS without COVID-19 (controls). In all 3 models, comorbidities, female sex, and a younger age were significantly associated (p < 0.02) with a higher risk of contracting COVID-19. Patients receiving natalizumab as last DMT (OR [95% CI]: 2.38 [1.66–3.42], p < 0.0001) and those who underwent an escalation treatment strategy (1.57 [1.16–2.13], p = 0.003) were at significantly higher COVID-19 risk. Moreover, PwMS receiving their last DMT requiring hospital access (1.65 [1.34–2.04], p < 0.0001) showed a significant higher risk than those taking self-administered DMTs at home. Discussion This case-control study embedded in the IMSR showed that PwMS at higher COVID-19 risk are younger, more frequently female individuals, and with comorbidities. Long-lasting escalation approach and last therapies that expose patients to the hospital environment seem to significantly increase the risk of SARS-CoV2 infection in PwMS. Classification of Evidence This study provides Class III evidence that among patients with MS, younger age, being female individuals, having more comorbidities, receiving natalizumab, undergoing an escalating treatment strategy, or receiving treatment at a hospital were associated with being infected with COVID-19. Among patients with MS who were infected with COVID-19, a severe course was associated with increasing age and having a progressive form of MS, whereas not being on treatment or receiving an interferon beta agent was protective.
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Affiliation(s)
- Pietro Iaffaldano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giuseppe Lucisano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Alessia Manni
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Damiano Paolicelli
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Francesco Patti
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Marco Capobianco
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Vincenzo Brescia Morra
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Patrizia Sola
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Ilaria Pesci
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giacomo Lus
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giovanna De Luca
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Alessandra Lugaresi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paola Cavalla
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Sara Montepietra
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giorgia Teresa Maniscalco
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Franco Granella
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paolo Ragonese
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Marika Vianello
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Laura Brambilla
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Rocco Totaro
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Simona Toscano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Simona Malucchi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Petracca
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Lucia Moiola
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Diana Ferraro
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Vito Lepore
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paola Mosconi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Michela Ponzio
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Gioacchino Tedeschi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giancarlo Comi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Mario Alberto Battaglia
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Massimo Filippi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Pia Amato
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Trojano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy.
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Zaratin P, Vermersch P, Amato MP, Brichetto G, Coetzee T, Cutter G, Edan G, Giovannoni G, Gray E, Hartung HP, Hobart J, Helme A, Hyde R, Khan U, Leocani L, Mantovani LG, McBurney R, Montalban X, Penner IK, Uitdehaag BM, Valentine P, Weiland H, Bertorello D, Battaglia MA, Baneke P, Comi G. The agenda of the global Patient Reported Outcomes for Multiple Sclerosis (PROMS) Initiative: progresses and open questions. Mult Scler Relat Disord 2022; 61:103757. [DOI: 10.1016/j.msard.2022.103757] [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: 02/09/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 11/25/2022]
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Zaratin P, Bertorello D, Guglielmino R, Devigili D, Brichetto G, Tageo V, Dati G, Kramer S, Battaglia MA, Di Luca M. The MULTI-ACT model: the path forward for participatory and anticipatory governance in health research and care. Health Res Policy Syst 2022; 20:22. [PMID: 35177080 PMCID: PMC8853400 DOI: 10.1186/s12961-022-00825-2] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/31/2022] [Indexed: 12/18/2022] Open
Abstract
The COVID-19 pandemic has unmasked even more clearly the need for research and care to form a unique and interdependent ecosystem, a concept which has emerged in recent years. In fact, to address urgent and unexpected missions such as “fighting all together the COVID-19 pandemic”, the importance of multi-stakeholder collaboration, mission-oriented governance and flexibility has been demonstrated with great efficacy. This calls for a policy integration strategy and implementation of responsible research and innovation principles in health, promoting an effective cooperation between science and society towards a shared mission. This article describes the MULTI-ACT framework and discusses how its innovative approach, encompassing governance criteria, patient engagement and multidisciplinary impact assessment, represents a holistic management model for structuring responsible research and innovation participatory governance in brain conditions research.
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Affiliation(s)
- Paola Zaratin
- Italian Multiple Sclerosis Society Foundation, Genova, Italy.
| | | | | | | | | | | | - Gabriele Dati
- Italian Multiple Sclerosis Society Foundation, Genova, Italy
| | | | - Mario Alberto Battaglia
- Italian Multiple Sclerosis Society Foundation, Genova, Italy.,Department of Life Sciences, University of Siena, Siena, Italy
| | - Monica Di Luca
- European Brain Council, Brussels, Belgium.,Laboratory of Pharmacology of Neurodegeneration-DiSFeB at the University of Milano, Milano, Italy
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Podda J, Tacchino A, Pedullà L, Monti Bragadin M, Battaglia MA, Brichetto G, Ponzio M. Mind wandering in people with Multiple Sclerosis: A psychometric study. Mult Scler Relat Disord 2022; 58:103521. [DOI: 10.1016/j.msard.2022.103521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/29/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
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Ponzio M, Tacchino A, Amicizia D, Piazza MF, Paganino C, Trucchi C, Astengo M, Simonetti S, Gallo D, Sansone A, Brichetto G, Battaglia MA, Ansaldi F. Prevalence of multiple sclerosis in Liguria region, Italy: an estimate using the capture-recapture method. Neurol Sci 2021; 43:3239-3245. [PMID: 34817728 PMCID: PMC9018629 DOI: 10.1007/s10072-021-05718-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/30/2021] [Indexed: 11/21/2022]
Affiliation(s)
- M Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.
| | - A Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - D Amicizia
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M F Piazza
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - C Paganino
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - C Trucchi
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Astengo
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | | | - D Gallo
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - A Sansone
- AISM Rehabilitation Centre Liguria, Italian Multiple Sclerosis Society, Genoa, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.,AISM Rehabilitation Centre Liguria, Italian Multiple Sclerosis Society, Genoa, Italy
| | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - F Ansaldi
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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Sormani MP, Schiavetti I, Carmisciano L, Cordioli C, Filippi M, Radaelli M, Immovilli P, Capobianco M, De Rossi N, Brichetto G, Cocco E, Scandellari C, Cavalla P, Pesci I, Zito A, Confalonieri P, Marfia GA, Perini P, Inglese M, Trojano M, Brescia Morra V, Tedeschi G, Comi G, Battaglia MA, Patti F, Salvetti M. COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context. Neurol Neuroimmunol Neuroinflamm 2021; 9:9/1/e1105. [PMID: 34753829 PMCID: PMC8579249 DOI: 10.1212/nxi.0000000000001105] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/15/2021] [Indexed: 11/15/2022]
Abstract
Background and Objectives It is unclear how multiple sclerosis (MS) affects the severity of COVID-19.
The aim of this study is to compare COVID-19–related outcomes
collected in an Italian cohort of patients with MS with the outcomes
expected in the age- and sex-matched Italian population. Methods Hospitalization, intensive care unit (ICU) admission, and death after
COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and
sex-matched Italian population in a retrospective observational case-cohort
study with population-based control. The observed vs the expected events
were compared in the whole MS cohort and in different subgroups (higher
risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1
comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the
χ2 test, and the risk excess was quantified by risk
ratios (RRs). Results The risk of severe events was about twice the risk in the age- and
sex-matched Italian population: RR = 2.12 for hospitalization
(p < 0.001), RR = 2.19 for ICU admission
(p < 0.001), and RR = 2.43 for death
(p < 0.001). The excess of risk was confined to
the higher-risk group (n = 553). In lower-risk patients (n = 809),
the rate of events was close to that of the Italian age- and sex-matched
population (RR = 1.12 for hospitalization, RR = 1.52 for ICU
admission, and RR = 1.19 for death). In the lower-risk group, an
increased hospitalization risk was detected in patients on anti-CD20 (RR
= 3.03, p = 0.005), whereas a decrease was
detected in patients on interferon (0 observed vs 4 expected events,
p = 0.04). Discussion Overall, the MS cohort had a risk of severe events that is twice the risk
than the age- and sex-matched Italian population. This excess of risk is
mainly explained by the EDSS score and comorbidities, whereas a residual
increase of hospitalization risk was observed in patients on anti-CD20
therapies and a decrease in people on interferon.
