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Portaccio E, Fonderico M, Iaffaldano P, Pastò L, Razzolini L, Bellinvia A, De Luca G, Ragonese P, Patti F, Brescia Morra V, Cocco E, Sola P, Inglese M, Lus G, Pozzilli C, Maimone D, Lugaresi A, Gazzola P, Comi G, Pesci I, Spitaleri D, Rezzonico M, Vianello M, Avolio C, Logullo FO, Granella F, Salvetti M, Zaffaroni M, Lucisano G, Filippi M, Trojano M, Amato MP. Disease-Modifying Treatments and Time to Loss of Ambulatory Function in Patients With Primary Progressive Multiple Sclerosis. JAMA Neurol 2022; 79:869-878. [PMID: 35877104 PMCID: PMC9315975 DOI: 10.1001/jamaneurol.2022.1929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/19/2022] [Indexed: 12/20/2022]
Abstract
Importance Except for ocrelizumab, treatment options in primary progressive multiple sclerosis (PPMS) are lacking. Objective To investigate the effectiveness of DMTs on the risk of becoming wheelchair dependent in a real-world population of patients with PPMS. Design, Setting, and Participants This was a multicenter, observational, retrospective, comparative effectiveness research study. Data were extracted on November 28, 2018, from the Italian multiple sclerosis register and analyzed from June to December 2021. Mean study follow-up was 11 years. Included in the study cohort were patients with a diagnosis of PPMS and at least 3 years of Expanded Disability Status Scale (EDSS) evaluations and 3 years of follow-up. Main Outcomes and Measures The risk of reaching an EDSS score of 7.0 was assessed through multivariable Cox regression models. Exposures Patients who received DMT before the outcome were considered treated. DMT was assessed as a time-dependent variable and by class of DMT (moderately and highly effective). Results From a total of 3298 patients with PPMS, 2633 were excluded because they did not meet the entry criteria for the phase 3, multicenter, randomized, parallel-group, double-blind, placebo-controlled study to evaluate the efficacy and safety of ocrelizumab in adults with PPMS (ORATORIO) trial. Among the remaining 665 patients (mean [SD] age, 43.0 [10.7] years; 366 female patients [55.0%]), 409 were further selected for propensity score matching (288 treated and 121 untreated patients). In the matched cohort, during the study follow-up, 37% of patients (152 of 409) reached an EDSS score of 7.0 after a mean (SD) follow-up of 10.6 (5.6) years. A higher EDSS score at baseline (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.13-1.55; P < .001), superimposed relapses (aHR, 2.37; 95% CI, 1.24-4.54; P = .009), and DMT exposure (aHR, 1.75; 95% CI, 1.04-2.94; P = .03) were associated with a higher risk of an EDSS score of 7.0, whereas the interaction term between DMT and superimposed relapses was associated with a reduced risk of EDSS score of 7.0 (aHR, 0.33; 95% CI, 0.16-0.71; P = .004). Similar findings were obtained when treatment according to DMT class was considered and when DMT was included as a time-dependent covariate. These results were confirmed in the subgroup of patients with available magnetic resonance imaging data. Conclusions and Relevance Results of this comparative effectiveness research study suggest that inflammation also occurs in patients with PPMS, may contribute to long-term disability, and may be associated with a reduced risk of becoming wheelchair dependent by current licensed DMTs.
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Affiliation(s)
- Emilio Portaccio
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Mattia Fonderico
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
| | - Luisa Pastò
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Lorenzo Razzolini
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Angelo Bellinvia
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico Santissima Annunziata, Università G. d’Annunzio Chieti-Pescara, Abruzzo, Italia
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Gian Filippo Ingrassia, Sezione Neuroscienze, Centro Sclerosi Multipla, University of Catania, Catania, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Napoli, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla; Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Patrizia Sola
- Centro Malattie Demielinizzanti, Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria, Unità Operativa Neurologia, University of Modena and Reggio Emilia, Modena, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genoa, Italia
| | - Giacomo Lus
- Università della Campania Luigi Vanvitelli, Naples, Italia
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant’Andrea Hospital, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, Unità Operativa Complessa Neurologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione, Garibaldi, Catania, Italia
| | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| | - Paola Gazzola
- Struttura Complessa Neurologia, L’Ospedale Antero Micone di Sestri Ponente, Genovese, Italia
| | - Giancarlo Comi
- San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Ospedale Di Vaio, Fidenza, Azienda Unità Sanitaria Locale, Parma, Italia
| | - Daniele Spitaleri
- Centro Sclerosi Multipla, Unità Operativa Complessa di Neurologia, Azienda Ospedaliera di Rilievo Nazionale, San G. Moscati di Avellino, Avellino, Italia
| | - Marta Rezzonico
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Socio Sanitaria Territoriale, Lariana Ospedale Sant’Anna, Como, Italia
| | - Marika Vianello
- Centro Sclerosi Multipla, Ospedale Regionale ‘Ca’ Foncello, Neurology Unit, Treviso, Italia
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Multiple Sclerosis Intradipartimental Center, Department of Neurosciences, Policlinico Riuniti, Foggia, Italy
| | | | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sant’Andrea Hospital/Sapienza University, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico Mediterraneo, Neuromed, Pozzilli, Isernia, Italia
| | - Mauro Zaffaroni
- Centro Sclerosi Multipla, ASST della Valle Olona, Ospedale di Gallarate, Gallarate, Italia
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italia
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neurophysiology Units, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
| | - Maria Pia Amato
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Florence, Italy
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Portaccio E, Bellinvia A, Razzolini L, Pastò L, Goretti B, Niccolai C, Fonderico M, Zaffaroni M, Pippolo L, Moiola L, Falautano M, Celico C, Viterbo R, Patti F, Chisari C, Gallo P, Riccardi A, Borghi M, Bertolotto A, Simone M, Pozzilli C, Bianchi V, Roscio M, Martinelli V, Comi G, Filippi M, Trojano M, Ghezzi A, Amato MP. Long-term Cognitive Outcomes and Socioprofessional Attainment in People With Multiple Sclerosis With Childhood Onset. Neurology 2022; 98:e1626-e1636. [DOI: 10.1212/wnl.0000000000200115] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background and ObjectivesPatients with pediatric-onset multiple sclerosis (MS) can be especially vulnerable to cognitive impairment (CI) due to the onset of MS during a critical period for CNS development and maturation. The objective of this longitudinal study was to assess long-term cognitive functioning and socioprofessional attainment in the Italian pediatric MS cohort, previously assessed at baseline and 2 and 5 years.MethodsThe 48 patients evaluated at the 5-year assessment were screened for inclusion. All participants were assessed with a cognitive test battery exploring 4 different cognitive abilities. Depression, fatigue, and socioprofessional attainment were also assessed. Mean cognitive z scores were calculated for the whole cohort, and their evolution over time was analyzed with an analysis of variance for repeated measurements test. Predictors of cognitive worsening or improvement were assessed with a linear mixed-model analysis.ResultsThirty-three participants were included (mean follow-up 12.8 ± 0.8 years). The global cognitive performance worsened at year 2 and improved at year 5, although the z score remained significantly lower than at baseline (−0.9 ± 1.2 vs −0.3 ± 0.9, p = 0.002). There was no significant variation between years 5 and 12 (−0.7 ± 1.1, p = 0.452). Higher IQ (>90) at baseline (effect 0.3, 95% CI 0.1–0.5, p = 0.017) and lower number of relapses in the 2 years before baseline (effect −0.1, 95% CI −0.1 to 0.1, p = 0.025) predicted better cognitive performances. Eighteen (54.5%) patients failed at least 2 tests compared with healthy controls and were defined as cognitively impaired. The presence of CI predicted worse socioprofessional attainment (β = 4.8, 95% CI 1.4–8.2, p = 0.008).DiscussionThe longitudinal cognitive trajectory in pediatric-onset MS has a heterogeneous course over time, with a decline in the first years followed by a partial recovery over the long term. However, at the last follow-up evaluation, the proportion of impaired patients was more than double compared with baseline, with a negative impact on the individual’s socioprofessional attainment in adulthood. This study underscores how cognitive reserve may partially mitigate the negative effects of brain damage, highlighting the critical importance of intellectual enrichment early during the disease course.
