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Bianchi A, Matranga D, Patti F, Maniscalco L, Pilotto S, Di Filippo M, Zaffaroni M, Annovazzi P, Bertolotto A, Gasperini C, Quartuccio E, Centonze D, Fantozzi R, Gajofatto A, Gobbin F, Landi D, Granella F, Buccafusca M, Marfia GA, Chisari C, Naldi P, Bergamaschi R, Greco G, Zarbo IR, Rizzo V, Ulivelli M, Bezzini D, Florio L, Turazzini M, Di Gregorio M, Pugliatti M, Salemi G, Ragonese P. The role of ethnicity and native-country income in multiple sclerosis: the Italian multicentre study (MS-MigIT). J Neurol 2024; 271:2182-2194. [PMID: 38366072 PMCID: PMC11055772 DOI: 10.1007/s00415-024-12214-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a complex disorder in which environmental and genetic factors interact modifying disease risk and course. This multicentre, case-control study involving 18 Italian MS Centres investigated MS course by ethnicity and native-country economic status in foreign-born patients living in Italy. METHODS We identified 457 MS patients who migrated to Italy and 893 age- and sex-matched native-born Italian patients. In our population, 1225 (93.2%) subjects were White Europeans and White Northern Americans (WENA) and 89 (6.8%) patients were from other ethnical groups (OEG); 1109 (82.1%) patients were born in a high-income (HI) Country and 241 (17.9%) in a low-middle-income (LMI) Country. Medical records and patients interviews were used to collect demographic and disease data. RESULTS We included 1350 individuals (973 women and 377 men); mean (SD) age was 45.0 (11.7) years. At onset, 25.45% OEG patients vs 12.47% WENA (p = 0.039) had > 3 STIR spine lesions. At recruitment, the same group featured mean (SD) EDSS score of 2.85 (2.23) vs 2.64 (2.28) (p = 0.044) reached in 8.9 (9.0) vs 12.0 (9.0) years (p = 0.018) and underwent 1.10 (4.44) vs. 0.99 (0.40) annual MRI examinations (p = 0.035). At disease onset, patients from LMI countries had higher EDSS score than HI patients (2.40 (1.43) vs 1.99 (1.17); p = 0.032). DISCUSSION Our results suggested that both ethnicity and socio-economic status of native country shape MS presentation and course and should be considered for an appropriate management of patients. To the best of our knowledge, this is the first study reporting on the impact of ethnicity in MS at an individual level and beyond an ecological population-perspective.
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Affiliation(s)
- Alessia Bianchi
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, University College London, London, UK
| | - Domenica Matranga
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Laura Maniscalco
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Silvy Pilotto
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Centre, Hospital of Gallarate, ASST Della Valle Olona, Gallarate, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Centre, Hospital of Gallarate, ASST Della Valle Olona, Gallarate, Italy
| | - Antonio Bertolotto
- Ospedale Koelliker, Turin and Neuroscience Institute Cavalieri Ottolenghi, Orbassano, Italy
| | - Claudio Gasperini
- Department of Neurology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Diego Centonze
- Unit of Neurology, Department of Neurorehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Roberta Fantozzi
- Unit of Neurology, Department of Neurorehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Gobbin
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Doriana Landi
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Multiple Sclerosis Clinical and Research Unit, Tor Vergata University Hospital, Rome, Italy
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Buccafusca
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, Messina, Italy
| | - Girolama Alessandra Marfia
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Multiple Sclerosis Clinical and Research Unit, Tor Vergata University Hospital, Rome, Italy
| | - Clara Chisari
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Paola Naldi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | | | | | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, Messina, Italy
| | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Daiana Bezzini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Lucia Florio
- IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Maria Di Gregorio
- Azienda Ospedaliera Universitaria OO.RR. S.Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.
- Interdepartmental Research Centre On Migration (CIR "Migrare"), University of Palermo, Palermo, Italy.
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Altieri M, Capuano R, Bisecco A, d'Ambrosio A, Risi M, Cavalla P, Vercellino M, Annovazzi P, Zaffaroni M, De Stefano N, Stromillo ML, D'Amico E, Zanghì A, Buscarinu MC, Lanzillo R, De Luca G, Calabrese M, Lorefice L, Di Filippo M, Valentino P, Gajofatto A, Marfia GA, Fuiani A, Nociti V, Tedeschi G, Gallo A. Quality of care provided by Multiple Sclerosis Centers during Covid-19 pandemic: Results of an Italian multicenter patient-centered survey. Mult Scler Relat Disord 2023; 77:104870. [PMID: 37454568 DOI: 10.1016/j.msard.2023.104870] [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: 11/16/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Covid-19 pandemic impacted on management of people with Multiple Sclerosis (pwMS). Level of satisfaction of pwMS regarding the care received by the staff of Multiple Sclerosis Centers (MSCs) during the pandemic was not fully investigated. In a large patient-centered multicenter study, the therapeutic adherence and quality of care of MSCs was assessed. METHODS In April-May 2021, an online survey was widespread by 16 Italian MSCs. Frequencies, percentages and/or means and standard deviations were calculated to describe the sample. ANOVAs were performed to evaluate the effect of sociodemographic and clinical variables on overall pwMS' rating of MSC assistance. RESULTS 1670 pwMS completed the survey (67.3% women). During the pandemic, 88% did not change their disease modifying therapy schedule, and 89.1% reached their MSCs with no or little difficulties. Even if only 1.3% of participants underwent a tele-health follow-up visit with their MSC staff, the 80.1% believed that tele-health services should be improved regardless of pandemic. 92% of participants were satisfied of how their MSC took charge of their needs; ANOVAs revealed an effect of disease duration on pwMS' level of satisfaction on MSCs management during the pandemic. CONCLUSIONS The results revealed an efficient MSCs response to Covid-19 pandemic and provided the basis for the implementing of tele-health services that would further improve the taking charge of patients, particularly those with longer disease, higher disability, and/or living far from their MSC.
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Affiliation(s)
- Manuela Altieri
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Capuano
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alvino Bisecco
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro d'Ambrosio
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Risi
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cavalla
- Dept. of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Marco Vercellino
- Dept. of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
| | - Nicola De Stefano
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Emanuele D'Amico
- Multiple Sclerosis Center, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Aurora Zanghì
- Multiple Sclerosis Center, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Maria Chiara Buscarinu
- Dept. of Neuroscience, Mental Health and Sensory Organs, Sapienza University, S. Andrea Hospital-site, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Dept. of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Center, Policlinico SS. Annunziata, Chieti, Italy
| | - Massimiliano Calabrese
- Multiple Sclerosis Center, Dept. of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Center, Dept. of Medical Sciences and Public Health, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | | | - Paola Valentino
- Institute of Neurology, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alberto Gajofatto
- Multiple Sclerosis Center, Dept. of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | | | - Aurora Fuiani
- Dept. of Neuroscience, Riuniti Hospital of Foggia, Foggia, Italy
| | - Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gioacchino Tedeschi
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Gallo
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Patti F, Chisari CG, Toscano S, Annovazzi P, Banfi P, Bergamaschi R, Clerici R, Conti MZ, Cortese A, Fantozzi R, Ferraro D, Fischetti M, Frigo M, Gatto M, Immovilli P, Leoni S, Malucchi S, Maniscalco G, Marfia GA, Paolicelli D, Perini P, Serrati C, Totaro R, Turano G, Valentino P, Zaffaroni M, Zuliani C, Centonze D. Patients with multiple sclerosis choose a collaborative role in making treatment decision: results from the Italian multicenter SWITCH study. Mult Scler Relat Disord 2023; 70:104474. [PMID: 36584654 DOI: 10.1016/j.msard.2022.104474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clinicians are increasingly recognizing the importance of shared decision-making in complex treatment choices, highlighting the importance of the patient's rationale and motivation for switching therapies. This study aimed to evaluate the association between different modalities of changing multiple sclerosis (MS) treatments, cognitive profile and attitude and preferences of patients concerning treatment choice. METHODS This multicenter cross-sectional study was conducted at 28 Italian MS centers in the period between June 2016 and June 2017. We screened all MS patients treated with any DMT, with a treatment compliance of at least 80% of therapy administered during the 3 last months who needed to modify MS therapy because of efficacy, safety or other reasons during a follow-up visit. At the time of switching the symbol digit modalities test (SDMT) and the Control Preference Scale (CPS) were evaluated. According to the CPS, patients were classified as "active" (i.e. who prefer making the medical decision themselves), "collaborative" (i.e. who prefer decisions be made jointly with the physician), or "passive" (i.e. who prefer the physician make the decision). RESULTS Out of 13,657 patients recorded in the log, 409 (3%) changed therapy. Of these, 336 (2.5%) patients, 69.6% were female and with mean age 40.6 ± 10.5 years, were enrolled. According to the CPS score evaluation, a significant high percentage of patients (51.1%) were considered collaborative, 74 patients (22.5%) were passive, and 60 (18.2%) patients were active. Stratifying according to CPS results, we found a higher SDMT score among collaborative patients compared to active and passive ones (45.8 ± 12.3 versus 41.0 ± 13.2 versus 41.7 ± 12.8, p < 0.05). CONCLUSION In this study, the CPS evaluation showed that more than 50% of patients who needed to change therapy chose a "collaborative" role in making treatment decision. Cognitive profile with SDMT seems to correlate with patients' preference on treatment decision, showing better scores in collaborative patients.
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Affiliation(s)
- Francesco Patti
- Department "GF Ingrassia" Section of Neurosciences, University of Catania, via S. Sofia 78, Catania 95129, Italy.
| | - Clara Grazia Chisari
- Department "GF Ingrassia" Section of Neurosciences, University of Catania, Catania, Italy
| | - Simona Toscano
- Department "GF Ingrassia" Section of Neurosciences, University of Catania, via S. Sofia 78, Catania 95129, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center, Hospital of Gallarate - ASST della Valle Olona, Gallarate, Italy
| | - Paola Banfi
- Operative Unit of Neurology and Stroke Unit, Varese, Italy
| | | | | | | | - Antonio Cortese
- Department of Human Neurosciences, Sapienza, University of Rome, Italy
| | | | - Diana Ferraro
- Department of Neuroscience, UO of Neurology, AOU Policlinico OB, Modena, Italy
| | | | - Maura Frigo
- Neurology Department, San Gerardo Hospital, Monza, Italy
| | - Maurizia Gatto
- Department of Neurology, General Regional Hospital "Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Paolo Immovilli
- Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy
| | | | - Simona Malucchi
- SCDO Neurologia-CRESM, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy
| | | | - Girolama Alessandra Marfia
- Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, "Tor Vergata" University, Rome, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Perini
- Multiple Sclerosis Center, Neurological Clinic, University Hospital of Padua, Italy
| | - Carlo Serrati
- Operative Unit of Neurology and Stroke Unit, IRCCS Hospital San Martino, Genoa, Italy
| | - Rocco Totaro
- Department of Neurology, Demyelinating Disease Center, San Salvatore Hospital, L'Aquila, Italy
| | - Gabriella Turano
- Department of Neurology, Mondovì General Hospital, Local Health Authority CN1, Mondovì, Cuneo, Italy
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate - ASST della Valle Olona, Gallarate, Italy
| | | | - Diego Centonze
- Department "GF Ingrassia" Section of Neurosciences, University of Catania, Catania, Italy; Unit of Neurology - IRCCS Neuromed, Pozzilli, Isernia, Italy.