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Affiliation(s)
- Maria Pia Sormani
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Irene Schiavetti
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Luca Carmisciano
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Cinzia Cordioli
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Massimo Filippi
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Marta Radaelli
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Paolo Immovilli
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Marco Capobianco
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Nicola De Rossi
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Giampaolo Brichetto
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Eleonora Cocco
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Cinzia Scandellari
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Paola Cavalla
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Ilaria Pesci
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Antonio Zito
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Paolo Confalonieri
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Girolama Alessandra Marfia
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Paola Perini
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Matilde Inglese
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Maria Trojano
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Vincenzo Brescia Morra
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Gioacchino Tedeschi
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Giancarlo Comi
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Mario Alberto Battaglia
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Francesco Patti
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Marco Salvetti
- From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy.
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29
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Bergamaschi R, Ponzano M, Schiavetti I, Carmisciano L, Cordioli C, Filippi M, Radaelli M, Immovilli P, Capobianco M, De Rossi N, Brichetto G, Cocco E, Scandellari C, Cavalla P, Pesci I, Zito A, Confalonieri P, Marfia GA, Perini P, Inglese M, Trojano M, Brescia Morra V, Pisoni E, Tedeschi G, Comi G, Battaglia MA, Patti F, Salvetti M, Sormani MP. The effect of air pollution on COVID-19 severity in a sample of patients with multiple sclerosis. Eur J Neurol 2021; 29:535-542. [PMID: 34735749 PMCID: PMC8652772 DOI: 10.1111/ene.15167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 01/01/2023]
Abstract
Background and purpose Some studies have shown that air pollution, often assessed by thin particulate matter with diameter below 2.5 µg/m3 (PM2.5), may contribute to severe COVID‐19 courses, as well as play a role in the onset and evolution of multiple sclerosis (MS). However, the impact of air pollution on COVID‐19 has never been explored specifically amongst patients with MS (PwMS). This retrospective observational study aims to explore associations between PM2.5 and COVID‐19 severity amongst PwMS. Methods Data were retrieved from an Italian web‐based platform (MuSC‐19) which includes PwMS with COVID‐19. PM2.5 2016–2018 average concentrations were provided by the Copernicus Atmospheric Monitoring Service. Italian patients inserted in the platform from 15 January 2020 to 9 April 2021 with a COVID‐19 positive test were included. Ordered logistic regression models were used to study associations between PM2.5 and COVID‐19 severity. Results In all, 1087 patients, of whom 13% required hospitalization and 2% were admitted to an intensive care unit or died, were included. Based on the multivariate analysis, higher concentrations of PM2.5 increased the risk of worse COVID‐19 course (odds ratio 1.90; p = 0.009). Conclusions Even if several other factors explain the unfavourable course of COVID‐19 in PwMS, the role of air pollutants must be considered and further investigated.
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Affiliation(s)
| | - Marta Ponzano
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Irene Schiavetti
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Luca Carmisciano
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST 'Papa Giovanni XXIII', Bergamo, Italy
| | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Marco Capobianco
- Regional Referral Multiple Sclerosis Centre, Department of Neurology, University Hospital San Luigi, Orbassano (Torino), Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy
| | | | - Eleonora Cocco
- Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy.,Dipartimento Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Cinzia Scandellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Ilaria Pesci
- Centro SM UOC Neurologia, Fidenza, AUSL PR, Fidenza, Italy
| | - Antonio Zito
- Multiple Sclerosis Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Neuroimmunology Department 'Carlo Besta' Neurological Institute, Milan, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Paola Perini
- Department of Neurology Multiple Sclerosis Center, University of Padua, Padova, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | | | - Enrico Pisoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania, Napoli, Italy
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Casa di Cura Privata del Policlinico, Milan, Italy
| | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy.,Department of Life Sciences, University of Siena, Siena, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy.,Centro Sclerosi Multipla, Policlinico Catania, University of Catania, Catania, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy.,Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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30
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Uccelli A, Laroni A, Ali R, Battaglia MA, Blinkenberg M, Brundin L, Clanet M, Fernandez O, Marriot J, Muraro P, Nabavi SM, Oliveri RS, Radue E, Ramo Tello C, Schiavetti I, Sellner J, Sorensen PS, Sormani MP, Wuerfel JT, Freedman MS. Safety, tolerability, and activity of mesenchymal stem cells versus placebo in multiple sclerosis (MESEMS): a phase 2, randomised, double-blind crossover trial. Lancet Neurol 2021; 20:917-929. [PMID: 34687636 DOI: 10.1016/s1474-4422(21)00301-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mesenchymal stem cells (MSCs), also known as mesenchymal stromal cells, have been proposed as a promising therapeutic option for people with multiple sclerosis on the basis of their immunomodulatory and neuroprotective properties. The MEsenchymal StEm cells for Multiple Sclerosis (MESEMS) study was devised to evaluate the safety, tolerability, and activity of autologous MSCs derived from bone marrow and infused intravenously in patients with active multiple sclerosis. METHODS MESEMS is a randomised phase 2 trial done at 15 sites in nine countries. Patients (aged 18-50 years) with active relapsing-remitting or progressive multiple sclerosis were included if they had a disease duration of 2-15 years since onset of multiple sclerosis and an Expanded Disability Status Scale score of 2·5-6·5. Patients were randomly assigned (1:1), according to a crossover design, to receive a single intravenous dose of autologous bone marrow-derived MSCs followed by placebo at week 24, or to receive placebo followed by autologous MSCs at week 24, with a follow-up visit at week 48. Primary objectives were to test safety and activity of MSC treatment. The primary safety endpoint was to assess the number and severity of adverse events within each treatment arm. The primary efficacy endpoint was the number of gadolinium-enhancing lesions (GELs) counted over week 4, 12, and 24 compared between treatment groups. The primary efficacy endpoint was assessed in the full analyis set, after all participants completed the week 24 visit. Efficacy endpoints were evaluated using a predefined statistical testing procedure. Safety was monitored throughout the study by recording vital signs and adverse events at each visit. FINDINGS From July 16, 2012, until July 31, 2019, 144 patients were randomly assigned to first receive early intravenous infusion of autologous bone marrow-derived MSCs (n=69) or placebo (n=75). MSC treatment did not meet the primary endpoint of efficacy on the total number of GELs accumulated from baseline to week 24 (rate ratio [RR] 0·94, 95% CI 0·58-1·50; p=0·78). 213 adverse events were recorded, similarly distributed between groups (93 cases recorded in 35 [51%] of 69 patients treated first with MSCs vs 120 cases in 42 [56%] of 75 patients infused first with placebo). The most frequent adverse events reported were infection and infestations, with a total of 54 (25%) of 213 adverse events (18 [19%] of 93 in the early-MSC group and 36 [30%] of 120 in the delayed-MSC group). Nine serious adverse events were reported in seven patients treated with placebo versus none in the MSC group. All serious adverse events were considered to be unrelated to the treatment infusion. No deaths were reported during the study. INTERPRETATION Bone marrow-derived MSC treatment was safe and well tolerated but did not show an effect on GELs, an MRI surrogate marker of acute inflammation, in patients with active forms of multiple sclerosis, at week 24. Thus, this study does not support the use of bone marrow-derived MSCs to treat active multiple sclerosis. Further studies should address the effect of MSCs on parameters related to tissue repair. FUNDING Fondazione Italiana Sclerosi Multipla (FISM), the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), and the Multiple Sclerosis International Federation (MSIF) for centralised activities. Individual trials participating in the MESEMS network are funded by the following agencies: FISM and Compagnia di San Paolo (Italy); The Danish Multiple Sclerosis Society, The Toyota Foundation, and Danish Blood Donors' Research Foundation (Denmark); the Spanish Health Research Institute Carlos 3 and the Andalusian Public Foundation Progreso y Salud (Spain); the Royan Institute for Stem Cell Biology and Technology (Iran); the Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, and Salzburg (Austria); the Fondation pour l'aide à la recherche sur la sclérose en plaques (ARSEP), French Muscular Dystrophy Association (AFM)-Telethon (France); the UK Multiple Sclerosis Society and the UK Stem Cell Foundation (UK); and the Multiple Sclerosis Society of Canada and The Multiple Sclerosis Scientific Research Foundation and Research Manitoba (Canada).