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Portaccio E, Bellinvia A, Fonderico M, Pastò L, Razzolini L, Totaro R, Spitaleri D, Lugaresi A, Cocco E, Onofrj M, Di Palma F, Patti F, Maimone D, Valentino P, Confalonieri P, Protti A, Sola P, Lus G, Maniscalco GT, Brescia Morra V, Salemi G, Granella F, Pesci I, Bergamaschi R, Aguglia U, Vianello M, Simone M, Lepore V, Iaffaldano P, Filippi M, Trojano M, Amato MP. Progression is independent of relapse activity in early multiple sclerosis: a real-life cohort study. Brain 2022; 145:2796-2805. [PMID: 35325059 DOI: 10.1093/brain/awac111] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Disability accrual in multiple sclerosis may occur as relapse-associated worsening or progression independent of relapse activity. The role of progression independent of relapse activity in early MS is yet to be established. The objective of this multicentre, observational, retrospective cohort study was to investigate the contribution of relapse-associated worsening and progression independent of relapse activity to confirmed disability accumulation in patients with clinically isolated syndrome and early relapsing-remitting multiple sclerosis, assessed within one year from onset and with follow-up >/= 5 years (n = 5169). Data were extracted from the Italian Multiple Sclerosis Register. Confirmed disability accumulation was defined by an increase in Expanded Disability Status Scale score confirmed at 6 months, and classified per temporal association with relapses. Factors associated with progression independent of relapse activity and relapse-associated worsening were assessed using multivariable Cox regression models. Over a follow-up period of 11.5 ± 5.5 years, progression independent of relapse activity occurred in 1427 (27.6%) and relapse-associated worsening in 922 (17.8%) patients. Progression independent of relapse activity was associated with older age at baseline (HR = 1.19; 95CI 1.13-1.25, p < 0.001), having a relapsing-remitting course at baseline (HR = 1.44; 95CI 1.28-1.61, p < 0.001), longer disease duration at baseline (HR = 1.56; 95%CI 1.28-1.90, p < 0.001), lower Expanded Disability Status Scale at baseline (HR = 0.92; 95CI 0.88-0.96, p < 0.001), lower number of relapses before the event (HR = 0.76; 95CI 0.73-0.80, p < 0.001). Relapse-associated worsening was associated with younger age at baseline (HR = 0.87; 95CI 0.81-0.93, p < 0.001), having a relapsing-remitting course at baseline (HR = 1.55; 95CI 1.35-1.79, p < 0.001), lower Expanded Disability Status Scale at baseline (HR = 0.94; 95CI 0.89-0.99, p = 0.017), higher number of relapses before the event (HR = 1.04; 95CI 1.01-1.07, p < 0.001). Longer exposure to disease modifying drugs was associated with a lower risk of both progression independent of relapse activity and relapse-associated worsening (p < 0.001). This study provides evidence that in early relapsing-onset multiple sclerosis cohort, progression independent of relapse activity was an important contributor to confirmed disability accumulation. Our findings indicate that insidious progression appears even in the earliest phases of the disease, suggesting that inflammation and neurodegeneration can represent a single disease continuum, in which age is one of the main determinants of disease phenomenology.
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Affiliation(s)
- Emilio Portaccio
- University of Florence, Department of NEUROFARBA, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Department of Neurology, Florence, Italy
| | - Angelo Bellinvia
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - Mattia Fonderico
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - Luisa Pastò
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | | | - Rocco Totaro
- San Salvatore Hospital, Demyelinating Disease Center, L'Aquila, Italy
| | - Daniele Spitaleri
- AORN San G. Moscati di Avellino, Department of Neurology, Avellino, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, Italy.,Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie, Bologna, Italy
| | - Eleonora Cocco
- University of Cagliari, Department of Medical Science and Public health, Centro Sclerosi Multipla, Cagliari, Italy
| | - Marco Onofrj
- University G. d'Annunzio di Chieti-Pescara, Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - Franco Di Palma
- ASST Lariana Ospedale S. Anna, Department of Neurology, Como, Italy
| | - Francesco Patti
- University of Catania, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Catania, Italy
| | - Davide Maimone
- Ospedale Garibaldi Centro, Department of Neurology, Catania, Italy
| | - Paola Valentino
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Paolo Confalonieri
- Fondazione IRCCS Istituto Neurologico C. Besta, Neuroimmunology Unit, Milan, Italy
| | | | - Patrizia Sola
- University of Modena and Reggio Emilia, Department of Neurology, Modena, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Vincenzo Brescia Morra
- Federico II University, Naples, Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Naples, Italy
| | - Giuseppe Salemi
- University of Palermo, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Palermo, Italy
| | - Franco Granella
- University of Parma, Unit of Neurosciences, Department of Medicine and Surgery, Parma, Italy
| | - Ilaria Pesci
- Ospedale VAIO di Fidenza AUSL PR, Department of Neurology, Fidenza, Italy
| | | | - Umberto Aguglia
- Magna Graecia University of Catanzaro, Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Marika Vianello
- Unit of Neurology, Ca' Fancello Hospital, AULSS2, Treviso, Italy
| | - Marta Simone
- University 'Aldo Moro' of Bari, Child Neuropsychiatric Unit, Department of Biomedical Sciences and Human Oncology, Bari, Italy
| | - Vito Lepore
- Public Health Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Pietro Iaffaldano
- University of Bari Aldo Moro, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy
| | - Massimo Filippi
- San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute; Neuroimaging Research Unit, Division of Neuroscience; Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- University of Bari Aldo Moro, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy
| | - Maria Pia Amato
- University of Florence, Department of NEUROFARBA, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Department of Neurology, Florence, Italy
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Tur C, Dubessy AL, Otero-Romero S, Amato MP, Derfuss T, Di Pauli F, Iacobaeus E, Mycko M, Abboud H, Achiron A, Bellinvia A, Boyko A, Casanova JL, Clifford D, Dobson R, Farez MF, Filippi M, Fitzgerald KC, Fonderico M, Gouider R, Hacohen Y, Hellwig K, Hemmer B, Kappos L, Ladeira F, Lebrun-Frénay C, Louapre C, Magyari M, Mehling M, Oreja-Guevara C, Pandit L, Papeix C, Piehl F, Portaccio E, Ruiz-Camps I, Selmaj K, Simpson-Yap S, Siva A, Sorensen PS, Sormani MP, Trojano M, Vaknin-Dembinsky A, Vukusic S, Weinshenker B, Wiendl H, Winkelmann A, Zuluaga Rodas MI, Tintoré M, Stankoff B. The risk of infections for multiple sclerosis and neuromyelitis optica spectrum disorder disease-modifying treatments: Eighth European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop Review. April 2021. Mult Scler 2022; 28:1424-1456. [PMID: 35196927 DOI: 10.1177/13524585211069068] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the recent years, the treatment of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) has evolved very rapidly and a large number of disease-modifying treatments (DMTs) are now available. However, most DMTs are associated with adverse events, the most frequent of which being infections. Consideration of all DMT-associated risks facilitates development of risk mitigation strategies. An international focused workshop with expert-led discussions was sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and was held in April 2021 to review our current knowledge about the risk of infections associated with the use of DMTs for people with MS and NMOSD and corresponding risk mitigation strategies. The workshop addressed DMT-associated infections in specific populations, such as children and pregnant women with MS, or people with MS who have other comorbidities or live in regions with an exceptionally high infection burden. Finally, we reviewed the topic of DMT-associated infectious risks in the context of the current SARS-CoV-2 pandemic. Herein, we summarize available evidence and identify gaps in knowledge which justify further research.