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4
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Nosadini M, Eyre M, Giacomini T, Valeriani M, Della Corte M, Praticò AD, Annovazzi P, Cordani R, Cordelli DM, Crichiutti G, Di Rosa G, Dolcemascolo V, Fetta A, Freri E, Gallo P, Gastaldi M, Granata T, Grazian L, Iorio R, Lombardini M, Margoni M, Mariotto S, Matricardi S, Melani F, Nardocci N, Papetti L, Passarini A, Pisani F, Po' C, Puthenparampil M, Ragona F, Savasta S, Siliquini S, Toldo I, Tozzo A, Turco EC, Varone A, Vogrig A, Zuliani L, Bugin S, Rossato S, Orsini A, Cantalupo G, Mancardi MM, Ferilli MAN, Foiadelli T, Sartori S. Early Immunotherapy and Longer Corticosteroid Treatment Are Associated With Lower Risk of Relapsing Disease Course in Pediatric MOGAD. Neurol Neuroimmunol Neuroinflamm 2022; 10:10/1/e200065. [PMID: 36446614 PMCID: PMC9709714 DOI: 10.1212/nxi.0000000000200065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND OBJECTIVES We sought to identify early factors associated with relapse and outcome in paediatric-onset myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD). METHODS In a multicenter retrospective cohort of pediatric MOGAD (≤18 years), onset features and treatment were compared in patients with monophasic vs relapsing disease (including cases with follow-up ≥12 months after onset or relapse at any time) and in patients with final Expanded Disability Status Scale (EDSS) 0 vs ≥1 at last follow-up (including cases with follow-up >3 months after last event or EDSS0 at any time). Multivariable logistic regression models were used to evaluate factors associated with relapsing disease course and EDSS ≥ 1 at final follow-up. RESULTS Seventy-five children were included (median onset age 7 years; median 30 months of follow-up). Presentation with acute disseminated encephalomyelitis was more frequent in children aged 8 years or younger (66.7%, 28/42) than in older patients (30.3%, 10/33) (p = 0.002), whereas presentation with optic neuritis was more common in children older than 8 years (57.6%, 19/33) than in younger patients (21.4%, 9/42) (p = 0.001). 40.0% (26/65) of patients relapsed. Time to first relapse was longer in children aged 8 years or younger than in older patients (median 18 vs 4 months) (p = 0.013). Factors at first event independently associated with lower risk of relapsing disease course were immunotherapy <7 days from onset (6.7-fold reduced odds of relapsing course, OR 0.15, 95% CI 0.03-0.61, p = 0.009), corticosteroid treatment for ≥5 weeks (6.7-fold reduced odds of relapse, OR 0.15, 95% CI 0.03-0.80, p = 0.026), and abnormal optic nerves on onset MRI (12.5-fold reduced odds of relapse, OR 0.08, 95% CI 0.01-0.50, p = 0.007). 21.1% (15/71) had EDSS ≥ 1 at final follow-up. Patients with a relapsing course had a higher proportion of final EDSS ≥ 1 (37.5%, 9/24) than children with monophasic disease (12.8%, 5/39) (p = 0.022, univariate analysis). Each 1-point increment in worst EDSS at onset was independently associated with 6.7-fold increased odds of final EDSS ≥ 1 (OR 6.65, 95% CI 1.33-33.26, p = 0.021). DISCUSSION At first attack of pediatric MOGAD, early immunotherapy, longer duration of corticosteroid treatment, and abnormal optic nerves on MRI seem associated with lower risk of relapse, whereas higher disease severity is associated with greater risk of final disability (EDSS ≥ 1).
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Affiliation(s)
- Margherita Nosadini
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy.
| | - Michael Eyre
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Thea Giacomini
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Massimiliano Valeriani
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Marida Della Corte
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Andrea D Praticò
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Pietro Annovazzi
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Ramona Cordani
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Duccio Maria Cordelli
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Giovanni Crichiutti
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Gabriella Di Rosa
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Valentina Dolcemascolo
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Anna Fetta
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Elena Freri
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Paolo Gallo
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Matteo Gastaldi
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Tiziana Granata
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Luisa Grazian
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Raffaele Iorio
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Martina Lombardini
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Monica Margoni
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Sara Mariotto
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Sara Matricardi
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Federico Melani
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Nardo Nardocci
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Laura Papetti
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Alice Passarini
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Francesco Pisani
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Chiara Po'
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Marco Puthenparampil
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Francesca Ragona
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Salvatore Savasta
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Sabrina Siliquini
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Irene Toldo
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Alessandra Tozzo
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Emanuela Claudia Turco
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Antonio Varone
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Alberto Vogrig
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Luigi Zuliani
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Samuela Bugin
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Sara Rossato
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Alessandro Orsini
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Gaetano Cantalupo
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Maria Margherita Mancardi
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Michela Ada Noris Ferilli
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Thomas Foiadelli
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
| | - Stefano Sartori
- From the Paediatric Neurology and Neurophysiology Unit (M.N., I.T., Stefano Sartori), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., L.Z., Stefano Sartori), Paediatric Research Institute "Città della Speranza," Padova, Italy; School of Biomedical Engineering and Imaging Sciences (M.E.), King's College London, United Kingdom; Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Unit of Child Neuropsychiatry (Thea Giacomini, R.C., M.M.M.), Clinical and Surgical Neurosciences Department, IRCCS Giannina Gaslini Institute, Genoa, Genoa, Liguria, Italy; Neuroscience Department (M.V., L.P., M.A.N.F.), Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Neurosciences (M.D.C., Antonio Varone), Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy; Unit of Rare Diseases of the Nervous System in Childhood (A.D.P.), Department of Clinical and Experimental Medicine, University of Catania, Italy; Multiple Sclerosis Center (P.A.), ASST della Valle Olona, Hospital of Gallarate, Italy; Child Neurology and Psychiatry Unit (D.M.C., A.F.), Department of Medical and Surgical Sciences (DIMEC), SOrsola Hospital, University of Bologna, Italy; Division of Pediatrics (Giovanni Crichiutti, V.D.), Department of Medicine, University Hospital of Udine, Italy; Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi," University of Messina, Italy; Department of Pediatric Neuroscience (E.F., T.G.., N.N., F.R., A.T.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; GALLO Multiple Sclerosis Centre (P.G., M.M., M.P.), Neurology Clinic, Department of Neuroscience, Università degli Studi di Padova, Italy; Neuroimmunology Laboratory (M.G.), IRCCS Mondino Foundation, Pavia, Italy; Unit of Pediatrics (L.G., C.P.), ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy; Institute of Neurology (R.I.), Fondazione Policlinico Universitario "AGemelli" IRCCS, Rome, Italy; Child Neurology Unit and Laboratories (M.L., F.M.), Neuroscience Department, Meyer Children's University Hospital, Florence, Italy; Neurology Unit (Sara Mariotto), Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Policlinico GB Rossi, Italy; Child Neurology and Psychiatry Unit (Sara Matricardi, Sabrina Siliquini), "GSalesi" Children's Hospital, Ospedali Riuniti Ancona, Italy; Child Neuropsychiatry Unit (A.P.), ASST Grande Ospedale Metropolitano Niguarda, Milano; Child Neuropsychiatry Unit (F.P., E.C.T.), Department of Medicine and Surgery, University of Parma, Italy; Pediatric Clinic (Salvatore Savasta, T.F.), Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Clinical Neurology (Alberto Vogrig), Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy; Department of Neurology (L.Z.), Ospedale San Bortolo, Vicenza, Italy; U.O.CPediatria (S.B., S.R.), Ospedale San Bortolo, Vicenza, Italy; Pediatric Neurology (A.O.), Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; Child Neuropsychiatry (Gaetano Cantalupo), Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Italy; and Department of Neuroscience (Stefano Sartori), University of Padova, Italy
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5
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Schiavetti I, Cordioli C, Stromillo ML, Teresa Ferrò M, Laroni A, Cocco E, Cola G, Pasquali L, Rilla MT, Signoriello E, Iodice R, Di Sapio A, Lanzillo R, Caleri F, Annovazzi P, Conte A, Liberatore G, Ruscica F, Docimo R, Bonavita S, Ulivelli M, Cavalla P, Patti F, Ferraro D, Clerico M, Immovilli P, Di Filippo M, Salvetti M, Sormani MP. Breakthrough SARS-CoV-2 infections in MS patients on disease-modifying therapies. Mult Scler 2022; 28:2106-2111. [PMID: 35735030 DOI: 10.1177/13524585221102918] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 11/15/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (pwMS) treated with anti-CD20 or fingolimod showed a reduced humoral response to SARS-CoV-2 vaccines. OBJECTIVE In this study we aimed to monitor the risk of breakthrough SARS-CoV-2 infection in pwMS on different disease-modifying therapies (DMTs). METHODS Data on the number of vaccinated patients and the number of patients with a breakthrough infection were retrospectively collected in 27 Italian MS centers. We estimated the rate of breakthrough infections and of infection requiring hospitalization per DMT. RESULTS 19,641 vaccinated pwMS were included in the database. After a median follow-up of 8 months, we observed 137 breakthrough infections. Compared with other DMTs, the rate of breakthrough infections was significantly higher on ocrelizumab (0.57% vs 2.00%, risk ratio (RR) = 3.55, 95% CI = 2.74-4.58, p < 0.001) and fingolimod (0.58% vs 1.62%, RR = 2.65, 95% CI = 1.75-4.00, p < 0.001), while there were no significant differences in any other DMT group. In the ocrelizumab group the hospitalization rate was 16.7% versus 19.4% in the pre-vaccination era (RR = 0.86, p = 0.74) and it was 3.9% in all the other DMT groups versus 11.9% in the pre-vaccination period (RR = 0.33, p = 0.02). CONCLUSIONS The risk of breakthrough SARS-CoV-2 infections is higher in patients treated with ocrelizumab and fingolimod, and the rate of severe infections was significantly reduced in all the DMTs excluding ocrelizumab.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Maria Laura Stromillo
- Clinica Neurologica e Malattie Neurometaboliche, Università degli Studi di Siena, Siena, Italy
| | - Maria Teresa Ferrò
- Neuroimmunology, Center for Multiple Sclerosis, Cardiocerebrovascular Department, Neurological Unit, ASST Crema, Crema, Italy
| | - Alice Laroni
- IRCCS Ospedale Policlinico San Martino, Genova, Italy/Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | - Gaia Cola
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Livia Pasquali
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | | | | | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Alessia Di Sapio
- Department of Neurology, Regina Montis Regalis Hospital, Mondovì, Italy
| | | | - Francesca Caleri
- Department of Neurology, MS Center, F. Tappeiner Hospital, Merano, Italy
| | - Pietro Annovazzi
- UOC Centro Sclerosi Multipla, ASST Valle-Olona, PO di Gallarate (VA), Varese, Italy
| | - Antonella Conte
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesca Ruscica
- UOC Neurologia e Centro SM Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Renato Docimo
- Multiple Sclerosis Center, Aversa Hospital "San Giuseppe Moscati", ASL Caserta, Aversa, Italy
| | - Simona Bonavita
- Dipartimento di Scienze Mediche e Chirurgiche avanzate, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Monica Ulivelli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Paola Cavalla
- Multiple Sclerosis Center and 1st Division of Neurology, Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | | | - Massimiliano Di Filippo
- Department of Medicine and Surgery, Section of Neurology, University of Perugia, Perugia, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
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6
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Mirabella M, Annovazzi P, Brownlee W, Cohen JA, Kleinschnitz C, Wolf C. Treatment Challenges in Multiple Sclerosis – A Continued Role for Glatiramer Acetate? Front Neurol 2022; 13:844873. [PMID: 35493825 PMCID: PMC9051342 DOI: 10.3389/fneur.2022.844873] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
Earlier diagnosis, access to disease-modifying therapies (DMTs), and improved supportive care have favorably altered the disease course of multiple sclerosis (MS), leading to an improvement in long-term outcomes for people with MS (PwMS). This success has changed the medical characteristics of the population seen in MS clinics. Comorbidities and the accompanying polypharmacy, immune senescence, and the growing number of approved DMTs make selecting the optimal agent for an individual patient more challenging. Glatiramer acetate (GA), a moderately effective DMT, interacts only minimally with comorbidities, other medications, or immune senescence. We describe here several populations in which GA may represent a useful treatment option to overcome challenges due to advanced age or comorbidities (e.g., hepatic or renal disease, cancer). Further, we weigh GA's potential merits in other settings where PwMS and their neurologists must base treatment decisions on factors other than selecting the most effective DMT, e.g., family planning, conception and pregnancy, or the need for vaccination.