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Affiliation(s)
- Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rehiana Ali
- Department of Brain Sciences, Imperial College London, London, UK
| | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Italy; Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Centre, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Lou Brundin
- Department of Clinical Neuroscience, Karolinska Institutet, and Division of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Michel Clanet
- Department of Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Oscar Fernandez
- Department of Neurology, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario, Málaga, Spain
| | - James Marriot
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Paolo Muraro
- Department of Brain Sciences, Imperial College London, London, UK
| | - Seyed Massood Nabavi
- Department of Brain and Cognitive Sciences, Cell Science Research Centre and Regenerative Medicine Department, Royan Institute for Stem Cell Biology and Technology, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Roberto S Oliveri
- Cell Therapy Unit, Department of Clinical Immunology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Ernst Radue
- Medical Image Analysis Centre and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Cristina Ramo Tello
- Multiple Sclerosis Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Per Soelberg Sorensen
- Danish Multiple Sclerosis Centre, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Jens Thomas Wuerfel
- Medical Image Analysis Centre and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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31
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Ponzio M, Amicizia D, Brichetto G, Tacchino A, Piazza MF, Paganino C, Trucchi C, Astengo M, Battaglia MA, Ansaldi F. The Prevalence of Multiple Sclerosis in Liguria region, Italy, using the capture–recapture method. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In recent years, there has been a growing interest in developing methods based on health administrative databases to estimate prevalence of chronic diseases, hoping that this would lead to more precise and reliable estimates. The capture-recapture method can be used to improve the prevalence of a disease reducing the bias of case underestimation.
Objective
To assess the prevalence of multiple sclerosis (MS) in the Liguria region in Italy using routinely collected healthcare data.
Methods
Data from three sources collected in Liguria Health Authority (A.Li.Sa.) databases - hospital discharge records, drug-dispensing records, disease-specific payment exemptions from copayment to health care - and a capture-recapture method with log-linear models were used to estimate the prevalence of MS. The accuracy of the case-finding algorithm was tested using a sample of people residents in Liguria Region with a definite diagnosis of MS extracted from clinical records of Liguria AISM Rehabilitation Service as reference standard.
Results
The case-finding algorithm to capture people with MS from routinely collected healthcare data used in our study found an observed crude prevalence of MS in Liguria region on 31 December 2017, of 202.4 cases per 100,000 inhabitants (95% CI: 195.3-209.5). After linkage to clinical data, the algorithm showed a sensitivity of 82.7%, with 22.1% of MS cases undetected on capture-recapture models. Consequently, the capture-recapture method prevalence estimate of 259.7 per 100,000 inhabitants (95% CI: 251.7-267.8) suggest that this region constitutes a high-risk area for MS.
Conclusions
Our initial study of crude MS prevalence showed an overall regional prevalence of MS of 202.4 cases per 100,000, capture-recapture analysis would add another 20%, to those figures. This method could be considered a good alternative to the population-based study design for estimating the prevalence of MS.
Key messages
Studies based on routinely collected healthcare data could help estimate the prevalence of chronic disease. To reduce the bias of case underestimation, the capture–recapture method can be useful.
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Affiliation(s)
- M Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - D Amicizia
- Department of Health Sciences, University of Genoa, Genoa, Italy
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - A Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - MF Piazza
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - C Paganino
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - C Trucchi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - M Astengo
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - MA Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | - F Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
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32
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Sormani MP, Inglese M, Schiavetti I, Carmisciano L, Laroni A, Lapucci C, Da Rin G, Serrati C, Gandoglia I, Tassinari T, Perego G, Brichetto G, Gazzola P, Mannironi A, Stromillo ML, Cordioli C, Landi D, Clerico M, Signoriello E, Frau J, Ferrò MT, Di Sapio A, Pasquali L, Ulivelli M, Marinelli F, Callari G, Iodice R, Liberatore G, Caleri F, Repice AM, Cordera S, Battaglia MA, Salvetti M, Franciotta D, Uccelli A. Effect of SARS-CoV-2 mRNA vaccination in MS patients treated with disease modifying therapies. EBioMedicine 2021; 72:103581. [PMID: 34563483 PMCID: PMC8456129 DOI: 10.1016/j.ebiom.2021.103581] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [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: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In patients with Multiple Sclerosis (pwMS) disease-modifying therapies (DMTs) affects immune response to antigens. Therefore, post-vaccination serological assessments are needed to evaluate the effect of the vaccine on SARS-CoV-2 antibody response. METHODS We designed a prospective multicenter cohort study enrolling pwMS who were scheduled for SARS-Cov-2 vaccination with mRNA vaccines (BNT162b2, Pfizer/BioNTech,Inc or mRNA-1273, Moderna Tx,Inc). A blood collection before the first vaccine dose and 4 weeks after the second dose was planned, with a centralized serological assessment (electrochemiluminescence immunoassay, ECLIA, Roche-Diagnostics). The log-transform of the antibody levels was analyzed by multivariable linear regression. FINDINGS 780 pwMS (76% BNT162b2 and 24% mRNA-1273) had pre- and 4-week post-vaccination blood assessments. 87 (11·2%) were untreated, 154 (19·7%) on ocrelizumab, 25 (3·2%) on rituximab, 85 (10·9%) on fingolimod, 25 (3·2%) on cladribine and 404 (51·7%) on other DMTs. 677 patients (86·8%) had detectable post-vaccination SARS-CoV-2 antibodies. At multivariable analysis, the antibody levels of patients on ocrelizumab (201-fold decrease (95%CI=128-317), p < 0·001), fingolimod (26-fold decrease (95%CI=16-42), p < 0·001) and rituximab (20-fold decrease (95%CI=10-43), p < 0·001) were significantly reduced as compared to untreated patients. Vaccination with mRNA-1273 resulted in a systematically 3·25-fold higher antibody level (95%CI=2·46-4·27) than with the BNT162b2 vaccine (p < 0·001). The antibody levels on anti-CD20 therapies correlated to the time since last infusion, and rituximab had longer intervals (mean=386 days) than ocrelizumab patients (mean=129 days). INTERPRETATION In pwMS, anti-CD20 treatment and fingolimod led to a reduced humoral response to mRNA-based SARS-CoV-2 vaccines. As mRNA-1273 elicits 3·25-higher antibody levels than BNT162b2, this vaccine may be preferentially considered for patients under anti-CD20 treatment or fingolimod. Combining our data with those on the cellular immune response to vaccines, and including clinical follow-up, will contribute to better define the most appropriate SARS-CoV-2 vaccine strategies in the context of DMTs and MS. FUNDING FISM[2021/Special-Multi/001]; Italian Ministry of Health'Progetto Z844A 5 × 1000'.