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Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Anne-Laure Dubessy
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France
| | - Susana Otero-Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Tobias Derfuss
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Franziska Di Pauli
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ellen Iacobaeus
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marcin Mycko
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland Medical Center, Cleveland, OH, USA
| | - Anat Achiron
- Sheba Medical Center at Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Angelo Bellinvia
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia/Institute of Clinical Neurology and Department of Neuroimmunology, Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - David Clifford
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK/Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Mauricio F Farez
- Center for Research on Neuroimmunological Diseases, FLENI, Buenos Aires, Argentina
| | - Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Kathryn C Fitzgerald
- Department of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mattia Fonderico
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Tunis, Tunisia
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Filipa Ladeira
- Neurology Department, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Christine Lebrun-Frénay
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, UR2CA-URRIS, Université Nice Côte d'Azur, Nice, France
| | - Céline Louapre
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute-ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthias Mehling
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico San Carlos, Idissc, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | - Caroline Papeix
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute-ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France
| | - Fredrik Piehl
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Isabel Ruiz-Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Krzysztof Selmaj
- Collegium Medicum, Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland/Center of Neurology, Lodz, Poland
| | - Steve Simpson-Yap
- Clinical Outcomes Research Unit, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Per Soelberg Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Adi Vaknin-Dembinsky
- Hadassah-Hebrew University Medical Center, Department of Neurology, The Agnes-Ginges Center for Neurogenetics Jerusalem, Jerusalem, Israel
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France/Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, Lyon, France
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Münster, Germany
| | | | | | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Bruno Stankoff
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France
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5
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De Meo E, Filippi M, Trojano M, Comi G, Patti F, Brescia Morra V, Salemi G, Onofrj M, Lus G, Cocco E, Fonderico M, Torri Clerici V, Maniscalco GT, Valentino P, Bertolotto A, Lugaresi A, Bergamaschi R, Rovaris M, Sola P, Tedeschi G, Pesci I, Aguglia U, Cavalla P, Maimone D, Granella F, Vianello M, Simone M, Portaccio E, Amato MP. Comparing natural history of early and late onset pediatric multiple sclerosis. Ann Neurol 2022; 91:483-495. [PMID: 35150168 DOI: 10.1002/ana.26322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/05/2022] [Accepted: 02/08/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe and compare disease course and prognosis of early (i.e., disease onset before age 11 years) and late (i.e., disease onset after age 11 years) onset pediatric multiple sclerosis. METHODS Prospectively-collected clinical information from Italian Multiple Sclerosis Register of 1993 pediatric multiple sclerosis patients, of whom 172 with early onset, was analyzed. Cox models adjusted for sex, baseline Expanded Disability Status Scale score and disease-modifying treatments and stratified for diagnostic criteria adopted (Poser vs McDonald) were used to assess the risk of reaching irreversible Expanded Disability Status Scale scores of 3, 4, and 6, and conversion to secondary progressive phenotype in early vs late onset pediatric patients. Prognostic factors were also evaluated. RESULTS A greater proportion of males, isolated brainstem involvement, and longer time interval between first and second clinical episode was observed in early vs late onset pediatric patients. Compared to late onset, early onset pediatric patients took longer time from disease onset to convert to secondary progressive phenotype and to reach all disability milestones. Recovery from first demyelinating event, time to first relapse, annualized relapse rate during the first 3 years of disease and disease-modifying treatments exposure were independent predictors for long-term disability in early onset pediatric patients. In late onset pediatric patients, isolated optic neuritis, multifocal symptoms or progressive course at disease onset were additional predictors for long-term disability. INTERPRETATION These findings point towards the existence of a different natural history in early vs late onset pediatric multiple sclerosis patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ermelinda De Meo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute.,Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro' Policlinico, Bari, Italy
| | | | - Francasco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, University of Catania, Catania
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Napoli
| | - Giuseppe Salemi
- Dipartimento di Biomedicina Sperimentale e Neuroscienze, Palermo
| | | | - Giacomo Lus
- Università della Campania Luigi Vanvitelli, Naples
| | - Eleonora Cocco
- Centro Sclerosi Multipla, ASSL Cagliari; Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari
| | | | | | - Giorgia Teresa Maniscalco
- Multiple Sclerosis Center and Neurological Clinic/Stroke Unit "A. Cardarelli" Hospital, Naples, Italy
| | | | | | | | | | | | - Patrizia Sola
- Centro Malattie Demielinizzanti - Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria/OCSAE, UO Neurologia, University of Modena and Reggio Emilia, Modena
| | | | - Ilaria Pesci
- Centro SM UO Neurologia, Ospedale Di Vaio, Fidenza
| | | | - Paola Cavalla
- Multiple Sclerosis Center and I Neurology Unit, Department of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia ARNAS Garibaldi, Catania
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma
| | - Marika Vianello
- Centro Sclerosi Multipla - Ospedale Regionale 'Ca' Foncello', Neurology Unit, Treviso
| | - Marta Simone
- Child Neuropsychiatric Unit-Department of Biomedical Science and Human Oncology-University of Bari Aldo Moro
| | | | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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6