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Affiliation(s)
- Massimiliano Mirabella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica, Rome, Italy
- *Correspondence: Massimiliano Mirabella ; orcid.org/0000-0002-7783-114X
| | - Pietro Annovazzi
- MS Center, ASST Valle Olona, Gallarate Hospital, Gallarate, Italy
| | - Wallace Brownlee
- Queen Square MS Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jeffrey A. Cohen
- Department of Neurology, Mellen Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States
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7
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Buonomo AR, Viceconte G, Calabrese M, De Luca G, Tomassini V, Cavalla P, Maniscalco GT, Ferraro D, Nociti V, Radaelli M, Buscarinu MC, Paolicelli D, Gajofatto A, Annovazzi P, Pinardi F, Di Filippo M, Cordioli C, Zappulo E, Scotto R, Gentile I, Spiezia AL, Petruzzo M, De Angelis M, Morra VB, Solaro C, Gasperini C, Cocco E, Moccia M, Lanzillo R. Correction to: Management of hepatitis B virus prophylaxis in patients treated with disease-modifying therapies for multiple sclerosis: a multicentric Italian retrospective study. J Neurol 2022; 269:3308-3309. [PMID: 35377015 PMCID: PMC9119876 DOI: 10.1007/s00415-022-11066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy.
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement, The Multiple Sclerosis Center of the University Hospital of Verona, Verona, Italy
| | - Giovanna De Luca
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Paola Cavalla
- Department of Neuroscience and Mental Health-City of Health and Science University, Hospital of Torino, Multiple Sclerosis Center, Turin, Italy
| | | | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Chiara Buscarinu
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, S. Andrea Hospital Site, Rome, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement, The Multiple Sclerosis Center of the University Hospital of Verona, Verona, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona-Gallarate Hospital, Gallarate, VA, Italy
| | | | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Montichiari Hospital, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy
| | - Antonio Luca Spiezia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Martina Petruzzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Marcello De Angelis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Claudio Gasperini
- Department of Neuroscience, San-Camillo Forlanini Hospital, Rome, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, Azienda Tutela Della Salute (ATS) Sardegna, Cagliari, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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8
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Di Filippo M, Cordioli C, Malucchi S, Annovazzi P, Cavalla P, Torri Clerici V, Ragonese P, Nociti V, Radaelli M, Laroni A, Buttari F, Lorefice L, Ferraro D, Gajofatto A, Prosperini L, Fantozzi R, Boffa L, Lanzillo R, Moccia M, Clerico M, De Luca G, Tomassini V, Calabrese M, Borrelli A, Paolicelli D, Maniscalco GT, Gazzola P, Gallo A, Solaro C, Cocco E, Gasperini C, Tortorella C. mRNA COVID-19 vaccines do not increase the short-term risk of clinical relapses in multiple sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:448-450. [PMID: 34408003 DOI: 10.1136/jnnp-2021-327200] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, University of Perugia, Perugia, Umbria, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Ospedale di Montichiari, Brescia, Italy
| | - Simona Malucchi
- A.O.U. Centro Sclerosi Multipla, San Luigi Gonzaga, Orbassano, Italy
| | - Pietro Annovazzi
- U.O.C. Centro Sclerosi Multipla, ASST Valle Olona, Gallarate, Italy
| | - Paola Cavalla
- Centro Sclerosi Multipla e Neurologia 1 D.U, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Valentina Torri Clerici
- Centro Sclerosi Multipla, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Dipartimento di Neuroimmunologia e Malattie Neuromuscolari, Milan, Italy
| | - Paolo Ragonese
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marta Radaelli
- UOC di Neurologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alice Laroni
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Maternità e Infanzia Università di Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Buttari
- Unità di Neurologia, IRCCS Neuromed, Pozzilli, Italy
| | - Lorena Lorefice
- Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Diana Ferraro
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Luca Prosperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | | | - Laura Boffa
- UOC Neurologia, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Roberta Lanzillo
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi Federico II, Naples, Italy
| | - Marcello Moccia
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi Federico II, Naples, Italy
| | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche dell'Università di Torino, AOU San Luigi Gonzaga di Orbassano, Orbassano, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Ospedale Universitario SS Annunziata, Chieti, Italy
| | - Valentina Tomassini
- Centro Sclerosi Multipla, Clinica Neurologica, Ospedale Universitario SS Annunziata, Chieti, Italy.,Istituto di Tecnologie Avanzate Biomediche (ITAB), Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, Facolta' di Medicina e Chirurgia, Universita' di Chieti-Pescara "G. d'Annunzio", Chieti, Italy
| | | | - Angela Borrelli
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | - Damiano Paolicelli
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giorgia Teresa Maniscalco
- Ospedale "A. Cardarelli", Dipartimento Emergenza Accettazione, Neurologia, Centro Regionale per la Sclerosi Multipla, Naples, Italy
| | - Paola Gazzola
- Centro Dipartimentale diagnosi e cura delle malattie demielinizzanti, Dipartimento Testa Collo, ASL3 Ospedale P.A. Micone, Genova, Italy
| | - Antonio Gallo
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Claudio Solaro
- Unità di Neuroriabilitazione, Ospedale Mons. L. Novarese, Moncrivello, Italy
| | - Eleonora Cocco
- Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
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9
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Portaccio E, Pastò L, Razzolini L, Moiola L, Martinelli V, Annovazzi P, Ghezzi A, Zaffaroni M, Lanzillo R, Brescia Morra V, Rinaldi F, Gallo P, Gasperini C, Paolicelli D, Simone M, Pozzilli C, De Giglio L, Cavalla P, Cocco E, Marrosu MG, Patti F, Solaro C, Comi G, Filippi M, Trojano M, Amato MP. Natalizumab treatment and pregnancy in multiple sclerosis: A reappraisal of maternal and infant outcomes after 6 years. Mult Scler 2022; 28:2137-2141. [PMID: 35296189 DOI: 10.1177/13524585221079598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the impact of timing of natalizumab cessation/redosing on long-term maternal and infant outcomes in 72 out of the original 74 pregnancies of the Italian Pregnancy Dataset in multiple sclerosis (MS). METHODS Maternal outcomes in patients who received natalizumab until conception and restarted the drug within 1 month after delivery ("treatment approach," (TA)) and patients who stopped natalizumab before conception and/or restarted the drug later than 1 month after delivery ("conservative approach," (CA)) were compared through multivariable Cox regression analyses. Pediatric outcomes were assessed through a semi-structured questionnaire. RESULTS After a mean follow-up of 6.1 years, CA (hazard ratio (HR) = 4.1, 95% CI 1.6-10.6, p = 0.003) was the only predictor of relapse occurrence. Worsening on the Expanded Disability Status Scale (EDSS) was associated with higher annualized relapse-rate during the follow-up (HR = 3.3, 95% CI 1.4-7.9 p = 0.007). We found no major development abnormalities in children. DISCUSSION Our data confirm that TA reduces the risk of disease activity; we did not observe an increase in major development abnormalities in the child.