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Affiliation(s)
- Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Alice Laroni
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Giorgio Da Rin
- Laboratory Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Serrati
- Department of Neurology, Imperia Hospital, Imperia, Italy
| | | | | | | | | | - Paola Gazzola
- Centro Sclerosi Multipla S.C. Neurologia Asl 3 Genovese
| | | | | | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Rome, Italy
| | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino Università di Torino
| | - Elisabetta Signoriello
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli
| | - Jessica Frau
- Centro Sclerosi Multipla Ospedale Binaghi Cagliari - ATS Sardegna, Università di Cagliari
| | - Maria Teresa Ferrò
- Neuroimmunology, Center for Multiple Sclerosis, Cerobrovascular Department, Neurological Unit, ASST Crema
| | - Alessia Di Sapio
- Department of Neurology, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Livia Pasquali
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, University of Siena
| | - Fabiana Marinelli
- Multiple Sclerosis Center, Fabrizio Spaziani Hospital, via Armando Fabi, Frosinone, Italy
| | | | - Rosa Iodice
- Clinica Neurologica, DSNRO Università Federico II di Napoli
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesca Caleri
- MS Center, Department of Neurology, F. Tappeiner Hospital Meran (BZ), Italy
| | - Anna Maria Repice
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | | | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy; Department of Life Sciences, University of Siena, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy; IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Diego Franciotta
- Autoimmunology Laboratory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Uccelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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Sormani MP, Schiavetti I, Landi D, Carmisciano L, De Rossi N, Cordioli C, Moiola L, Radaelli M, Immovilli P, Capobianco M, Brescia Morra V, Trojano M, Tedeschi G, Comi G, Battaglia MA, Patti F, Fragoso YD, Sen S, Siva A, Furlan R, Salvetti M. SARS-CoV-2 serology after COVID-19 in multiple sclerosis: An international cohort study. Mult Scler 2021; 28:1034-1040. [PMID: 34328824 DOI: 10.1177/13524585211035318] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The MuSC-19 project is an Italian cohort study open to international partners that collects data on multiple sclerosis (MS) patients with COVID-19. During the second wave of the pandemic, serological tests became routinely available. OBJECTIVE To evaluate the seroprevalence of anti-SARS-CoV-2 antibodies according to the use of disease-modifying therapy (DMT) in a subset of patients included in the MuSC-19 data set who had undergone a serological test. METHODS We evaluated the association between positive serological test results and time elapsed since infection onset, age, sex, Expanded Disability Status Scale score, comorbidities and DMT exposure using a multivariable logistic model. RESULTS Data were collected from 423 patients (345 from Italy, 61 from Turkey and 17 from Brazil) with a serological test performed during follow-up. Overall, 325 out of 423 tested patients (76.8%) had a positive serological test. At multivariate analysis, therapy with anti-CD20 was significantly associated with a reduced probability of developing antibodies after COVID-19 (odds ratio (OR) = 0.20, p = 0.002). CONCLUSION Patients with MS maintain the capacity to develop humoral immune response against SARS-COV-2, although to a lesser extent when treated with anti-CD20 drugs. Overall, our results are reassuring with respect to the possibility to achieve sufficient immunization with vaccination.
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Affiliation(s)
- Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Luca Carmisciano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Lucia Moiola
- Department of Neurology, Multiple Sclerosis Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST 'Papa Giovanni XXIII', Bergamo, Italy
| | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Marco Capobianco
- Department of Neurology, Regional Referral Multiple Sclerosis Centre, University Hospital San Luigi, Torino, Italy
| | | | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania, Napoli, Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy/Department of Life Sciences, University of Siena, Siena, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy/Centro Sclerosi Multipla, Policlinico Catania, University of Catania, Catania, Italy
| | | | - Sedat Sen
- School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Aksel Siva
- School of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Roberto Furlan
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy/Italian Neuroimmunology Association-AINI, Florence, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy/Unit of Neurology, IRCCS Neuromed, Isernia, Italy
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Sormani MP, Salvetti M, Labauge P, Schiavetti I, Zephir H, Carmisciano L, Bensa C, De Rossi N, Pelletier J, Cordioli C, Vukusic S, Moiola L, Kerschen P, Radaelli M, Théaudin M, Immovilli P, Casez O, Capobianco M, Ciron J, Trojano M, Stankoff B, Créange A, Tedeschi G, Clavelou P, Comi G, Thouvenot E, Battaglia MA, Moreau T, Patti F, De Sèze J, Louapre C. DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France. Ann Clin Transl Neurol 2021; 8:1738-1744. [PMID: 34240579 PMCID: PMC8351392 DOI: 10.1002/acn3.51408] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [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: 04/27/2021] [Revised: 05/15/2021] [Accepted: 05/30/2021] [Indexed: 12/15/2022] Open
Abstract
We evaluated the effect of DMTs on Covid‐19 severity in patients with MS, with a pooled‐analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid‐19 severity was assessed by multivariate ordinal‐logistic models and pooled by a fixed‐effect meta‐analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti‐CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid‐19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled‐analysis confirms an increased risk of severe Covid‐19 in patients on anti‐CD20 therapies and supports the protective role of interferon.
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Affiliation(s)
- Maria Pia Sormani
- Department of Health Sciences, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy.,Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Pierre Labauge
- Department of Neurology, CHU de Montpellier, Montpellier, France
| | - Irene Schiavetti
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Helene Zephir
- Department of Neurology, U 1172, CRC-SEP, University Hospital of Lille, Lille, France
| | - Luca Carmisciano
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Caroline Bensa
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Jean Pelletier
- Department of Neurology, Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, 13005, France
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Sandra Vukusic
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
| | - Lucia Moiola
- Department of Neurology, Multiple Sclerosis Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Marie Théaudin
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Olivier Casez
- Department of Neurology, University Hospital Grenoble Alpes, Neuro Inflammatory Unit, Grenoble, France
| | - Marco Capobianco
- Department of Neurology, Regional Referral Multiple Sclerosis Centre, University Hospital San Luigi, Orbassano (Torino), Italy
| | - Jonathan Ciron
- Department of Neurology, CHU de Toulouse, CRC-SEP, Toulouse, France
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Bruno Stankoff
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France.,Neurology Department, St Antoine Hospital, APHP, Paris, France
| | - Alain Créange
- Service de Neurologie and CRC SEP, APHP, Groupe Hospitalier Henri Mondor, UPEC Université, Créteil, France
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania, Napoli, Italy
| | - Pierre Clavelou
- University of Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Giancarlo Comi
- Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Nîmes, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy.,Department of Life Sciences, University of Siena, Siena, Italy
| | - Thibault Moreau
- Department of Neurology, University hospital of Dijon, EA4184, Dijon, France
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy.,Centro Sclerosi Multipla, Policlinico Catania, University of Catania, Catania, Italy
| | - Jérôme De Sèze
- Department of Neurology, CIC INSERM 1434, CHU de Strasbourg, Strasbourg, France
| | - Celine Louapre
- Sorbonne University, Paris Brain Institute, ICM, Assistance Publique Hôpitaux de Paris APHP, Hôpital de la Pitié-Salpêtrière, Inserm, CNRS, CIC Neuroscience, Paris, France