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De Meo E, Portaccio E, Prestipino E, Nacmias B, Bagnoli S, Razzolini L, Pastò L, Niccolai C, Goretti B, Bellinvia A, Fonderico M, Giorgio A, Stromillo ML, Filippi M, Sorbi S, De Stefano N, Amato MP. Effect of BDNF Val66Met polymorphism on hippocampal subfields in multiple sclerosis patients. Mol Psychiatry 2022; 27:1010-1019. [PMID: 34650209 DOI: 10.1038/s41380-021-01345-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 01/20/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism was shown to strongly affect BDNF function, but its role in modulating gray matter damage in multiple sclerosis (MS) patients is still not clear. Given BDNF relevance on the hippocampus, we aimed to explore BDNF Val66Met polymorphism effect on hippocampal subfield volumes and its role in cognitive functioning in MS patients. Using a 3T scanner, we obtained dual-echo and 3DT1-weighted sequences from 50 MS patients and 15 healthy controls (HC) consecutively enrolled. MS patients also underwent genotype analysis of BDNF, neurological and neuropsychological evaluation. Hippocampal subfields were segmented by using Freesurfer. The BDNF Val66Met polymorphism was found in 22 MS patients (44%). Compared to HC, MS patients had lower volume in: bilateral hippocampus-amygdala transition area (HATA); cornus ammonis (CA)1, granule cell layer of dentate gyrus (GCL-DG), CA4 and CA3 of the left hippocampal head; molecular layer (ML) of the left hippocampal body; presubiculum of right hippocampal body and right fimbria. Compared to BDNF Val66Val, Val66Met MS patients had higher volume in bilateral hippocampal tail; CA1, ML, CA3, CA4, and GCL-DG of left hippocampal head; CA1, ML, and CA3 of the left hippocampal body; left HATA and presubiculum of the right hippocampal head. In MS patients, higher lesion burden was associated with lower volume of presubiculum of right hippocampal body; lower volume of left hippocampal tail was associated with worse visuospatial memory performance; lower volume of left hippocampal head with worse performance in semantic fluency. Our findings suggest the BNDF Val66Met polymorphism may have a protective role in MS patients against both hippocampal atrophy and cognitive impairment. BDNF genotype might be a potential biomarker for predicting cognitive prognosis, and an interesting target to study for neuroprotective strategies.
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Affiliation(s)
- Ermelinda De Meo
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Emilio Portaccio
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Elio Prestipino
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Benedetta Nacmias
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Silvia Bagnoli
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | | | - Luisa Pastò
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Benedetta Goretti
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | | | | | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit,, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sandro Sorbi
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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7
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Portaccio E, Fonderico M, Hemmer B, Derfuss T, Stankoff B, Selmaj K, Tintorè M, Amato MP. Impact of COVID-19 on multiple sclerosis care and management: Results from the European Committee for Treatment and Research in Multiple Sclerosis survey. Mult Scler 2022; 28:132-138. [PMID: 33764197 PMCID: PMC8689421 DOI: 10.1177/13524585211005339] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The spread of Coronavirus disease-19 (COVID-19) poses unique challenges in the management of people with multiple sclerosis (PwMS). OBJECTIVES To collect data about the impact of COVID-19 emergency on access to care for PwMS and on MS treatment practices. METHODS Between March and July 2020, the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) promoted an online survey covering patient access to care, management of relapses and visits, disease-modifying therapy (DMT) and experience with COVID-19. RESULTS Three-hundred and sixty neurologists from 52 countries (68% from Europe) completed the survey. 98% reported COVID-19-related restrictions. Telemedicine was adopted to overcome the limited access to care and was newly activated (73%) or widely implemented (17%). 70% reported changes in DMT management. Interferons and glatiramer were considered safe. Dimethyl fumarate, teriflunomide and fingolimod were considered safe except for patients developing lymphopenia. No modifications were considered for natalizumab in 64%, cladribine in 24%, anti-CD20 in 22% and alemtuzumab in 17%; 18% (for alemtuzumab and cladribine) and 43% (for anti-CD20) considered postponing treatment. CONCLUSION The ECTRIMS survey highlighted the challenges in keeping standards of care in clinical practice. Telemedicine clearly needs to be implemented. Gathering data on DMT safety will remain crucial to inform treatment decisions.
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Affiliation(s)
| | - Mattia Fonderico
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Bernhard Hemmer
- Neurology Department, Klinikum rechts der Isar TU München, Münich, Germany/Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Tobias Derfuss
- Departments of Neurology and Biomedicine, University Hospital of Basel, Basel, Switzerland
| | - Bruno Stankoff
- Department of Neurology, ICM, Hôpital Pitié Salpêtrière, Paris, France
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Mar Tintorè
- Department of the Neurology/Neuroimmunology and Research Institute Barcelona, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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8
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Portaccio E, Bellinvia A, Fonderico M, Pastò L, Razzolini L, Totaro R, Spitaleri D, Lugaresi A, Cocco E, Onofrj M, Di Palma F, Patti F, Maimone D, Valentino P, Confalonieri P, Protti A, Sola P, Lus G, Maniscalco G, Morra VB, Salemi G, Granella F, Pesci I, Bergamaschi R, Aguglia U, Vianello M, Simone M, Lepore V, Iaffaldano P, Filippi M, Trojano M, Amato MP. Progression independent of relapse activity in early multiple sclerosis patients. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Meo ED, Bonacchi R, Fonderico M, Filippi M, Patti F, Morra VB, Salemi G, Lus G, Onofrj M, Cocco E, Maniscalco G, Bertolotto A, Confalonieri P, Bergamaschi R, Lugaresi A, Valentino P, Cavalla P, Maimone D, Sola P, Granella F, Pesci I, Rovaris M, Simone M, Trojano M, Amato MP. Long-term disability progression in childhood and adolescent onset multiple sclerosis patients. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Portaccio E, Tudisco L, Pastò L, Razzolini L, Fonderico M, Bellinvia A, Ghezzi A, Annovazzi P, Zaffaroni M, Moiola L, Martinelli V, Chisari CG, Patti F, Mancardi G, Pozzilli C, De Giglio L, Totaro R, Lugaresi A, Di Tommaso V, Paolicelli D, Cocco E, Marrosu MG, Comi G, Filippi M, Trojano M, Amato MP. Pregnancy in multiple sclerosis women with relapses in the year before conception increases the risk of long-term disability worsening. Mult Scler 2021; 28:472-479. [PMID: 34132146 DOI: 10.1177/13524585211023365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The influence of pregnancy on long-term disability in multiple sclerosis (MS) is still controversial. OBJECTIVE To assess the risk of long-term disability worsening after pregnancy in MS women as compared with a propensity-score (PS) matched group of MS women without pregnancy. METHODS In the setting of the Italian Pregnancy Dataset, MS patients with (pregnancy group (PG)) and without pregnancy (control group (CG)) were recruited. Time to disability worsening on the Expanded Disability Status Scale (EDSS) was assessed through a multivariable Cox regression model. RESULTS The PS-matching retained 230 PG and 102 CG patients. After a follow-up of 6.5 +/- 3.1 years, disability worsening occurred in 87 (26.2%) women. In the multivariable analysis, disability worsening was associated with pregnancy in women with relapses in the year before conception (adjusted hazard ratio (aHR) = 1.74; 95% confidence interval (CI) 1.06-2.84; p = 0.027), higher EDSS (aHR = 1.39; 95% CI 1.12-1.74; p = 0.003), younger age (aHR = 0.95; 95% CI 0.91-0.99; p = 0.022) and shorter DMD exposure over the follow-up (p < 0.008). CONCLUSION Pregnancy in MS women with relapses in the year before conception increases the risk of long-term disability worsening. Our findings underscore the importance of counselling in MS women facing a pregnancy that should be planned after a period of clinical stability, favouring treatment optimization in patients with recent disease activity.