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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
| | - Luisa Pastò
- Division Neurological Rehabilitation, Careggi University Hospital, Florence, Italy
| | - Lorenzo Razzolini
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, 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
| | - Pietro Annovazzi
- Dipartimento di Scienze della Salute, Università del Piemonte Orientale, Novara, Italy
| | - Angelo Ghezzi
- Dipartimento di Scienze della Salute, Università del Piemonte Orientale, Novara, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST Valle Olona, Gallarate Hospital (VA), Gallarate, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Francesca Rinaldi
- Department of Neurosciences, Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova, Padova, Italy
| | - Paolo Gallo
- Department of Neurosciences, Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova, Padova, Italy
| | - Claudio Gasperini
- Department of Neurology, San Camillo Forlanini Hospital, Rome, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Marta Simone
- Child and Adolescence Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University Aldo Moro Bari, Bari, 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
| | - Paola Cavalla
- Neurology Unit 1 and MS Center, City of Health and Science University Hospital, Torino, Italy
| | - Eleonora Cocco
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Giovanna Marrosu
- Dipartimento di Scienze Mediche e Chirurgiche, e Tecnologie Avanzate, GF Ingrassia Università di Catania, Catania, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche, e Tecnologie Avanzate, GF Ingrassia Università di Catania, Catania, Italy/Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Claudio Solaro
- Department of Rehabilitation, "Mons. Luigi Novarese" Hospital, Moncrivello, Italy
| | - Giancarlo Comi
- Multiple Sclerosis Center, ASST Valle Olona, Gallarate Hospital (VA), Gallarate, 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/Neurorehabilitation Unit and Neurophysiology Service, 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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10
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Martinelli V, Albanese M, Altieri M, Annovazzi P, Arabi S, Bucello S, Caleri F, Cerqua R, Costanzi C, Cottone S, Dalla Costa G, Direnzo V, Fantozzi R, Favaretto A, Lorefice L, Montini F, Noce A, Plewnia K, Repice AM, Sacco R, Vecchio D. Gut-oriented interventions in patients with multiple sclerosis: fact or fiction? Eur Rev Med Pharmacol Sci 2022; 26:935-946. [PMID: 35179760 DOI: 10.26355/eurrev_202202_28003] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, disimmune disease of the central nervous system whose etiology and pathogenesis remain poorly understood, due to its complex and multifactorial nature. Evidence of a bidirectional connection linking the gut microbiome with the intestinal barrier and the immune system (the gut-brain axis) may have implications for the pathogenesis of inflammatory demyelinating diseases such as MS. This narrative review summarizes the evidence for the gut-brain axis involvement in the pathogenesis of MS and examines the role of gut-oriented interventions in MS. PATIENTS AND METHODS We reviewed all available studies in PubMed concerning gut-directed interventions and MS. This research was conducted using different combinations of pertinent keywords (multiple sclerosis, immune-mediated inflammatory diseases, autoimmune diseases, first demyelinating event, neurocognition, neurological disorders, neurology practice, risk factors, taxonomic biomarkers, nutrition, diet, dietary additives, complementary treatment, gut bacteria, gut microbiome, microbiome, gut-brain axis, epidemiology, alpha-linolenic acid, fermentative metabolites, fat, saturated fat, monounsaturated fat, polyunsaturated fat, omega-3 fatty acids, calorie restricted diet, fasting, fecal microbiome, fecal microbiota transplantation, animal testing). RESULTS There is an emerging evidence that alterations in the gut microbiome and increased intestinal permeability may be causative factors in the complex interplay between nutrition, metabolic status and the immune-inflammatory response in patients with MS. This suggests the possibility that modification of lifestyle and the microbiome, for example by specific diets or fecal microbiota transplantation, supplementation with bile acids and intestinal barrier enhancers, may positively influence the pathogenesis of MS. CONCLUSIONS Although the role of nutritional factors in the pathogenesis of MS remains to be established, there is evidence that appropriate gut-directed interventions such as diet, nutritional supplementation or fecal transplantation may modulate the inflammatory response and improve the course of MS as a complementary treatment in the disease.
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Affiliation(s)
- V Martinelli
- Neurology Unit, Department of Neurology, MS Center, Ospedale San Raffaele, Milan, Italy.
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11
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Moiola L, Zanetta C, Di Cristinzi M, Nozzolillo A, Rinaldi F, Brambilla L, Annovazzi P, Lus G, Puorro G, Frau J, Malucchi S, Bianco A, Lapucci C, Marfia G, Gallo A, Cerqua R, Cavalla P, Filippi M. Italian multicenter observational study on real-life experience with alemtuzumab in naïve patients with aggressive multiple sclerosis. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118109] [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: 12/01/2022]
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12
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Russo CV, Saccà F, Frau J, Annovazzi P, Signoriello E, Bonavita S, Grasso R, Clerico M, Cordioli C, Laroni A, Capobianco M, Torri Clerici V, Sartori A, Cavalla P, Maniscalco GT, La Gioia S, Caleri F, Giugno A, Iodice R, Carotenuto A, Cocco E, Fenu G, Zaffaroni M, Baroncini D, Lus G, Gallo A, De Mercanti SF, Lapucci C, Di Francescantonio V, Brambilla L, Sormani MP, Signori A. A real-world study of alemtuzumab in a cohort of Italian patients. Eur J Neurol 2021; 29:257-266. [PMID: 34558755 PMCID: PMC9293282 DOI: 10.1111/ene.15121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 01/02/2023]
Abstract
Background and purpose Real‐world data on alemtuzumab are limited and do not provide evidence of its effectiveness after various disease‐modifying therapies (DMTs). Our aim was to provide real‐world data on the impact of clinical variables and previous DMTs on clinical response to alemtuzumab. Methods Sixteen Italian multiple sclerosis centers retrospectively included patients who started alemtuzumab from January 2015 to December 2018, and recorded demographics, previous therapies, washout duration, relapses, Expanded Disability Status Scale (EDSS) score, and magnetic resonance imaging data. Negative binomial regression models were used to assess the effect of factors on annualized relapse (ARR) after alemtuzumab initiation. Results We studied 322 patients (mean age 36.8 years, median EDSS score 3, median follow‐up 1.94 years). Previous treatments were: fingolimod (106), natalizumab (80), first‐line oral agents (56), first‐line injectables (interferon/glatiramer acetate; 30), and other drugs (15). Thirty‐five patients were treatment‐naïve. The pre‐alemtuzumab ARR was 0.99 and decreased to 0.13 during alemtuzumab treatment (p < 0.001). The number of previous‐year relapses was associated with alemtuzumab ARR (adjusted risk ratio [RR] 1.38, p = 0.009). Progression‐free survival was 94.5% after 1 year, and 89.2% after 2 years of alemtuzumab treatment. EDSS score improvement occurred in 13.5% after 1 year, and 20.6% after 2 years. Re‐baselining patients after 6 months of alemtuzumab treatment, led to no evidence of disease activity status in 71.6% after 1 year and 58.9% after 2 years. Conclusions Alemtuzumab decreases ARR independent of previous therapy, including patients with disease activity during natalizumab treatment. Overall, 90% of patients showed no disease progression, and 20% an improvement after 2 years of alemtuzumab.
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Affiliation(s)
| | - Francesco Saccà
- NSRO Department, University of Naples Federico II, Napoli, Italy
| | - Jessica Frau
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center, ASST della Valle Olona, Hospital of Gallarate, Gallarate, Italy
| | | | | | | | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche, University of Torino, Torino, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari Hospital, Montichiari, Italy
| | - Alice Laroni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR) and IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Marco Capobianco
- SC Neurologia e Centro di Riferimento Regionale SM - AOU S. Luigi, Orbassano, Torino, Italy
| | - Valentina Torri Clerici
- Neuro-Immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milano, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, ASUGI, University of Trieste, Trieste, Italy
| | - Paola Cavalla
- MS Center, City of Health & Science University Hospital, Torino, Italy
| | | | - Sara La Gioia
- Centro Sclerosi Multipla, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Caleri
- Neurology Department, F. Tappeiner Hospital Meran (BZ) of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Alessia Giugno
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rosa Iodice
- NSRO Department, University of Naples Federico II, Napoli, Italy
| | | | - Eleonora Cocco
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST della Valle Olona, Hospital of Gallarate, Gallarate, Italy
| | - Damiano Baroncini
- Multiple Sclerosis Center, ASST della Valle Olona, Hospital of Gallarate, Gallarate, Italy
| | - Giacomo Lus
- University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Antonio Gallo
- University of Campania "Luigi Vanvitelli", Napoli, Italy
| | | | - Caterina Lapucci
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR) and IRCCS San Martino-IST, University of Genova, Genova, Italy
| | | | - Laura Brambilla
- Neuro-Immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milano, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
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13
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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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14
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Di Gregorio M, Torri Clerici VLA, Fenu G, Gaetani L, Gallo A, Cavalla P, Ragonese P, Annovazzi P, Gajofatto A, Prosperini L, Landi D, Nicoletti CG, Di Carmine C, Totaro R, Nociti V, De Fino C, Ferraro D, Tomassini V, Tortorella C, Righini I, Amato MP, Manni A, Paolicelli D, Iaffaldano P, Lanzillo R, Moccia M, Buttari F, Fantozzi R, Cerqua R, Zagaglia S, Farina D, De Luca G, Buscarinu MC, Pinardi F, Cocco E, Gasperini C, Solaro CM, Di Filippo M. Defining the course of tumefactive multiple sclerosis: A large retrospective multicentre study. Eur J Neurol 2021; 28:1299-1307. [PMID: 33305459 DOI: 10.1111/ene.14672] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Tumefactive multiple sclerosis (TuMS) (i.e., MS onset presenting with tumefactive demyelinating lesions [TDLs]) is a diagnostic and therapeutic challenge. We performed a multicentre retrospective study to describe the clinical characteristics and the prognostic factors of TuMS. METHODS One hundred two TuMS patients were included in this retrospective study. Demographic, clinical, magnetic resonance imaging (MRI), laboratory data and treatment choices were collected. RESULTS TuMS was found to affect women more than men (female:male: 2.4), with a young adulthood onset (median age: 29.5 years, range: 11-68 years, interquartile range [IQR]: 38 years). At onset, 52% of TuMS patients presented with the involvement of more than one functional system and 24.5% of them with multiple TDLs. TDLs most frequently presented with an infiltrative MRI pattern (38.7%). Cerebrospinal fluid immunoglobulin G oligoclonal bands were often demonstrated (76.6%). In 25.3% of the cases, more than one acute-phase treatment was administered, and almost one-half of the patients (46.6%) were treated with high-efficacy treatments. After a median follow-up of 2.3 years (range: 0.1-10.7 years, IQR: 3.4 years), the median Expanded Disability Status Scale (EDSS) score was 1.5 (range: 0-7, IQR: 2). Independent risk factors for reaching an EDSS score ≥3 were a higher age at onset (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03-1.14, p < 0.01), a higher number of TDLs (OR: 1.67, 95% CI: 1.02-2.74, p < 0.05) and the presence of infiltrative TDLs (OR: 3.34, 95% CI: 1.18-9.5, p < 0.001) at baseline. CONCLUSIONS The management of TuMS might be challenging because of its peculiar characteristics. Large prospective studies could help to define the clinical characteristics and the best treatment algorithms for people with TuMS.