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Podda J, Ponzio M, Pedullà L, Monti Bragadin M, Battaglia MA, Zaratin P, Brichetto G, Tacchino A. Predominant cognitive phenotypes in multiple sclerosis: Insights from patient-centered outcomes. Mult Scler Relat Disord 2021; 51:102919. [PMID: 33799285 DOI: 10.1016/j.msard.2021.102919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since combining information from different domains could be useful to increase prediction accuracy over and above what can be achieved at the level of single category of markers, this study aimed to identify distinct and predominant subtypes, i.e., cognitive phenotypes, in people with multiple sclerosis (PwMS) considering both cognitive impairment and mood disorders. METHODS A latent class analysis (LCA) was applied on data from 872 PwMS who were tested with Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT) and Hospital Anxiety and Depression Scale (HADS). Furthermore, the distribution of demographic (i.e., age, gender, years of education) and clinical characteristics (i.e., disease duration, disease course, disability level) was examined amongst the identified phenotypes. RESULTS Based on model fit and parsimony criteria, LCA identified four cognitive phenotypes: 1) only memory difficulties (n = 247; 28.3%); 2) minor memory and language deficits with mood disorders (n = 185; 21.2%); 3) moderate memory, language and attention impairments (n = 164; 18.8%); 4) severe memory, language, attention, information processing and executive functions difficulties (n = 276; 31.7%). CONCLUSIONS Since less is known about the progressive deterioration of cognition in PwMS, a taxonomy of distinct subtypes that consider information from different clustered domains (i.e., cognition and mood) represents both a challenge and opportunity for an advanced understanding of cognitive impairments and development of tailored cognitive treatments in MS.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margherita Monti Bragadin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Paola Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
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36
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Podda J, Tacchino A, Pedullà L, Monti Bragadin M, Battaglia MA, Brichetto G. Focus on neglected features of cognitive rehabilitation in MS: Setting and mode of the treatment. Mult Scler 2020; 28:1009-1019. [PMID: 33045916 PMCID: PMC9131413 DOI: 10.1177/1352458520966300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cognitive rehabilitation in multiple sclerosis (MS) aims at reducing patients’
cognitive impairments, improving their awareness and ability to take cognitive
difficulties into account in their daily living. However, at this moment, more
high-quality randomized trials are needed to draw conclusion about the
effectiveness of cognitive interventions in MS. Although existing studies
provide clear descriptions of intervention key ingredients (e.g. targeted
cognitive domain as well as treatment frequency and duration) and the practical
details needed to manage these key elements (e.g. restorative approaches,
compensatory strategies, or environmental modifications), other crucial aspects
received less attention in rehabilitation research. The aim of this topical
review is to try to elucidate some critical issues that were only partly
addressed and analyzed by the scientific literature: setting (center-based vs
home-based) and mode (individual vs group) of the cognitive rehabilitation
treatment.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Margherita Monti Bragadin
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
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Abstract
Abstract
Background
Multiple Sclerosis (MS) is a complex and progressive disease of the central nervous system. In Italy, prevalence of MS ranges from 198 (continental Regions) to 370 (Sardinia) per 100,000. Despite a National Health System, differences among Regions cause inequalities in access to and quality of care, also involving chronic diseases and disabilities, including MS.
Methods
Interviews and focus groups involving persons with MS, caregivers, institutions, patients association and other stakeholders were conducted in 2019, to evaluate MS policy landscape, existing services, guidelines and care pathways regarding diagnosis, therapy, follow up, strenghts and weaknesses.
Results
600 MS specialized neurologists and 350 MS nurses operate in 240 MS Centers located in hospital neurology departments providing clinical care, disease modifying drugs (DMDs), interdisciplinary care. 13 Regions on 20 approved a PDTA (Diagnosis, Therapy, Care Pathway), other are due by 2020. A reference national PDTA has been already discussed by Regional Health Authorities Conference and Ministry of Health. Regional multistakeholder observatories will be organized. A national MS registry started in 2017, at present involving over 140 Centers and including data of 50% (60.000 patients) of estimated prevalence.
Discussion
MS specialized centers are recognized as the key component of MS care in Italy and the main refererral for 80% of patients, also taking in account that over 60% of patients receive a DMD. Access to rehabilitation is lacking and hospital, community and primary care linkage is needed, also considering transition from early stages to severe disability. Access to psycological support is variable and cost containment strategies restrict drug access and symptomatic care in some areas along with lacking of interdisciplinary management. It is mandatory to integrate health and social care pathways accordingly with the National Plan for Chronicity in which MS has to be included.
Key messages
MS specialized centers are the backbone care network in Italy. Integrated care pathways (PDTA) stated as National Health System rules define the right for the patients to receive the proper care.
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Affiliation(s)
- D Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy
| | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - M Ponzio
- Research Area, FISM, Genoa, Italy
| | - T Manacorda
- Department of health services research and policy, LSHTM, London, UK
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Bezzini D, Battaglia MA, Ulivelli M. Immunisation status against major diseases preventable with vaccines in multiple sclerosis patients. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) patients are more susceptible to infections than the general population due to the utilization of immunosuppressive drugs (DMDs) which require particular attention to the occurrence of infectious events. So, immunisation policies are mandatory or recommended.
Methods
In this pilot study, subjects receiving a diagnosis of relapsing-remitting MS since 2011 at a MS center in central Italy were enrolled. The immunization status against major infectious agents and safety of most used vaccines were recorded.
Results
103 patients (67% females), mean age 42 years, with no or mild disability (85%) were examined. The majority received vaccines against poliomyelitis (92%), hepatitis B (47%), tetanus and diphtheria (89%), but a small percentage got boosters every 10 years (31% for tetanus and 28% for diphtheria); other vaccines evaluated: pertussis (37%), mumps (23%), meningococcus B, C (5%), flu (1%). Evaluating immunization status due to vaccines or illnesses, a significant percentage of patients using immunosuppressive drugs was susceptible to infections, such as measles (44%), chicken pox (32%) and rubella (65%). Only 17% of patients were vaccinated after diagnosis and, regarding vaccine safety, only 1 had a relapse within 6 months following measles, mumps and rubella vaccine.
Conclusions
This study shows a very low number of vaccinations among patients, confirming the need of preventive information on their importance and safety for MS patients: major adverse events of therapy in MS include severe infections and the majority of patients are female in reproductive age. This pilot phase was followed by an ongoing study involving 25 Italian MS Centers and 3000 patients that will provide in 2022 useful results on vaccination policies and safety. The knowledge of immunisation status is crucial for the clinical practice in the management of DMDs, and for the public health policies for a vaccine campaign targeted to MS patients.
Key messages
Lack of information on vaccine safety bring to a low adherence to immunization program. The immunization status of patients is essential for a correct management of therapies.
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Affiliation(s)
- D Bezzini
- Department of Life Sciences, University of Siena, Siena (SI), Italy
| | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena (SI), Italy
| | - M Ulivelli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena (SI), Italy
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Bezzini D, Vaccaro MC, Bandiera P, Messmer Uccelli M, Battaglia MA. Young multiple sclerosis in Italy: attitude towards present life and expectations for the future. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is usually diagnosed between 20 and 40 years, affecting the most productive and active period of life.
Aim
To analyse the health perception of young people with MS and to compare the present results with a previous one.
Methods
A descriptive cross-sectional study was conducted in 2017. A validate and anonymous questionnaire was administered to 613 Italian young, aged 18-40, affected by MS (women 78.5%).
Results
Analyzing the declared health status, most of young MS defined good health status (76% good or excellent health) with differences between age class (82% at 25-29 years vs 71% at 35-40) and with a reverse trend with the increasing of disability (92% in subject with no disability vs 34% in ones with a medium or severe disability). The comparison against 2004 data highlights an improvement in the health conditions perceived, also for ones with a serious disability. Regarding the time elapsed from diagnosis, the trend was not linear, since respondents with a diagnosis <1 year indicated a worst health condition than those with a diagnosis from 5 to 10 years. Significant percentage of them paid attention to positive attitudes in health promotion: 71% practiced physical activity, 70% controlled smoke and alcohol consumption, 38% was on a special diet.