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Affiliation(s)
- Emilio Portaccio
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Laura Tudisco
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Luisa Pastò
- Division Neurological Rehabilitation, Careggi University Hospital, Florence, Italy
| | - Lorenzo Razzolini
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Mattia Fonderico
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Angelo Bellinvia
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Center, ASST Valle Olona, Gallarate Hospital (VA), Gallarate, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona, Gallarate Hospital (VA), Gallarate, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST Valle Olona, Gallarate Hospital (VA), Gallarate, Italy
| | - Lucia Moiola
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Martinelli
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesco Patti
- Department of Neurology, University of Catania, Catania, Italy
| | | | - Carlo Pozzilli
- Department of Neurology and Psychiatry, 'La Sapienza' University, Rome, Italy
| | - Laura De Giglio
- Department of Neurology and Psychiatry, 'La Sapienza' University, Rome, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, Department of Neurology, San Salvatore Hospital, L'Aquila, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy/Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Valeria Di Tommaso
- Department of Neuroscience and Imaging, University 'G. d'Annunzio' of Chieti, Chieti, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Eleonora Cocco
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Giovanna Marrosu
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy/Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Maria Pia Amato
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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11
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Portaccio E, Bellinvia A, Prestipino E, Nacmias B, Bagnoli S, Razzolini L, Pastò L, Niccolai C, Goretti B, Fonderico M, Zimatore GB, Losignore NA, Sorbi S, Amato MP. The Brain-Derived Neurotrophic Factor Val66Met Polymorphism Can Protect Against Cognitive Impairment in Multiple Sclerosis. Front Neurol 2021; 12:645220. [PMID: 33815257 PMCID: PMC8011315 DOI: 10.3389/fneur.2021.645220] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family, involved in neuronal survival and synaptic plasticity. The BDNF Val66Met polymorphism is known to reduce BDNF expression and secretion; its role in multiple sclerosis (MS) is poorly investigated. Objectives and Methods: In this multicenter, retrospective study, we assessed the role of BDNF Val66Met polymorphism on cognitive and motor disability in MS patients consecutively referred to the University of Florence and the Hospital of Barletta. All patients underwent a genetic analysis for the presence of Val66Met polymorphism and a comprehensive neuropsychological examination on the Rao's Brief Repeatable Battery and the Stroop Color Word Test. Possible predictors of the Expanded Disability Status Scale (EDSS) score and number of failed neuropsychological tests were assessed through linear multivariable regression models. Results: Ninety-eight patients were recruited. Patients with the BDNF Val66Met polymorphism (35.7%) were more frequently males (p = 0.020), more disabled (p = 0.026) and, marginally, older (p = 0.064). In the multivariable analysis, BDNF Val66Met polymorphism was associated with a better cognitive performance (B = −1.1 ± 0.5, p = 0.027). Higher EDSS score was associated with a progressive disease course (B = 3.4, p < 0.001) and, marginally, with the presence of the BDNF Val66Met polymorphism (B = 0.56, p = 0.066). Discussion: Our results preliminarily suggest a protective role of BDNF Val66Met polymorphism against cognitive impairment in MS patients, possibly related to a detrimental effect of increased BDNF concentration in a neuroinflammatory environment.
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Affiliation(s)
- Emilio Portaccio
- SOD Riabilitazione Neurologica, AOU Careggi, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Elio Prestipino
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Benedetta Nacmias
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, University of Florence, Florence, Italy
| | - Silvia Bagnoli
- NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Luisa Pastò
- SOD Riabilitazione Neurologica, AOU Careggi, Florence, Italy
| | | | | | | | | | | | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, University of Florence, Florence, Italy
| | - Maria Pia Amato
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, University of Florence, Florence, Italy
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12
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Amato MP, Fonderico M, Portaccio E, Pastò L, Razzolini L, Prestipino E, Bellinvia A, Tudisco L, Fratangelo R, Comi G, Patti F, De Luca G, Brescia Morra V, Cocco E, Pozzilli C, Sola P, Bergamaschi R, Salemi G, Inglese M, Millefiorini E, Galgani S, Zaffaroni M, Ghezzi A, Salvetti M, Lus G, Florio C, Totaro R, Granella F, Vianello M, Gatto M, Di Battista G, Aguglia U, Logullo FO, Simone M, Lucisano G, Iaffaldano P, Trojano M. Disease-modifying drugs can reduce disability progression in relapsing multiple sclerosis. Brain 2020; 143:3013-3024. [DOI: 10.1093/brain/awaa251] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/30/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
An ever-expanding number of disease-modifying drugs for multiple sclerosis have become available in recent years, after demonstrating efficacy in clinical trials. In the real-world setting, however, disease-modifying drugs are prescribed in patient populations that differ from those included in pivotal studies, where extreme age patients are usually excluded or under-represented. In this multicentre, observational, retrospective Italian cohort study, we evaluated treatment exposure in three cohorts of patients with relapsing-remitting multiple sclerosis defined by age at onset: paediatric-onset (≤18 years), adult-onset (18–49 years) and late-onset multiple sclerosis (≥50 years). We included patients with a relapsing-remitting phenotype, ≥5 years follow-up, ≥3 Expanded Disability Status Scale (EDSS) evaluations and a first neurological evaluation within 3 years from the first demyelinating event. Multivariate Cox regression models (adjusted hazard ratio with 95% confidence intervals) were used to assess the risk of reaching a first 12-month confirmed disability worsening and the risk of reaching a sustained EDSS of 4.0. The effect of disease-modifying drugs was assessed as quartiles of time exposure. We found that disease-modifying drugs reduced the risk of 12-month confirmed disability worsening, with a progressive risk reduction in different quartiles of exposure in paediatric-onset and adult-onset patients [adjusted hazard ratios in non-exposed versus exposed >62% of the follow-up time: 8.0 (3.5–17.9) for paediatric-onset and 6.3 (4.9–8.0) for adult-onset, P < 0.0001] showing a trend in late-onset patients [adjusted hazard ratio = 1.9 (0.9–4.1), P = 0.07]. These results were confirmed for a sustained EDSS score of 4.0. We also found that relapses were a risk factor for 12-month confirmed disability worsening in all three cohorts, and female sex exerted a protective role in the late-onset cohort. This study provides evidence that sustained exposure to disease-modifying drugs decreases the risk of disability accumulation, seemingly in a dose-dependent manner. It confirms that the effectiveness of disease-modifying drugs is lower in late-onset patients, although still detectable.