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Affiliation(s)
- Maria Di Gregorio
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy.,Azienda Ospedaliero-Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | - Giuseppe Fenu
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.,Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Lorenzo Gaetani
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | - Antonio Gallo
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cavalla
- Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Ragonese
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Pietro Annovazzi
- U.O.C. Centro Sclerosi Multipla, ASST Valle Olona, Varese, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Luca Prosperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Doriana Landi
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy.,U.O.S.D Sclerosi Multipla, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Carolina Gabri Nicoletti
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy.,U.O.S.D Sclerosi Multipla, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Rocco Totaro
- Centro Malattie Demielinizzanti, Ospedale San Salvatore, L'Aquila, Italy
| | - Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara De Fino
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diana Ferraro
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.,Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, University Hospital of Wales, Cardiff University School of Medicine, Cardiff, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Isabella Righini
- UO Neurologia-Dipartimento di Specialità Mediche- Nuovo Ospedale delle Apuane, Massa, Italy
| | - Maria Pia Amato
- Dipartimento NEUROFARBA, Sezione di Neuroscienze, Università degli Studi di Firenze, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Alessia Manni
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Damiano Paolicelli
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Roberta Lanzillo
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi "Federico II", Naples, Italy
| | - Marcello Moccia
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi "Federico II", Naples, Italy.,UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Fabio Buttari
- Unità di Neurologia, IRCCS Neuromed, Pozzilli, Italy
| | | | - Raffaella Cerqua
- Clinica Neurologica, Dipartimento di Medicina Sperimentale e Clinica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Sara Zagaglia
- Department of Clinical and Experimental Epilepsy, Queen Square, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, UK
| | - Deborah Farina
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Maria Chiara Buscarinu
- Dipartimento di Neuroscienze, Salute Mentale ed Organi di Senso, Università degli Studi di Roma "LaSapienza", Rome, Italy
| | - Federica Pinardi
- IRCCS Istituto delle scienze neurologiche di Bologna, UOSI riabilitazione SM, Bologna, Italy
| | - Eleonora Cocco
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.,Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | | | - Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
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Mantero V, Baroncini D, Balgera R, Guaschino C, Basilico P, Annovazzi P, Zaffaroni M, Salmaggi A, Cordano C. Mild COVID-19 infection in a group of teriflunomide-treated patients with multiple sclerosis. J Neurol 2020; 268:2029-2030. [PMID: 32865629 PMCID: PMC7457441 DOI: 10.1007/s00415-020-10196-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Vittorio Mantero
- Department of Neurology, MS Center, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy.
| | | | - Roberto Balgera
- Department of Neurology, MS Center, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Clara Guaschino
- MS Center, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy
| | - Paola Basilico
- Department of Neurology, MS Center, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Pietro Annovazzi
- MS Center, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy
| | - Mauro Zaffaroni
- MS Center, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy
| | - Andrea Salmaggi
- Department of Neurology, MS Center, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Christian Cordano
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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16
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Signori A, Saccà F, Lanzillo R, Maniscalco GT, Signoriello E, Repice AM, Annovazzi P, Baroncini D, Clerico M, Binello E, Cerqua R, Mataluni G, Perini P, Bonavita S, Lavorgna L, Zarbo IR, Laroni A, Pareja-Gutierrez L, La Gioia S, Frigeni B, Barcella V, Frau J, Cocco E, Fenu G, Clerici VT, Sartori A, Rasia S, Cordioli C, Stromillo ML, Di Sapio A, Pontecorvo S, Grasso R, Barone S, Barrilà C, Russo CV, Esposito S, Ippolito D, Landi D, Visconti A, Sormani MP. Cladribine vs other drugs in MS: Merging randomized trial with real-life data. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/6/e878. [PMID: 32801167 PMCID: PMC7641098 DOI: 10.1212/nxi.0000000000000878] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/16/2020] [Indexed: 12/27/2022]
Abstract
Objective Cladribine tablets were tested against placebo in randomized controlled trials (RCTs). In this study, the effectiveness of cladribine vs other approved drugs in patients with relapsing-remitting MS (RRMS) was compared by matching RCT to observational data. Methods Data from the pivotal trial assessing cladribine tablets vs placebo (CLARITY) were propensity score matched to data from the Italian multicenter database i-MuST. This database included 3,150 patients diagnosed between 2010 and 2018 at 24 Italian MS centers who started a disease-modifying drug. The annualized relapse rate (ARR) over 2 years from treatment start and the 24-week confirmed disability progression were compared between patients treated with cladribine and other approved drugs (interferon, glatiramer acetate, fingolimod, natalizumab, and dimethyl fumarate), with comparisons with placebo as a reference. Treatment effects were estimated by the inverse probability weighting negative binomial regression model for ARR and Cox model for disability progression. The treatment effect has also been evaluated according to baseline disease activity. Results All weighted baseline characteristics were well balanced between groups. All drugs tested had an effect vs placebo close to that detected in the RCT. Patients treated with cladribine had a significantly lower ARR compared with interferon (relapse ratio [RR] = 0.48; p < 0.001), glatiramer acetate (RR = 0.49; p < 0.001), and dimethyl fumarate (RR = 0.6; p = 0.001); a similar ARR to that with fingolimod (RR = 0.74; p = 0.24); and a significantly higher ARR than natalizumab (RR = 2.13; p = 0.014), confirming results obtained by indirect treatment comparisons from RCTs (network meta-analyses). The relative effect of cladribine tablets 10 mg (cumulative dose 3.5 mg/kg over 2 years) was higher in patients with high disease activity vs all treatments except fingolimod and natalizumab. Effects on disability progression were largely nonsignificant, probably due to lack of power for such analysis. Conclusion In patients with RRMS, cladribine tablets showed lower ARR compared with matched patients who started interferon, glatiramer acetate, or dimethyl fumarate; was similar to fingolimod; and was higher than natalizumab. The beneficial effect of cladribine tablets was generally amplified in the subgroup of patients with high disease activity. Classification of evidence This study provides Class III evidence that for patients with RRMS, cladribine-treated patients had lower ARR compared with interferon, glatiramer acetate, or dimethyl fumarate; similar ARR compared with fingolimod; and higher ARR compared with natalizumab.
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Affiliation(s)
- Alessio Signori
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Francesco Saccà
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Roberta Lanzillo
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Giorgia Teresa Maniscalco
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Elisabetta Signoriello
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Anna Maria Repice
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Pietro Annovazzi
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Damiano Baroncini
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Marinella Clerico
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Eleonora Binello
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Raffaella Cerqua
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Giorgia Mataluni
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Paola Perini
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Simona Bonavita
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Luigi Lavorgna
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Ignazio Roberto Zarbo
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Alice Laroni
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Lorena Pareja-Gutierrez
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Sara La Gioia
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Barbara Frigeni
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Valeria Barcella
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Jessica Frau
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Eleonora Cocco
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Giuseppe Fenu
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Valentina Torri Clerici
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Arianna Sartori
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Sarah Rasia
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Cinzia Cordioli
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Maria Laura Stromillo
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Alessia Di Sapio
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Simona Pontecorvo
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Roberta Grasso
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Stefania Barone
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Caterina Barrilà
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Cinzia Valeria Russo
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Sabrina Esposito
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Domenico Ippolito
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Doriana Landi
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Andrea Visconti
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy
| | - Maria Pia Sormani
- From the Department of Health Sciences (A. Signori, M.P.S.), Section of Biostatistics, University of Genoa; Department of Neurosciences (F.S., R.L., C.V.R.), Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples; Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli" (G.T.M.), Naples; Centro di Sclerosi Multipla (E.S.), II Clinica Neurologica, Università della Campania "Luigi Vanvitelli," Napoli; 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center) (A.M.R.), Careggi University Hospital, University of Florence; Multiple Sclerosis Study Center (P.A., D.B.), ASST Valle Olona, PO di Gallarate (VA); Clinical and Biological Sciences Department (M.C.), Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano; Centro SM (E.B.), Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino; Neurological Clinic (R.C.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Policlinic Tor Vergata (G.M., D.L.), Rome; The Multiple Sclerosis Center of the Veneto Region (P.P.), Department of Neurosciences, University of Padua; Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (S. Bonavita, L.L., S.E., D.I.), University of Campania Luigi Vanvitelli, Naples; Department of Clinical and Experimental Medicine (I.R.Z.), University of Sassari; Department Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (A.L.), Center of Excellence for Biomedical Research (CEBR), University of Genova; Neuroimmunology and Neuromuscular Diseases Unit (L.P.-G., V.T.C.), IRCCS Foundation Carlo Besta Neurological Institute, Milan; Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo (S.L.G., B.F., V.B.); Department of Medical Science and Public Health (J.F., E.C., G.F.), University of Cagliari; Neurology Clinic (A. Sartori), Department of Medical, Surgical, and Health Sciences, University of Trieste; Multiple Sclerosis Center (S.R., C.C.), ASST Spedali Civili, PO di Montichiari (BS); Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; 2nd Neurology Unit and CReSM (Regional Referral Multiple Sclerosis Center) (A.D.S.), AOU San Luigi Gonzaga, Orbassano, Torino; Regina Montis Regalis Hospital (A.D.S.), Mondovì; Department of Neurology and Psychiatry (S.P.), Sapienza University, Rome; Neurologia Universitaria OORR (R.G.), Foggia; Institute of Neurology (S. Barone), University Magna Graecia of Catanzaro; Department of Neurology (C.B.), Valduce Hospital, Como; Merck Serono S.p.A. (A.V.), Rome; and IRCCS Ospedale Policlinico San Martino (A.L., M.P.S.), Genova, Italy.