Conclusions
Diagnosis and disability constitute a decisive factor in the assessment of the state of health, but the perception goes to stabilize with time, even if the conditions tend to worsen. In this regard, the worst declared conditions in patients with a recent diagnosis seem to be influenced by psychological factors. So, the moment of diagnosis need a better management. Only 30% got adult vaccination (vs 61% in young Italians) due to lack of information on vaccine safety in MS patients. The improvement of perceived health in young with MS is another proof of the progress of MS treatments, which appears transversal to all the conditions of disability.
Key messages
The perception of health is strongly related to disability and to time elapsed from diagnosis. In the last 15 years the progress of MS management improved well-being of all MS young patients.
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Affiliation(s)
- D Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | | | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
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Ponzio M, Trojano M, Capobianco M, Pugliatti M, Ulivelli M, Mosconi P, Patti F, Zaratin P, Lepore V, Battaglia MA. Italian multiple sclerosis register as the basis for post-authorization safety studies. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
While the safety and efficacy of Disease Modifying Therapy (DMT) in multiple sclerosis (MS) are assessed in clinical trials, these are of relatively short duration and always confined to highly selected patient groups. The evaluation of real-world data such as patient registries, is vital as it offers long-term data collection and is patient rather than product-focused during the lifetime of MS, and allows to document a patient's treatment history throughout the disease course. Patient registries can play an important role in monitoring the safety of drus. Regulators and the pharmaceutical industry have shown interest in complementing or even replacing phase 4 clinical studies with data from MS registries.
The Italian MS Register (IMSR), in collaboration with the Big MS Data initiative, that also includes the national MS registries of Denmark, France, and Sweden and the international database network MSBase, came together with industry to conduct studies on post-authorization safety (PASS) and treatment effectiveness. The IMSR includes the clinical history of approximately 55,000 patients, or approximatively 45% of the estimated cases of MS in Italy. More than 10,000 patients have a follow-up duration of over 10 years.
A Core Protocol outlining principles of PASS projects was created in which aggregated results made available to sponsors and health authorities. The Core Protocol specifies variables, emphasizes improved capture of adverse events, in particular cancer, non-melanoma skin cancers and immunosuppression-related infections, all MedDRA-coded. EUROCAT codes for pregnancy outcomes are also documented.
Regulators, the pharmaceutical industry and national-level registries have jointly identified a format of collaboration on PASS for DMT in MS to benefit patients and the larger society. In this way, we hope to contribute to a framework that will include emerging and existing registries with the common goal of contributing to the advancement of knowledge in MS.
Key messages
The real-world data can contribute to understanding of the impact of disease-modifying therapy on long term. A format of collaboration among clinical research, regulators and pharmaceutical industry could be a winning framework to improve the knowledge on safety and treatment effectiveness in MS.
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Affiliation(s)
- M Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - M Trojano
- Department of Basic Medicine Sciences, Neurosci and Sense Organs, University of Bari, Bari, Italy
| | - M Capobianco
- Neurological Unit, University Hospital San Luigi, Orbassano, Italy
| | - M Pugliatti
- Centro Di Servizio E Ricerca Sulla Sclerosi Multipla, AOU Di Ferrara, Ferrara, Italy
| | - M Ulivelli
- UOC Neurologia e Neurofisiologia Clinica, Università degli Studi di Siena, Siena, Italy
| | - P Mosconi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - F Patti
- AOU Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - P Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - V Lepore
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M A Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
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Battaglia MA, Pugliatti M, Soelberg Sørensen P, Tiu C, Carrascal P, Quoidbach V. Rethinking MS in Europe: Prioritizing integrated services for people with multiple sclerosis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is a chronic disease of the central nervous system. Over 750,000 people are affected across Europe. The European Brain Council initiated in 2018 a project RETHINKING MS, calling for change in MS care.
Methods
The research framework included desk research data mapping and expert interviews. A series of clinical and patient-oriented benchmarks along the care process were developed. Data were analysed in collaboration with experts from across Europe to build an interdisciplinary consensus around practical and sustainable policy responses to MS in Europe.
Results
Results indicate that a timely diagnosis is important to enable a prompt initiation of specific drugs and symptomatic treatment which, in turn, can prevent potentially irreversible disability. Care must be individualised to each person and their specific symptoms and needs. Regular monitoring is key to personalise care and provide adequate support but there are often delays to diagnosis and limitations to treatment personalisation due to inadequate access to diagnostic facilities and MS specialists. Access to therapies can also be extremely challenging. The interdisciplinary approach is essential; disease management includes aspects of lifestyle modification, as many 'brain healthy' lifestyle factors may delay progression and relapses. Finally, social care can greatly improve quality of life for people with MS, social workers and occupational therapists can also support people with MS in their professional and daily lives.
Conclusions
Conclusions link timely diagnosis and coordinated care, long-term adaptable support to better quality of life. Primary prevention modification of lifestyle factors
Key messages
Policies for multiple sclerosis in Europe have to be changed. Primary and secondary prevention are possible.
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Affiliation(s)
- M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - M Pugliatti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - P Soelberg Sørensen
- Danish Multiple Sclerosis Center, University of Copenhagen, Copenhagen, Denmark
| | - C Tiu
- Department of Neurology, Cristina Tiu, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - P Carrascal
- European Multiple Sclerosis Platform and Multiple Sclerosis, Bilbao, Spain
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Cuccaro C, Bezzini D, Vaccaro MC, Coletta V, Messina G, Battaglia MA. The Italian well-being: a race against time. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Well-being is the result of many factors such as health, happiness, expectations, values. Italy has been one of European countries that in recent years has suffered most combination of economic, political and social stress, with consequences on well-being. The aims of study are i) to examine health and happiness perceptions of young adults ii) to compare actual results with a previous survey conducted in 2004.
Methods
A descriptive cross-sectional study was conducted between Jan-Dec 2017. A validated questionnaire was administered from the Italian Centre for Social Investment (CENSIS) to 1,003 young Italians, aged 18-40. The anonymous questionnaire investigated emotional aspects, health status, social life and socioeconomic status. The statistical analysis (chi-square p < 0.05) was carried out to evaluate the association between the items of the questionnaire and variables such as age, sex, education level, income, work status, Marital Status (MS), Self-Confidence (SC), social-life.
Results
The sample resulted quite happy (2017 vs 2004:56.1% vs 63.7%), the happiness increasing with the socio-economic level and appearing to be related to work status, MS, SC and income (p < 0.05). Good or excellent health were reported by 89.8% (2004:86.1%) with a decrease in older age, and significant differences for all studied variables (excluded MS). Although the majority declared to be satisfied with their social life (2017 vs 2004:73.4% vs 85.7%) and economic status (2017 vs 2004:49.8% vs 70.7%), the future still seems uncertain, with respondents unabled to make predictions about work (2017 vs 2004:49.9% vs 19.8%) or when having children (2017 vs 2004:44.6% vs 61.2%).
Conclusions
Quality of life of Italians is still satisfactory, with a good degree of happiness and health, despite a clear decrease compared to 2004. The survey highlights that young people continue to perceive the future as uncertain, mainly due to job instability, with difficulty planning their lives.
Key messages
In ten years the Italian well-being has been reduced, despite the perceived level of happiness and health still being positive. The lack of job opportunities, the awareness of employment instability are the main causes of the lack of confidence in the future.