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Affiliation(s)
- Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Emilio Portaccio
- SOC Neurologia, Ospedale San Giovanni di Dio, AUSL Toscana Centro1, Florence, Italy
| | - Luisa Pastò
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Elio Prestipino
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Laura Tudisco
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Giancarlo Comi
- San Raffaele Hospital - INSPE; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, University of Catania, Catania, Sicily, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS Annunziata, Università ‘G. d'Annunzio’, Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Napoli, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, S. Andrea Hospital, Dept. of Human Neuroscience, Sapienza University, Rome, Italy
| | - Patrizia Sola
- Centro Malattie Demielinizzanti - Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria/OCSAE, UO Neurologia, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Sicily, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Enrico Millefiorini
- Multiple Sclerosis Center, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Simonetta Galgani
- multiple sclerosis Centre, Department of Neurosciences, S. Camillo - Forlanini Hospital, Rome, Italy
| | - Mauro Zaffaroni
- ASST della Valle Olona, Multiple Sclerosis Center, S. Antonio Abate Hospital of Gallarate, Gallarate, Italy
| | - Angelo Ghezzi
- ASST della Valle Olona, Multiple Sclerosis Center, S. Antonio Abate Hospital of Gallarate, Gallarate, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital/Sapienza University, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Rome, Italy
| | - Giacomo Lus
- Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Ciro Florio
- Multiple Sclerosis Center, Cardarelli Hospital, Naples, Italy
| | - Rocco Totaro
- Demyelinating Diseases Center, Department of Neurology, San Salvatore Hospital, L'Aquila, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Italy
| | - Marika Vianello
- Centro Sclerosi Multipla - Ospedale Regionale ‘Ca’ Foncello', Neurology Unit, Treviso, Italy
| | - Maurizia Gatto
- Ospedale Generale Regionale ‘F. Miulli’, Neurology Unit, Acquaviva delle Fonti (BA), Italy
| | | | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Neurology Unit, Catanzaro, Italy
| | | | - Marta Simone
- Child Neuropsychiatric Unit, Department of Biomedical Sciences and Human Oncology, University ‘Aldo Moro’ of Bari, Policlinico Piazza G. Cesare, 11, 70121, Bari, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
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13
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Bellinvia A, Prestipino E, Portaccio E, Razzolini L, Fonderico M, Fratangelo R, Tudisco L, Pastò L, Amato MP. Experience with rituximab therapy in a real-life sample of multiple sclerosis patients. Neurol Sci 2020; 41:2939-2945. [PMID: 32350672 DOI: 10.1007/s10072-020-04434-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune, neuroinflammatory, and neurodegenerative disease of the central nervous system. B cells have recently emerged as a promising target to significantly reduce inflammatory disease activity in MS, with successful trial studies using antiCD20 therapies. However, real-life data about safety and efficacy are limited. OBJECTIVES To analyze the clinical and radiological inflammatory activity, adherence to therapy, and safety of rituximab (RTX) in an MS patients' sample, treated from 2015 to 2018 in our center PATIENTS AND METHODS: Retrospective study on prospectively collected data about relapses, disability progression, and radiological activity (new T2 lesions and Gd-enhancing lesions) were recorded and used to assess no evidence of disease activity (NEDA) at 12 months. RTX-related adverse events were recorded. RTX was administered intravenously at a dosage of 1000 mg twice 2 weeks apart, then every 6 months. RESULTS Sixty-nine patients were included. Fifty-three (76.8%) had a relapsing-remitting, two a primary progressive course, and 14 a secondary progressive course. The mean follow-up period was 16 ± 9.7 months. Thirty-five (50.7%) patients had relapses in the year prior to RTX therapy, with a mean annualized relapse rate of 0.75, significantly reduced to 0.36 at 12 months (p < 0.001). Among the 36 patients included in the study who had an MRI available at 12 months, MRI activity was reduced from 88% (n = 32) to 8.3% (n = 3) at follow-up (p < 0.001). Twelve (17.4%) patients suspended RTX during the study. CONCLUSIONS Our real-life experience confirms that off-label therapy with RTX may represent a valid, cost-effective therapeutic option in MS.
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Affiliation(s)
- Angelo Bellinvia
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Elio Prestipino
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Emilio Portaccio
- SOC Neurologia, AUSL Toscana Centro, San Giovanni di Dio Hospital, Florence, Italy
| | - Lorenzo Razzolini
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Mattia Fonderico
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Roberto Fratangelo
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Laura Tudisco
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Luisa Pastò
- SOD Neurological Rehabilitation, Careggi University Hospital, Florence, Italy
| | - Maria P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
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14
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Antonioni A, Fonderico M, Granieri E. Hirayama Disease: A Case of an Albanian Woman Clinically Stabilized Without Surgery. Front Neurol 2020; 11:183. [PMID: 32256441 PMCID: PMC7090124 DOI: 10.3389/fneur.2020.00183] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/25/2020] [Indexed: 11/15/2022] Open
Abstract
Hirayama Disease (HD) is a rare clinical condition that usually affects young people with preference for Asian males. It appears with unilateral distal amyotrophy or asymmetric bilateral amyotrophy of an upper limb which is to refer to an involvement of the spinal metamers C7-C8-T1. A clinical case of a female patient of Albanian nationality is described, with onset of the disease in adulthood and clinical and electrophysiological features suggestive of HD, without any characteristic imaging findings. Clinical investigations, EMG and radiological data facilitated the diagnosis and allowed the exclusion of degenerative forms of the motor neuron and radiculopathies. In this paper, we want to point out that the diagnosis of this pathology should be hypothesized even in the absence of characteristic epidemiological and imaging data.