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Moccia M, Annovazzi P, Buscarinu MC, Calabrese M, Cavalla P, Cordioli C, Di Filippo M, Ferraro D, Gajofatto A, Gallo A, Lanzillo R, Laroni A, Lorefice L, Mallucchi S, Nociti V, Paolicelli D, Pinardi F, Prosperini L, Radaelli M, Ragonese P, Tomassini V, Tortorella C, Cocco E, Gasperini C, Solaro C. Harmonization of real-world studies in multiple sclerosis: Retrospective analysis from the rirems group. Mult Scler Relat Disord 2020; 45:102394. [PMID: 32683308 DOI: 10.1016/j.msard.2020.102394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/25/2020] [Accepted: 07/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Worldwide multiple sclerosis (MS) centers have coordinated their efforts to use data acquired in clinical practice for real-world observational studies. In this retrospective study, we aim to harmonize outcome measures, and to evaluate their heterogeneity within the Rising Italian Researchers in MS (RIReMS) study group. METHODS RIReMS members filled in a structured questionnaire evaluating the use of different outcome measures in clinical practice. Thereafter, thirty-four already-published papers from RIReMS centers were used for heterogeneity analyses, using the DerSimonian and Laird random-effects method to compute the between-study variance (τ2). RESULTS Based on questionnaire results, we defined basic modules for diagnosis and follow-up, consisting of outcome measures recorded by all participating centers at the time of diagnosis, and, then, at least annually; we also defined more detailed/optional modules, with outcome measures recorded less frequently and/or in the presence of specific clinical indications. Looking at heterogeneity, we found 5-year variance in age at onset (ES=27.34; 95%CI=26.18, 28.49; p<0.01; τ2=4.76), and 7% in female percent (ES=66.42; 95%CI=63.08, 69.76; p<0.01; τ2=7.15). EDSS variance was 0.2 in studies including patients with average age <36.1 years (ES=1.96; 95%CI=1.69, 2.24; p<0.01; τ2=0.19), or from 36.8 to 41.1 years (ES=2.70; 95%CI=2.39, 3.01; p<0.01; τ2=0.18), but increased to 3 in studies including patients aged >41.4 years (ES=4.37; 95%CI=3.40, 5.35; p<0.01; τ2=2.96). The lowest variance of relapse rate was found in studies with follow-up duration ≤2 years (ES=9.07; 95%CI=5.21, 12.93; p = 0.02; τ2=5.53), whilst the lowest variance in EDSS progression was found in studies with follow-up duration >2 years (ES=5.41; 95%CI=3.22, 7.60; p = 0.02; τ2=1.00). DISCUSSION We suggest common sets of biomarkers to be acquired in clinical practice, that can be used for research purposes. Also, we provide researchers with specific indications for improving inclusion criteria and data analysis, ultimately allowing data harmonization and high-quality collaborative studies.
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Affiliation(s)
- Marcello Moccia
- MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Italy.
| | | | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy
| | | | - Paola Cavalla
- MS Center, Department of Neurosciences and Mental Health, AOU City of Health & Science University Hospital, Turin, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberta Lanzillo
- MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Simona Mallucchi
- Multiple Sclerosis Centre, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | | | - Luca Prosperini
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | - Marta Radaelli
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Paolo Ragonese
- Department of Biomedicine Neurosciences and advanced Diagnostic (BiND), University of Palermo, Italy
| | - Valentina Tomassini
- Institute for Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara "G. d'Annunzio", Chieti, Italy; MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy; Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom
| | - Carla Tortorella
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Claudio Gasperini
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | - Claudio Solaro
- Rehabilitation Department, Mons. L. Novarese, Moncrivello, Vercelli, Italy
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18
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Patti F, Chisari CG, D'Amico E, Annovazzi P, Banfi P, Bergamaschi R, Clerici R, Conti MZ, Cortese A, Fantozzi R, Fischetti M, Frigo M, Gatto M, Immovilli P, Leoni S, Malucchi S, Maniscalco G, Marfia GA, Paolicelli D, Perini P, Serrati C, Sola P, Totaro R, Turano G, Valentino P, Zaffaroni M, Zuliani C, Centonze D. Clinical and patient determinants of changing therapy in relapsing-remitting multiple sclerosis (SWITCH study). Mult Scler Relat Disord 2020; 42:102124. [DOI: 10.1016/j.msard.2020.102124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/14/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
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19
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Tortorella C, Solaro C, Annovazzi P, Boffa L, Buscarinu MC, Buttari F, Calabrese M, Cavalla P, Cocco E, Cordioli C, De Luca G, Di Filippo M, Fantozzi R, Ferraro D, Gajofatto A, Gallo A, Lanzillo R, Laroni A, Fermo SL, Malucchi S, Maniscalco GT, Moccia M, Nociti V, Paolicelli D, Pesci I, Prosperini L, Ragonese P, Tomassini V, Clerici VLAT, Rodegher M, Gherardi M, Gasperini C. Informing MS patients on treatment options: a consensus on the process of consent taking. Neurol Sci 2020; 41:2249-2253. [PMID: 32240416 DOI: 10.1007/s10072-020-04339-z] [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: 07/31/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
In the last years, change in multiple sclerosis (MS) therapeutic scenario has highlighted the need for an improved doctor-patient communication in advance of treatment initiation in order to allow patient's empowerment in the decision-making process. AIMS: The aims of our project were to review the strategies used by Italian MS specialists to inform patients about treatment options and to design a multicentre shared document that homogenizes the information about disease-modifying treatment (DMTs) and the procedure of taking informed consent in clinical practice. RESULTS: The new resource, obtained by consensus among 31 neurologists from 27 MS Centres in Italy with the supervision of a medico-legal advisor, received the aegis of Italian Neurological Society (SIN) and constitutes a step toward a standardized decision process around DMTs in MS.
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Affiliation(s)
- C Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.
| | - C Solaro
- Department of Rehabilitation, Mons L Novarese Hospital, Moncrivello, Italy
| | - P Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona, PO di Gallarate, (VA), Italy
| | - L Boffa
- Department of Neurosciences, MS Center, Tor Vergata University, Rome, Italy
| | - M C Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs Sapienza University Rome, Rome, Italy
| | - F Buttari
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - M Calabrese
- Neurology B, Department of Neurosciences Biomedicine and Movements, University of Verona, Verona, Italy
| | - P Cavalla
- MS Center (P.C.), City of Health & Science University Hospital, Turin, Italy
| | - E Cocco
- Department Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - C Cordioli
- Multiple Sclerosis Center, ospedale di Montichiari, Spedali Civili di Brescia, Montichiari, Italy
| | - G De Luca
- Neurology Clinic, Multiple Sclerosis Center SS. Annunziata Hospital, Chieti, Italy
| | - M Di Filippo
- Clinica Neurologica, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - R Fantozzi
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - D Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Science, University of Campania, Naples, Italy
| | - R Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - A Laroni
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Lo Fermo
- Clinica Neurologica A.O.U. Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - S Malucchi
- Neurologia 2-CRESM, AOU San Luigi Gonzaga, Orbassano, Italy
| | - G T Maniscalco
- Department of Neurology and Stroke Unit, "A. Cardarelli Hospital", Naples, Italy
| | - M Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.,Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - V Nociti
- Istituto di Neurologia, Fondazione Policlinico Universitario 'A Gemelli' IRCCS, Rome, Italy
| | - D Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - I Pesci
- Ospedale di Vaio, Centro SM, Fidenza, Parma, Italy
| | - L Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - P Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Palermo, Italy
| | - V Tomassini
- Department of Neurosciences, Imaging and Clinical Sciences, School of Medicine, Institute for Advanced Biomedical Technologies (ITAB), University of Chieti-Pescara "G. d'Annunzio, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - V L A Torri Clerici
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - M Rodegher
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Gherardi
- SC Medicina Legale AUSL Valle D'Aosta, Aosta, Italy
| | - C Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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20
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Baroncini D, Annovazzi P, Guaschino C, Minonzio G, Hametner S, Stadelmann C, Comi G, Ghezzi A, Zaffaroni M. Long-term remission of tumefactive relapsing multiple sclerosis after alemtuzumab rescue treatment in an adolescent patient. Mult Scler Relat Disord 2020; 41:102061. [PMID: 32203930 DOI: 10.1016/j.msard.2020.102061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/22/2020] [Accepted: 03/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Damiano Baroncini
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy.
| | - P Annovazzi
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - C Guaschino
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - G Minonzio
- Neuroradiology Unit, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - S Hametner
- Institute of Neurology, Medical University Vienna, Vienna, Austria; Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - C Stadelmann
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - G Comi
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy
| | - A Ghezzi
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - M Zaffaroni
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
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21
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Maniscalco GT, Saccà F, Lanzillo R, Annovazzi P, Baroncini D, Binello E, Repice A, Perini P, Clerico M, Mataluni G, Bonavita S, La Gioia S, Gutierrez LP, Laroni A, Frau J, Cocco E, Torri Clerici V, Zarbo IR, Sartori A, Signoriello E, Rasia S, Cordioli C, Stromillo ML, Cerqua R, Pontecorvo S, Di Sapio A, Grasso R, Barone S, Lavorgna L, Barrilà C, Landi D, Russo CV, Frigeni B, Ippolito D, Turano G, Carmisciano L, Sormani MP, Signori A. First therapy choice in newly diagnosed Multiple Sclerosis patients: A multicenter Italian study. Mult Scler Relat Disord 2020; 42:102059. [PMID: 32208344 DOI: 10.1016/j.msard.2020.102059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The approval of an increasing number of disease modifying drugs for the treatment of Multiple Sclerosis (MS) creates new challenges for patients and clinicians on the first treatment choice. The main aim of this study was to assess factors impacting first therapy choice in a large Italian MS cohort. METHODS Newly diagnosed relapsing-remitting (RR) MS patients (2010-2018) followed in 24 Italian MS centres were included in the study. We evaluated the association of baseline demographics, clinical and MRI characteristics to the first treatment choice by logistic regression models applied to pre-defined binary alternatives: dimethyl fumarate vs injectables (interferon and glatiramer acetate), teriflunomide vs injectables, fingolimod vs dimethyl fumarate and fingolimod vs natalizumab. RESULTS We enrolled 3025 patients in the period between January 2010 and June 2018. Relapses in the previous year (OR = 2.75; p = 0.001), presence of spinal cord lesions (OR = 1.80; p = 0.002) and higher number (>9) of T2 lesions on the baseline brain MRI scan (OR = 1.65; p = 0.022) were the factors associated to dimethyl fumarate choice as first therapy vs an injectable drug. Older age (OR = 1.06; p < 0.001), male sex (OR = 2.29; p = 0.001) and higher EDSS (OR = 1.36; p < 0.001) were the factors associated with the choice of teriflunomide vs injectables. In more recent years, dimethyl fumarate (OR = 3.23; p < 0.001) and teriflunomide (OR = 2.53; p < 0.001) were chosen more frequently than injectables therapies. The main determinant for the choice of fingolimod as compared with dimethyl fumarate was a higher EDSS (OR = 1.56; p = 0.001), while there was a weak association with a longer disease duration (p = 0.068) and a longer time from onset to diagnosis (p = 0.085). Compared to fingolimod, natalizumab was preferred in patients with a younger age (OR = 0.95; p = 0.003) and higher EDSS (OR = 1.45; p = 0.007) and a shorter disease duration (OR = 0.52; p = 0.076). CONCLUSION Many factors guided therapeutic decision for our Italian cohort of MS patients; they are mainly related to MS disease activity, baseline EDSS, disease duration and age.