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Affiliation(s)
- C Cuccaro
- Post Graduate School of Public Health, University of Siena, Siena, Italy
| | - D Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | - G Messina
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
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43
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Bezzini D, Kundisova L, Gori F, Martini A, Giovannetti L, Stoppa G, Chellini E, Ulivelli M, Nante N, Messina G, Battaglia MA. Mortality trend for multiple sclerosis in Italy during the period 1980-2015. Mult Scler Relat Disord 2020; 44:102240. [PMID: 32512288 DOI: 10.1016/j.msard.2020.102240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The epidemiology of Multiple Sclerosis (MS) is relevant for health-services planning. Most of MS prevalence and incidence studies in Italy referred to specific geographical areas and periods, whereas mortality data are routinely collected at the national level. The aim was to assess MS mortality trend and geographical differences in Italy from 1980 to 2015. METHODS Mortality data were provided by the Italian Institute of Statistics. Due to a low number of annual deaths, mortality data were analysed for both the entire period under study and for sub-periods. Temporal trends were first evaluated using age-adjusted mortality rates (AMRs) comparing each sub-period with the initial one. Then, the annual percent change in mortality was estimated through the joinpoint regression model. Spatial differences between 5 main geographical areas were evaluated using standardized mortality ratios (SMRs). RESULTS During the study period, 4,959 deaths for males and 7,434 for females were observed. The higher overall AMR was observed for females (F:0.71 vs. M: 0.56 per 100,000 persons per year). Analysing mortality by gender and geographical area, SMRs 〈 100 were observed in South Italy for both sexes, and in Central Italy for males only, whereas SMRs 〉 100 for Islands for both sexes, and in North-East and North-West for females only. The analysis of the mortality trend through AMRs calculated for sub-periods revealed no difference between the first and the last period for males, whereas a significant increase in mortality was observed for females. The joinpoint regression analysis showed a significant decrease in mortality up to 1995 for males (APC -3.23%) and up to 1999 for females, (APC -1.01%), followed by a significant increase for both sexes, but more marked for females (APC +1.9% M, +2.34% F). CONCLUSION The increasing trend of mortality for MS, especially for females, may reflect the increase in the prevalence of MS and the improvement in the quality of diagnosis or coding of the cause of death.
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Affiliation(s)
- Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy.
| | - Lucia Kundisova
- Post Graduate School of Public Health, University of Siena, Siena, Italy.
| | - Francesco Gori
- Post Graduate School of Public Health, University of Siena, Siena, Italy.
| | - Andrea Martini
- Institute for Study, Prevention and Cancer Network, Florence, Italy.
| | - Lucia Giovannetti
- Institute for Study, Prevention and Cancer Network, Florence, Italy.
| | - Giorgia Stoppa
- Department of Statistics, Informatics, Applications, University of Florence, Florence, Italy.
| | | | - Monica Ulivelli
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy.
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Gabriele Messina
- Post Graduate School of Public Health, University of Siena, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
| | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy; Italian Multiple Sclerosis Foundation, Genoa, Italy.
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Solari A, Giordano A, Sastre-Garriga J, Köpke S, Rahn AC, Kleiter I, Aleksovska K, Battaglia MA, Bay J, Copetti M, Drulovic J, Kooij L, Mens J, Meza Murillo ER, Milanov I, Milo R, Pekmezovic T, Vosburgh J, Silber E, Veronese S, Patti F, Voltz R, Oliver D. EAN guideline on palliative care of people with severe, progressive multiple sclerosis. Eur J Neurol 2020; 27:1510-1529. [PMID: 32469447 DOI: 10.1111/ene.14248] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Patients with severe, progressive multiple sclerosis (MS) have complex physical and psychosocial needs, typically over several years. Few treatment options are available to prevent or delay further clinical worsening in this population. The objective was to develop an evidence-based clinical practice guideline for the palliative care of patients with severe, progressive MS. METHODS This guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Formulation of the clinical questions was performed in the Patients-Intervention-Comparator-Outcome format, involving patients, carers and healthcare professionals (HPs). No uniform definition of severe MS exists: in this guideline, constant bilateral support required to walk 20 m without resting (Expanded Disability Status Scale score > 6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. RESULTS Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patient's wish to hasten death, symptom management, multidisciplinary rehabilitation, interventions for caregivers and interventions for HPs. A total of 34 recommendations (33 weak, 1 strong) and seven good practice statements were devised. CONCLUSIONS The provision of home-based palliative care (either general or specialist) is recommended with weak strength for patients with severe, progressive MS. Further research on the integration of palliative care and MS care is needed. Areas that currently lack evidence of efficacy in this population include advance care planning, the management of symptoms such as fatigue and mood problems, and interventions for caregivers and HPs.
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Affiliation(s)
- A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - A Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - J Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Köpke
- Institute of Clinical Nursing Science, University of Cologne, Cologne, Germany.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A C Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - J Bay
- Multiple Sclerosis International Federation, People with MS Advisory Committee, Copenhagen, Denmark
| | - M Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - J Drulovic
- Clinic of Neurology, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - L Kooij
- Nieuw Unicum, Zandvoort, The Netherlands
| | - J Mens
- Nieuw Unicum, Zandvoort, The Netherlands
| | - E R Meza Murillo
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Milanov
- Medical University of Sofia, Sofia, Bulgaria
| | - R Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - T Pekmezovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Vosburgh
- Israel Multiple Sclerosis Society, Tel-Aviv, Israel
| | - E Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - S Veronese
- FARO Charitable Foundation, Turin, Italy
| | - F Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - R Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - D Oliver
- The Tizard Centre, University of Kent, Canterbury, UK
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45
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Tacchino A, Ponzio M, Pedullà L, Podda J, Bragadin MM, Pedrazzoli E, Konrad G, Battaglia MA, Mokkink L, Brichetto G. Italian validation of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ). Neurol Sci 2020; 41:3273-3281. [DOI: 10.1007/s10072-020-04363-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/20/2020] [Indexed: 12/20/2022]
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46
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Gori F, Kundisova L, Bezzini D, Martini A, Giovannetti L, Chellini E, Nante N, Messina G, Battaglia MA. Mortality trends for multiple sclerosis in Italy. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is the immune-mediated inflammatory disease affecting myelinated axons of the central nervous system with enormous socio-economic impact. The aim of this study was to analyze mortality trends for MS in Italy.
Methods
The mortality data relative to period 1980-2015 were provided by Italian Institute of Statistics, data were aggregated in 5 intervals (1980-1986; 1987-1993; 1994-2000; 2001-2008; 2008-2015). The Age-Standardized mortality Rates (SR) with respective 95% confidence intervals (95%CI) were calculated (using the European standard 2013) in order to evaluate the mortality trends (in confrontation to the initial period) and Standardized Mortality Ratios (SMR), in order to confront mortality in 5 major geographic areas: North-East (NE), North-West (NW), Central Italy (CI), South Italy (SI) and Islands (I).
Results
During the study period 4959 deaths for males and 7433 for females were observed. The SRs were significantly higher for females (0.71;95%CI:0.70-0.73 vs. 0.56; 95%CI:0.54-0.57).
Significantly higher SMR were observed for both sexes in I (M:123.3 vs F:112.7), for females also in NE (106.5) and NW (115.8). Significantly lower SMR for both sexes were observed in SI (M:88.8; F:71.4) and for males in CI (90.9).
The observed SRs during the five intervals for males were: 0.65(95%CI 0.60-0.69); 0.52 (95%CI 0.49-0.56); 0.46 (95%CI 0.43-0.49); 0.53 (95%CI 0.49-0.56); 0.59 (95%CI 0.56-0.62); and for females: 0.69 (0.65-0.73); 0.69 (0.65-0.73); 0.61 (0.58-0.65); 0.68 (0.65-0.72); 0.81(0.77-0.84); respectively. An initial decrease of SRs was observed for males until 2001-2007 in confrontation to the initial period (p < 0.05). For females significant increase of SRs was observed in 2008-2015 (p < 0.05).