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Affiliation(s)
- Annibale Antonioni
- Section of Neurology, Psychology and Psychiatry, Department of Biomedical and Specialty-Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Mattia Fonderico
- Section of Neurology, Psychology and Psychiatry, Department of Biomedical and Specialty-Surgical Sciences, University of Ferrara, Ferrara, Italy.,Department of Neuroscience, Firenze, Italy
| | - Enrico Granieri
- Section of Neurology, Psychology and Psychiatry, Department of Biomedical and Specialty-Surgical Sciences, University of Ferrara, Ferrara, Italy
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15
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Fonderico M, Biagioli T, Lanzilao L, Bellinvia A, Fratangelo R, Pastò L, Prestipino E, Razzolini L, Tudisco L, Ginestroni A, Vuolo L, Fainardi E, Ballerini C, Portaccio E, Amato MP. Prognostic role of intrathecal IgM synthesis in multiple sclerosis: Results from a clinical series. Mult Scler 2020; 27:198-207. [PMID: 32091300 DOI: 10.1177/1352458520907913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is emerging evidence that intrathecal IgM synthesis (ITMS) is a risk factor for conversion to clinically defined multiple sclerosis (CDMS) in clinically isolated syndrome (CIS) patients. OBJECTIVES The objective of this study is to verify the prognostic role of ITMS as a risk factor for the second clinical attack in patients after the first demyelinating event. METHODS Monocentric observational study performed on prospectively acquired clinical data and retrospective evaluation of magnetic resonance imaging (MRI) data. ITMS was assessed according to Reiber's non-linear function. We compared time to the second attack by using Kaplan-Meier curves and performed adjustment by Cox regression analysis. RESULTS Demographics and clinical data were collected prospectively in a cohort of 68 patients. ITMS occurred in 40% (27/68) of patients who had a higher T1-hypointense lesion load at brain MRI (p = 0.041). In multivariate Cox regression analysis (adjusted for age, sex, baseline Expanded Disability Status Scale, IgG oligoclonal bands and disease-modifying treatment exposure), relapsing-remitting multiple sclerosis (MS) patients with ITMS were at higher risk to experience a second clinical attack (adjusted hazard ratio (aHR) = 6.3, 95% confidence interval (CI) = 2.1-18.4, p = 0.001). CONCLUSION Together with previous studies, our findings support the role of ITMS as a prognostic biomarker in MS.
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Affiliation(s)
- Mattia Fonderico
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Tiziana Biagioli
- Central Diagnostic Laboratory, Careggi University Hospital, Florence, Italy
| | - Luisa Lanzilao
- Central Diagnostic Laboratory, Careggi University Hospital, Florence, Italy
| | - Angelo Bellinvia
- Department of Neurofarba, University of Florence, Florence, Italy
| | | | - Luisa Pastò
- SODc Riabilitazione Neurologica, University Hospital Careggi, Florence, Italy
| | - Elio Prestipino
- Department of Neurofarba, University of Florence, Florence, Italy
| | | | - Laura Tudisco
- Department of Neurofarba, University of Florence, Florence, Italy
| | | | - Luisa Vuolo
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Clara Ballerini
- Department of Experimental and Clinical Medicine (DMSC), University of Florence, Florence, Italy
| | - Emilio Portaccio
- SOC Neurologia, Ospedale San Giovanni di Dio, AUSL Toscana Centro, Florence, Italy
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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16
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Amato MP, Prestipino E, Bellinvia A, Niccolai C, Razzolini L, Pastò L, Fratangelo R, Tudisco L, Fonderico M, Mattiolo PL, Goretti B, Zimatore GB, Losignore NA, Portaccio E, Lolli F. Cognitive impairment in multiple sclerosis: An exploratory analysis of environmental and lifestyle risk factors. PLoS One 2019; 14:e0222929. [PMID: 31634346 PMCID: PMC6802833 DOI: 10.1371/journal.pone.0222929] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/10/2019] [Indexed: 01/18/2023] Open
Abstract
Background Many potentially modifiable risk factors for MS are investigated. It is not known, however, if these factors also apply to MS-related cognitive impairment (CI), a frequent consequence of MS. Objective The aim of our study was to assess risk factors for CI in MS patients, focusing on environmental exposures, lifestyle and comorbidities. Methods We included MS patients referring to MS Centers in Florence and Barletta between 2014 and 2017. Neuropsychological performance was assessed through the Rao’s battery and Stroop test, cognitive reserve (premorbid intelligence quotient–IQ) was evaluated using the National Adult Reading Test (NART). Potential risk factors were investigated through a semi-structured questionnaire. Results 150 patients were included. CI was detected in 45 (30%) subjects and was associated with older age (p<0.005), older age at MS onset (p = 0.016), higher EDSS score (p<0.005), progressive disease course (p = 0.048) and lower premorbid IQ score (p<0.005). As for risk factors, CI was related with lower physical activity in childhood-adolescence (p<0.005). In women, hormonal therapy resulted to be protective against CI (p = 0.041). However, in the multivariable analysis, the only significant predictors of CI were older age (p<0.05; OR 1.06, 95% CI 1.02–1.10) and lower premorbid IQ (p<0.05; OR 0.93, 95% CI: 0.88–0.98). Removing IQ from the model, CI was associated with higher EDSS (p = 0.030; OR 1.25, 95% CI 1.02–1.53) and, marginally, previous physical activity (p = 0.066; OR 0.49, 95% CI: 0.23–1.05) Conclusions Our findings suggest that physical activity in childhood-adolescence could be a contributor to cognitive reserve building, thus representing a potential protective factors for MS-related CI susceptible to preventive strategies.
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Affiliation(s)
- Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- * E-mail:
| | - Elio Prestipino
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Angelo Bellinvia
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Claudia Niccolai
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Lorenzo Razzolini
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Luisa Pastò
- SOD Neurological Rehabilitation, Careggi University Hospital, Florence, Italy
| | - Roberto Fratangelo
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Laura Tudisco
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Mattia Fonderico
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Paolo Luca Mattiolo
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | - Benedetta Goretti
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | | | | | | | - Francesco Lolli
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
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17
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Bellinvia A, Pastò L, Razzolini L, Fratangelo R, Prestipino E, Fonderico M, Tudisco L, Amato MP. The clinical spectrum of anti-MOG associated acquired demyelinating disorders: Three case-reports. Mult Scler Relat Disord 2019; 33:51-54. [PMID: 31152967 DOI: 10.1016/j.msard.2019.05.006] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The spectrum of differential diagnosis of acquired demyelinating disorders of the central nervous system has been recently broadened. There is now growing evidence that supports anti-myelin oligodendrocyte antibodies associated demyelination as a distinct disease entity, with some clinical characteristics that somehow overlap those of Multiple Sclerosis (MS) and anti-AQP4+ Neuromyelitis Optica Spectrum Disorders (AQP4+NMOSD) but different pathogenesis and treatment strategies. SUMMARY We hereby present 3 cases of anti-MOG+ patients with different disease courses - ranging from mild to severe - all presenting with Optic neuritis (ON) at the onset. Optic neuritis (ON) is a common manifestation of different central nervous system (CNS) inflammatory disorders and can represent the first clinical event of MS and NMOSD. ON is also the most common presentation of antiMOG demyelinating disorders, followed by - and sometimes associated with - myelitis, most commonly extended over more than 2 spinal cord segments and defined as longitudinally extended transverse myelitis (LETM). All the three patients tested negative for oligoclonal bands in CSF and anti-AQP4 Ab in serum, had a relapsing disease course characterized by prominent involvement of the optic nerve and spinal cord, with good recovery after treatment with high-dose corticosteroids. However, they had a different disease course at follow-up and underwent different treatment approaches. CONCLUSIONS Since anti-MOG+ patients can have a multiphasic disease course and accumulate disability over time, a high degree of suspicion and early diagnosis are of critical importance for treatment decision-making in clinical practice. AIM The aim of this case report is to enhance focus on an emerging disease spectrum among acquired CNS demyelinating disorders.