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Affiliation(s)
- Giorgia T Maniscalco
- Neurological Clinic and Multiple Sclerosis Center of "AORN A.Cardarelli", Naples, Italy
| | - Francesco Saccà
- Department of Neurosciences Reproductive Sciences and Odontostomatology Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis study center, ASST Valle Olona PO di Gallarate (VA), Italy
| | - Pietro Annovazzi
- Multiple Sclerosis study center, ASST Valle Olona PO di Gallarate (VA), Italy
| | - Damiano Baroncini
- Multiple Sclerosis study center, ASST Valle Olona PO di Gallarate (VA), Italy
| | - Eleonora Binello
- Centro SM Dipartimento di Neuroscienze, Ospedale Universitario Città della Salute e della Scienza di Torino, Italy
| | - Annamaria Repice
- 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center), Careggi University Hospital University of Florence, Italy
| | - Paola Perini
- The Multiple Sclerosis Center of the Veneto Region Department of Neurosciences, University of Padua, Padua, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, Neurology Unit University of Torino San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Giorgia Mataluni
- Multiple Sclerosis Clinical and Research Unit Department of Systems Medicine, Tor Vergata University and Hospital, Rome, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Sara La Gioia
- Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo, Italy
| | - Lorena Pareja Gutierrez
- Neuroimmunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Alice Laroni
- Department Neuroscience, University of Genova Rehabilitation Ophthalmology Genetics Maternal and Child Health Center of Excellence for Biomedical Research (CEBR); IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Jessica Frau
- Multiple Sclerosis Centre Binaghi Hospital, ATS Sardegna-University of Cagliari
| | - Eleonora Cocco
- Multiple Sclerosis Centre Binaghi Hospital, ATS Sardegna-University of Cagliari
| | - Valentina Torri Clerici
- Neuroimmunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | | | - Arianna Sartori
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, Italy
| | | | - Sarah Rasia
- Multiple Sclerosis Center, ASST Spedali Civili, PO di Montichiari (BS), Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili, PO di Montichiari (BS), Italy
| | | | - Raffaella Cerqua
- Neurological Clinic Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Simona Pontecorvo
- Department of Neurology and Psychiatry, Rome; Neurology and Stroke Unit Division, San Giovanni-Addolorata Hospital, Sapienza University, Rome, Italy
| | - Alessia Di Sapio
- Department of Neurology, Ospedale Regina Montis Regalis-ASLCN1, Mondovì, Italy
| | | | - Stefania Barone
- Institute of Neurology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit Department of Systems Medicine, Tor Vergata University and Hospital, Rome, Italy
| | - Cinzia Valeria Russo
- Department of Neurosciences Reproductive Sciences and Odontostomatology Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Barbara Frigeni
- Centro Sclerosi Multipla ASST Papa Giovanni XXIII di Bergamo, Italy
| | - Domenico Ippolito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Gabriella Turano
- Department of Neurology, Ospedale Regina Montis Regalis-ASLCN1, Mondovì, Italy
| | - Luca Carmisciano
- Department of Health Sciences Section of Biostatistics, University of Genova, Italy
| | - Maria Pia Sormani
- Department of Health Sciences Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences Section of Biostatistics, University of Genova, Italy.
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22
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Giacomini T, Foiadelli T, Annovazzi P, Nosadini M, Gastaldi M, Franciotta D, Panarese C, Capris P, Camicione P, Lanteri P, De Grandis E, Prato G, Cordani R, Nobili L, Morana G, Rossi A, Pistorio A, Cellerino M, Uccelli A, Sartori S, Savasta S, Mancardi MM. Pediatric optic neuritis and anti MOG antibodies: a cohort of Italian patients. Mult Scler Relat Disord 2019; 39:101917. [PMID: 31896061 DOI: 10.1016/j.msard.2019.101917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND recent studies reported that anti myelin oligodendrocyte glycoprotein (MOG) antibody (ab) related optic neuritis (ON) tend to have characteristics that differ from seronegative ones. The aim of our study was to investigate the clinical characteristics of pediatric anti-MOG ON by comparing anti MOG-ab-seropositive and seronegative patients with ON. METHODS in this retrospective Italian multicentre study, participants were identified by chart review of patients evaluated for acquired demyelinating syndromes of the central nervous system (over the period 2009-2019). We selected patients presenting with ON as their first demyelinating event. Inclusion criteria were age < 18 years at symptoms onset; presentation consistent with ON; negativity of anti-aquaporin 4 antibodies (AQP4). Only patients who were tested for MOG-IgG1-ab with a live cell-based assay were included. RESULTS 22 patients (10 MOG-ab-positive and 12 MOG-ab-negative) were included. Fundus oculi examination at onset showed disc swelling in 9/10 in the MOG-ab-positive cohort and 2/10 in the seronegative group (P = 0.002). Retinal Fiber Nerve Layer (RFNL) thickness measured by Spectral Domain Optical Coherence Tomography (S-OCT) was increased in the 5/5 MOG-ab-positive patients tested and was normal or reduced in the seronegative patients tested (4/4 patients) (P = 0.024). Visual acuity impairment at onset did not differ significantly between the two groups, but the MOG-ab-positive cohort showed better recovery at follow-up both regarding visual acuity (P = 0.025) and expanded disability status scale (EDSS) (P = 0.013). A final diagnosis of MS was frequent among seronegative patients (6/12, 50%), whereas none of the MOG-ab-positive group received a diagnosis of MS (P = 0.015). Clinical relapse frequency was low in both groups: 2/10 MOG-ab-positive and 2/12 seronegative cases relapsed, with a median follow up of 25 months. CONCLUSION optic disc swelling and increased RFNL at baseline are strongly associated with MOG-ab positivity. MOG-ab-positive patients with ON showed better recovery compared to the seronegative ones. The relapse rate was low and did not differ among the two groups.
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Affiliation(s)
- Thea Giacomini
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center. ASST Valle Olona - Gallarate Hospital, Gallarate (VA), Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Claudio Panarese
- CSF Laboratory, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Paolo Capris
- Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Paola Camicione
- Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Paola Lanteri
- Unit of Neurophisyology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Elisa De Grandis
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Giulia Prato
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Ramona Cordani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Lino Nobili
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Giovanni Morana
- Unit of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Rossi
- Unit of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maria Cellerino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonio Uccelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Salvatore Savasta
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Maria Margherita Mancardi
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy.
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Novi G, Bovis F, Capobianco M, Frau J, Mataluni G, Curti E, Zuliani L, Cavalla P, Brambilla L, Annovazzi P, Repice AM, Lanzillo R, Esposito S, Benedetti L, Maietta I, Sica F, Buttari F, Malucchi S, Fenu G, Landi D, Bosa C, Realmuto S, Malentacchi M, Granella F, Signori A, Bonavita S, Uccelli A, Sormani MP. Efficacy of different rituximab therapeutic strategies in patients with neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2019; 36:101430. [DOI: 10.1016/j.msard.2019.101430] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 11/17/2022]
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Ferraro D, Annovazzi P, Moccia M, Lanzillo R, De Luca G, Nociti V, Fantozzi R, Paolicelli D, Ragonese P, Gajofatto A, Boffa L, Cavalla P, Lo Fermo S, Buscarinu MC, Lorefice L, Cordioli C, Calabrese M, Gallo A, Pinardi F, Tortorella C, Di Filippo M, Camera V, Maniscalco GT, Radaelli M, Buttari F, Tomassini V, Cocco E, Gasperini C, Solaro C. Characteristics and treatment of Multiple Sclerosis-related trigeminal neuralgia: An Italian multi-centre study. Mult Scler Relat Disord 2019; 37:101461. [PMID: 31678859 DOI: 10.1016/j.msard.2019.101461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of trigeminal neuralgia (TN) in Multiple Sclerosis (MS) patients is higher than in the general population and its management can be particularly challenging. Our aim is to describe the characteristics, treatment and prognostic factors of MS-related TN in a retrospective multicentre study. METHODS Neurologists members of the RIREMS group (Rising Researchers in MS) enrolled MS patients with a TN diagnosis and filled out a spreadsheet comprising their clinical data. RESULTS Population consisted of 298 patients. First-choice preventive treatments were carbamazepine and oxcarbazepine. A surgical procedure was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%); one third of patients underwent at least two procedures. Surgery was associated with higher disability, male sex and longer interval between MS and TN onset. Patients (77%) who stayed on at least one preventive medication at most recent follow-up, after a mean period of 8 years, had a higher disability compared to the untreated group. Furthermore, patients with higher disability at TN onset were less likely to discontinue their first preventive medication due to pain remission, had bilateral TN more frequently and underwent surgical interventions earlier. CONCLUSION MS patients with a higher disability at TN onset and with a longer interval between MS and TN onset had differing clinical features and outcomes: pain was more frequently bilateral, surgery was more frequent and anticipated, and preventive medication discontinuation due to pain remission was less common.
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Affiliation(s)
- Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, Modena 41126, Italy.