Conclusions
An increase of mortality for MS, observed for females, especially after 2000 may reflect the raising prevalence of MS in Italy. Important geographical differences were observed for five main areas.
Key messages
During the study period an increase of mortality for MS was observed for females. Important differences were observed between five main Italian geographic areas.
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Affiliation(s)
- F Gori
- Department of Molecular and Developmental Medicine, Post-graduate School of Public Health, University of Siena, Siena, Italy
| | - L Kundisova
- Department of Molecular and Developmental Medicine, Post-graduate School of Public Health, University of Siena, Siena, Italy
| | - D Bezzini
- Life Science Department, University of Siena, Siena, Italy
| | - A Martini
- Institute for Study, Prevention and Cancer Network, Firenze, Italy
| | - L Giovannetti
- Institute for Study, Prevention and Cancer Network, Firenze, Italy
| | - E Chellini
- Institute for Study, Prevention and Cancer Network, Firenze, Italy
| | - N Nante
- Department of Molecular and Developmental Medicine, Post-graduate School of Public Health, University of Siena, Siena, Italy
- Life Science Department, University of Siena, Siena, Italy
| | - G Messina
- Department of Molecular and Developmental Medicine, Post-graduate School of Public Health, University of Siena, Siena, Italy
- Life Science Department, University of Siena, Siena, Italy
| | - M A Battaglia
- Department of Molecular and Developmental Medicine, Post-graduate School of Public Health, University of Siena, Siena, Italy
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Gori F, Cuccaro C, Santamaria M, Cardaci R, Burgassi S, Battaglia MA, Messina G. Could chips and nuts be vector of food-borne outbreaks during happy hour? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A Greater tendency to eat meals outside the home has led to an increase in the attendance of restaurants, cafes, and fast food. That is one of the reasons why the global interest in handling food has risen over the years. The aim of this study is to understand the level of microbial contamination in the food that is served along happy hour in cafe.
Methods
This cross sectional pilot study was performed from April to May 2018 in the city of Siena, central Italy (<60000 citizens). Ten cafes were randomly selected. Samples of peanuts and potatoes were obtained in three different moments, at the beginning (T0), in the middle (T1), at the end (T2) of happy hours events. Collection of the samples was obtained using sterile kit and laboratory analysis was conducted in the University lab. The samples were located on selective medium and the growth of microbial pathogens were checked at 24 and 48 hours. The tested microorganisms were Enterococci, Staphylococci, Coliforms bacteria, Molds, and Yeasts. The statistical analyses were conducted using the Wilcoxon test using Stata 12.
Results
A significant Yeasts contamination appeared only on chips at T0, while within T0 and T1 we found a significant increase of Enterococci, Staphylococci, and Yeasts (p < 0.05) both in peanuts and chips. Comparing T1 and T2 only Yeasts showed significant growth in potatoes (p = 0.04). Between T0 and T2 we also found the growth of Coliforms bacteria in peanuts (p = 0.03).
Conclusions
We showed an increase in the microbial load associated with food handling, mostly of Enterococci. Long exposure time increased the likelihood of contamination and the possibility to exceed the dose for the occurrence of good outbreak. It is likely that offering small portions of handling food would reduce the manipulation by participants and the risk of food-borne outbreaks.
Key messages
Define the most frequent microrganisms could be associated with backed food and evaluate which one of these can exceed the dose for the occurrence of disease in long time. Reflect on the likelihood that the risk of food-borne outbreak caused by manipulation of happy hour participants, may result in an increase in hospital admissions.
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Affiliation(s)
- F Gori
- Department of Molecular and Developmental Medicine, Post-graduate School of Public Health, University of Siena, Siena, Italy
| | - C Cuccaro
- Department of Molecular and Developmental Medicine, Post-graduate School of Public Health, University of Siena, Siena, Italy
| | | | - R Cardaci
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - S Burgassi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - M A Battaglia
- Life Science Department, University of Siena, Siena, Italy
| | - G Messina
- Department of Molecular and Developmental Medicine, Post-graduate School of Public Health, University of Siena, Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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48
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Brichetto G, Monti Bragadin M, Fiorini S, Battaglia MA, Konrad G, Ponzio M, Pedullà L, Verri A, Barla A, Tacchino A. The hidden information in patient-reported outcomes and clinician-assessed outcomes: multiple sclerosis as a proof of concept of a machine learning approach. Neurol Sci 2019; 41:459-462. [PMID: 31659583 PMCID: PMC7005074 DOI: 10.1007/s10072-019-04093-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
Abstract
Machine learning (ML) applied to patient-reported (PROs) and clinical-assessed outcomes (CAOs) could favour a more predictive and personalized medicine. Our aim was to confirm the important role of applying ML to PROs and CAOs of people with relapsing-remitting (RR) and secondary progressive (SP) form of multiple sclerosis (MS), to promptly identifying information useful to predict disease progression. For our analysis, a dataset of 3398 evaluations from 810 persons with MS (PwMS) was adopted. Three steps were provided: course classification; extraction of the most relevant predictors at the next time point; prediction if the patient will experience the transition from RR to SP at the next time point. The Current Course Assignment (CCA) step correctly assigned the current MS course with an accuracy of about 86.0%. The MS course at the next time point can be predicted using the predictors selected in CCA. PROs/CAOs Evolution Prediction (PEP) followed by Future Course Assignment (FCA) was able to foresee the course at the next time point with an accuracy of 82.6%. Our results suggest that PROs and CAOs could help the clinician decision-making in their practice.
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Affiliation(s)
- Giampaolo Brichetto
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy. .,AISM Rehabilitation Center of Liguria, Genoa, Italy.
| | - Margherita Monti Bragadin
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy.,AISM Rehabilitation Center of Liguria, Genoa, Italy
| | - Samuele Fiorini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | | | | | - Michela Ponzio
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Alessandro Verri
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Annalisa Barla
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Andrea Tacchino
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy
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49
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Bonzano L, Pedullà L, Tacchino A, Brichetto G, Battaglia MA, Mancardi GL, Bove M. Upper limb motor training based on task-oriented exercises induces functional brain reorganization in patients with multiple sclerosis. Neuroscience 2019; 410:150-159. [DOI: 10.1016/j.neuroscience.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
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50
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Trojano M, Bergamaschi R, Amato MP, Comi G, Ghezzi A, Lepore V, Marrosu MG, Mosconi P, Patti F, Ponzio M, Zaratin P, Battaglia MA. Correction to: The Italian multiple sclerosis register. Neurol Sci 2019; 40:907. [PMID: 30815752 DOI: 10.1007/s10072-019-03772-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Unfortunately in the original publication, the affiliation of the author Maria Pia Amato was incorrect. The author inadvertently missed out to include her second affiliation.
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Affiliation(s)
- Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, "Aldo Moro" Policlinico Italy, Piazza Umberto I, Bari, Bari, Italy.
| | | | - Maria Pia Amato
- Department NEUROFARBA, MS Center AOU Careggi, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Giancarlo Comi
- Neurology Department and INSPE-Institute of Experimental Neurology, Vita-Salute San Raffaele University, Milan, Italy
| | - Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Va, Italy
| | - Vito Lepore
- Coreserach Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.,Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Paola Mosconi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesco Patti
- Department of Neurosciences G.F. Ingrassia, University of Catania, Catania, Italy
| | - Michela Ponzio
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy
| | - Paola Zaratin
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy
| | - Mario Alberto Battaglia
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy. .,Department of Life Sciences, University of Siena, Siena, Italy.
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