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Affiliation(s)
- A Bellinvia
- Department NEUROFARBA, Section Neurosciences, University of Florence, Viale Pieraccini 16, 50139 Florence, Italy.
| | - L Pastò
- Department NEUROFARBA, Section Neurosciences, University of Florence, Viale Pieraccini 16, 50139 Florence, Italy
| | - L Razzolini
- Department NEUROFARBA, Section Neurosciences, University of Florence, Viale Pieraccini 16, 50139 Florence, Italy
| | - R Fratangelo
- Department NEUROFARBA, Section Neurosciences, University of Florence, Viale Pieraccini 16, 50139 Florence, Italy
| | - E Prestipino
- Department NEUROFARBA, Section Neurosciences, University of Florence, Viale Pieraccini 16, 50139 Florence, Italy
| | - M Fonderico
- Department NEUROFARBA, Section Neurosciences, University of Florence, Viale Pieraccini 16, 50139 Florence, Italy
| | - L Tudisco
- Department NEUROFARBA, Section Neurosciences, University of Florence, Viale Pieraccini 16, 50139 Florence, Italy
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Viale Pieraccini 16, 50139 Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Italy
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18
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Castellazzi M, Ligi D, Contaldi E, Quartana D, Fonderico M, Borgatti L, Bellini T, Trentini A, Granieri E, Fainardi E, Mannello F, Pugliatti M. Multiplex Matrix Metalloproteinases Analysis in the Cerebrospinal Fluid Reveals Potential Specific Patterns in Multiple Sclerosis Patients. Front Neurol 2018; 9:1080. [PMID: 30619040 PMCID: PMC6305439 DOI: 10.3389/fneur.2018.01080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/27/2018] [Indexed: 02/02/2023] Open
Abstract
Background: Matrix metalloproteinases (MMPs) are pleiotropic enzymes involved in extracellular protein degradation and turnover. MMPs are implicated in the pathogenesis of many neurological diseases, including multiple sclerosis (MS). Objective: To search the level of MMPs in the cerebrospinal fluid (CSF) of MS patients and detect possible disease-specific patterns. Methods: CSF samples from 32 MS patients and, from 15 control subjects with other inflammatory neurological diseases (OIND) were analyzed. The Bio-Plex Pro Human MMP 9-Plex Panel (Bio-Rad) was used for the quantification of MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-10, MMP-12, and MMP-13. Results: CSF MMP-1 and MMP-12 levels were significantly reduced in MS as compared with OIND. In MS patients' CSF: (i) MMP-1 levels were significantly higher in women vs. men; (ii) MMP-10 concentrations were higher in patients with CSF-restricted IgG oligoclonal bands, and (iii) MMP-7 levels were increased in patients with longer disease duration. In the OIND group MMP-7 and MMP-12 levels significantly and directly correlated with age. Conclusions: Our study contributes to investigating the role of MMPs in MS, with regard to CSF immunological features and disease duration. Sex-specific differences were also detected in MMPs CSF levels.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
| | - Daniela Ligi
- Department of Biomolecular Sciences, University "Carlo Bo" of Urbino, Urbino, Italy
| | - Elena Contaldi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Davide Quartana
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Luca Borgatti
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Tiziana Bellini
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy.,University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Alessandro Trentini
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Enrico Granieri
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Enrico Fainardi
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy.,Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Ferdinando Mannello
- Department of Biomolecular Sciences, University "Carlo Bo" of Urbino, Urbino, Italy
| | - Maura Pugliatti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
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19
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Fonderico M, Laudisi M, Andreasi NG, Bigoni S, Lamperti C, Panteghini C, Garavaglia B, Carecchio M, Emanuele EA, Forni GL, Granieri E. Patient Affected by Beta-Propeller Protein-Associated Neurodegeneration: A Therapeutic Attempt with Iron Chelation Therapy. Front Neurol 2017; 8:385. [PMID: 28878728 PMCID: PMC5573443 DOI: 10.3389/fneur.2017.00385] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/20/2017] [Indexed: 11/13/2022] Open
Abstract
Here, we report the case of a 36-year-old patient with a diagnosis of de novo mutation of the WDR45 gene, responsible for beta-propeller protein-associated neurodegeneration, a phenotypically distinct, X-linked dominant form of Neurodegeneration with Brain Iron Accumulation. The clinical history is characterized by a relatively stable intellectual disability and a hypo-bradykinetic and hypertonic syndrome with juvenile onset. Genetic investigations and T1 and T2-weighted MR images align with what is described in literature. The patient was also subjected to PET with 18-FDG investigation and DaT-Scan study. In reporting relevant clinical data, we want to emphasize the fact that the patient received a chelation therapy with deferiprone (treatment already used in other forms of NBIA with encouraging results), which, however, had to be interrupted because the parkinsonian symptoms worsened. Conversely, the patient has benefited from non-drug therapies and, in particular, from an adapted motor activity with assisted pedaling (method in the process of validation in treatments of parkinsonian syndromes), which started before the treatment with deferiprone and still continues.
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Affiliation(s)
- Mattia Fonderico
- Department of Biomedical and Specialistic Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, Ferrara University, Ferrara, Italy
| | - Michele Laudisi
- Department of Biomedical and Specialistic Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, Ferrara University, Ferrara, Italy
| | - Nico Golfrè Andreasi
- Department of Biomedical and Specialistic Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, Ferrara University, Ferrara, Italy
| | - Stefania Bigoni
- Department of Medical Sciences, Section of Medical Genetics, Ferrara University, Ferrara, Italy
| | - Costanza Lamperti
- Unit of Molecular Neurogenetics, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Celeste Panteghini
- Unit of Molecular Neurogenetics, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Barbara Garavaglia
- Unit of Molecular Neurogenetics, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Miryam Carecchio
- Department of Clinical Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elia Antonio Emanuele
- Department of Clinical Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gian L Forni
- Centro della Microcitemia e Anemie Congenite-Haematology, Galliera Hospital, Genoa, Italy
| | - Enrico Granieri
- Department of Biomedical and Specialistic Surgical Sciences, Section of Neurological, Psychiatric and Psychological Sciences, Ferrara University, Ferrara, Italy
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