| | | | - Marcello Moccia
- MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Naples, Italy
| | - Roberta Lanzillo
- MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Naples, Italy
| | | | - Viviana Nociti
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | | | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Paolo Ragonese
- Department of Biomedicine Neurosciences and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Alberto Gajofatto
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Laura Boffa
- Neurology Unit, Tor Vergata Hospital, Rome, Italy
| | - Paola Cavalla
- MS Center, Department of Neurosciences and Mental Health, AOU City of Health & Science University Hospital, Turin, Italy
| | | | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Massimiliano Calabrese
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Carla Tortorella
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | | | - Valentina Camera
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, Modena 41126, Italy
| | | | - Marta Radaelli
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | | | - Valentina Tomassini
- Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Claudio Gasperini
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | - Claudio Solaro
- Rehabilitation Department, Mons. L. Novarese, Moncrivello, Vercelli, Italy
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25
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Calabrese M, Gasperini C, Tortorella C, Schiavi G, Frisullo G, Ragonese P, Fantozzi R, Prosperini L, Annovazzi P, Cordioli C, Di Filippo M, Ferraro D, Gajofatto A, Malucchi S, Lo Fermo S, De Luca G, Stromillo ML, Cocco E, Gallo A, Paolicelli D, Lanzillo R, Tomassini V, Pesci I, Rodegher ME, Solaro C. "Better explanations" in multiple sclerosis diagnostic workup: A 3-year longitudinal study. Neurology 2019; 92:e2527-e2537. [PMID: 31043476 PMCID: PMC6659006 DOI: 10.1212/wnl.0000000000007573] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 08/22/2018] [Accepted: 01/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The exclusion of other diseases that can mimic multiple sclerosis (MS) is the cornerstone of current diagnostic criteria. However, data on the frequency of MS mimics in real life are incomplete. METHODS A total of 695 patients presenting with symptoms suggestive of MS in any of the 22 RIREMS centers underwent a detailed diagnostic workup, including a brain and spinal cord MRI scan, CSF and blood examinations, and a 3-year clinical and radiologic follow-up. FINDINGS A total of 667 patients completed the study. Alternative diagnoses were formulated in 163 (24.4%) cases, the most frequent being nonspecific neurologic symptoms in association with atypical MRI lesions of suspected vascular origin (40 patients), migraine with atypical lesions (24 patients), and neuromyelitis optica (14 patients). MS was diagnosed in 401 (60.1%) patients according to the 2017 diagnostic criteria. The multivariate analysis revealed that the absence of CSF oligoclonal immunoglobulin G bands (IgG-OB) (odds ratio [OR] 18.113), the presence of atypical MRI lesions (OR 10.977), the absence of dissemination in space (DIS) of the lesions (OR 5.164), and normal visual evoked potentials (OR 3.550) were all independent predictors of an alternative diagnosis. INTERPRETATION This observational, unsponsored, real-life study, based on clinical practice, showed that diseases that mimicked MS were many, but more than 45% were represented by nonspecific neurologic symptoms with atypical MRI lesions of suspected vascular origin, migraine, and neuromyelitis optica. The absence of IgG-OB and DIS, the presence of atypical MRI lesions, and normal visual evoked potentials should be considered suggestive of an alternative disease and red flags for the misdiagnosis of MS.
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Affiliation(s)
- Massimiliano Calabrese
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy.
| | - Claudio Gasperini
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Carla Tortorella
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Gianmarco Schiavi
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Giovanni Frisullo
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Paolo Ragonese
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Roberta Fantozzi
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Luca Prosperini
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Pietro Annovazzi
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Cinzia Cordioli
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Massimiliano Di Filippo
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Diana Ferraro
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Alberto Gajofatto
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Simona Malucchi
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Salvatore Lo Fermo
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Giovanna De Luca
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Maria L Stromillo
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Eleonora Cocco
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Antonio Gallo
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Damiano Paolicelli
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Roberta Lanzillo
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Valentina Tomassini
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Ilaria Pesci
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Maria E Rodegher
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
| | - Claudio Solaro
- From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy
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26
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Saccà F, Lanzillo R, Signori A, Maniscalco GT, Signoriello E, Lo Fermo S, Repice A, Annovazzi P, Baroncini D, Clerico M, Binello E, Cerqua R, Mataluni G, Bonavita S, Lavorgna L, Zarbo IR, Laroni A, Rossi S, Pareja Gutierrez L, La Gioia S, Frigeni B, Barcella V, Frau J, Cocco E, Fenu G, Torri Clerici V, Sartori A, Rasia S, Cordioli C, Di Sapio A, Pontecorvo S, Grasso R, Barrilà C, Russo CV, Esposito S, Ippolito D, Bovis F, Gallo F, Sormani MP. Determinants of therapy switch in multiple sclerosis treatment-naïve patients: A real-life study. Mult Scler 2018; 25:1263-1272. [DOI: 10.1177/1352458518790390] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: With many options now available, first therapy choice is challenging in multiple sclerosis (MS) and depends mainly on neurologist and patient preferences. Objectives: To identify prognostic factors for early switch after first therapy choice. Methods: Newly diagnosed relapsing–remitting MS patients from 24 Italian centers were included. We evaluated the association of baseline demographics, clinical, and magnetic resonance imaging (MRI) data to the switch probability for lack of efficacy or intolerance/safety with a multivariate Cox analysis and estimated switch rates by competing risks models. Results: We enrolled 3025 patients. The overall switch frequency was 48% after 3 years. Switch risk for lack of efficacy was lower with fingolimod (hazard ratio (HR) = 0.50; p = 0.009), natalizumab (HR = 0.13; p < 0.001), dimethyl-fumarate (HR = 0.60; p = 0.037), teriflunomide (HR = 0.21; p = 0.031) as compared to interferons. Younger age (HR = 0.96; p < 0.001), diagnosis delay (HR = 1.23; p = 0.021), higher baseline Expanded Disability Status Scale (HR = 1.17; p = 0.001), and spinal cord lesions (HR = 1.46; p = 0.001) were independently associated with higher inefficacy switch rates. We found lower switch for intolerance/safety with glatiramer acetate (HR = 0.61; p = 0.001), fingolimod (HR = 0.35; p = 0.002), and dimethyl-fumarate (HR = 0.57; p = 0.022) as compared to interferons, while it increased with natalizumab (HR = 1.43; p = 0.022). Comorbidities were associated with intolerance switch (HR = 1.28; p = 0.047). Conclusion: Several factors are associated with higher switch risk in patients starting a first-line therapy and could be integrated in the decision-making process of first treatment choice.
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Affiliation(s)
- Francesco Saccà
- Multiple Sclerosis Center, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Center, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
| | - Giorgia T Maniscalco
- Neurological Clinic and Multiple Sclerosis Center, “AORN A.Cardarelli,” Naples, Italy
| | - Elisabetta Signoriello
- Multiple Sclerosis Center, II Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Salvatore Lo Fermo
- Neurological Clinic, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Annamaria Repice
- 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center), Careggi University Hospital and University of Florence, Florence, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Gallarate, Italy
| | - Damiano Baroncini
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Gallarate, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Eleonora Binello
- Centro Sclerosi Multipla, Dipartimento di Neuroscienze, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Raffaella Cerqua
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | | | - Simona Bonavita
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Lavorgna
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ignazio Roberto Zarbo
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alice Laroni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR) and IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Silvia Rossi
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Lorena Pareja Gutierrez
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Sara La Gioia
- Centro Sclerosi Multipla, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Barbara Frigeni
- Centro Sclerosi Multipla, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Valeria Barcella
- Centro Sclerosi Multipla, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Jessica Frau
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Valentina Torri Clerici
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Arianna Sartori
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
| | - Sarah Rasia
- Multiple Sclerosis Center, ASST Spedali Civili, PO di Montichiari (BS), Montichiari, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili, PO di Montichiari (BS), Montichiari, Italy
| | - Alessia Di Sapio
- 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center), AOU San Luigi Gonzaga, Torino, Italy; Regina Montis Regalis Hospital, Mondovì, Italy
| | - Simona Pontecorvo
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | | | - Cinzia Valeria Russo
- Multiple Sclerosis Center, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Sabrina Esposito
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Domenico Ippolito
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
| | - Fabio Gallo
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
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27
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Frau J, Sormani MP, Signori A, Realmuto S, Baroncini D, Annovazzi P, Signoriello E, Maniscalco GT, La Gioia S, Cordioli C, Frigeni B, Rasia S, Fenu G, Grasso R, Sartori A, Lanzillo R, Stromillo ML, Rossi S, Forci B, Cocco E. Clinical activity after fingolimod cessation: disease reactivation or rebound? Eur J Neurol 2018; 25:1270-1275. [DOI: 10.1111/ene.13694] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J. Frau
- Department of Medical Sciences and Public Health University of Cagliari CagliariItaly
| | - M. P. Sormani
- Department of Health Sciences Section of Biostatistics University of Genova GenovaItaly
| | - A. Signori
- Department of Health Sciences Section of Biostatistics University of Genova GenovaItaly
| | - S. Realmuto
- Department of Experimental Biomedicine and Clinical Neurosciences University of Palermo PalermoItaly
| | - D. Baroncini
- Multiple Sclerosis Study Centre AO s. Antonio Abate GallarateItaly
| | - P. Annovazzi
- Multiple Sclerosis Study Centre AO s. Antonio Abate GallarateItaly
| | - E. Signoriello
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences Second University of Naples NaplesItaly
| | - G. T. Maniscalco
- Neurological Clinic and Multiple Sclerosis Centre of ‘AORN A.Cardarelli’ NaplesItaly
| | - S. La Gioia
- USC Neurologia ASST Papa Giovanni XXIII BergamoItaly
| | - C. Cordioli
- Multiple Sclerosis Center Spedali Civili of Brescia Presidio di Montichiari BresciaItaly
| | - B. Frigeni
- USC Neurologia ASST Papa Giovanni XXIII BergamoItaly
| | - S. Rasia
- Multiple Sclerosis Center Spedali Civili of Brescia Presidio di Montichiari BresciaItaly
| | - G. Fenu
- Department of Medical Sciences and Public Health University of Cagliari CagliariItaly
| | - R. Grasso
- Neurologia Universitaria OORR FoggiaItaly
| | - A. Sartori
- Clinica Neurologica Azienda Ospedaliero‐Universitaria Ospedali Riuniti di Trieste TriesteItaly
| | - R. Lanzillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology Multiple Sclerosis Centre Federico II University NaplesItaly
| | - M. L. Stromillo
- Department of Medicine, Surgery and Neuroscience University of Siena SienaItaly
| | - S. Rossi
- Neuroimmunology and Neuromuscular Diseases Unit IRCCS Fondazione Istituto Neurologico Carlo Besta MilanoItaly
| | - B. Forci
- Dipartimento di Neuroscienze Azienda Ospedaliero‐Universitaria Careggi Area del farmaco e Salute del bambino (NEUROFARBA) Florence Italy
| | - E. Cocco
- Department of Medical Sciences and Public Health University of Cagliari CagliariItaly
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28
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Mallucci G, Annovazzi P, Miante S, Torri-Clerici V, Matta M, La Gioia S, Cavarretta R, Mantero V, Costantini G, D'Ambrosio V, Zaffaroni M, Ghezzi A, Perini P, Rossi S, Bertolotto A, Rottoli MR, Rovaris M, Balgera R, Cavalla P, Montomoli C, Bergamaschi R. Two-year real-life efficacy, tolerability and safety of dimethyl fumarate in an Italian multicentre study. J Neurol 2018; 265:1850-1859. [PMID: 29948245 DOI: 10.1007/s00415-018-8916-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 02/07/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dimethyl-fumarate (DMF) demonstrated efficacy and safety in relapsing-remitting multiple sclerosis (MS) in randomized clinical trials. OBJECTIVES To track and evaluate post-market DMF profile in real-world setting. MATERIALS AND METHODS Patients receiving DMF referred to Italian MS centres were enrolled and prospectively followed, collecting demographic clinical and radiological data. RESULTS Among the 735 included patients, 45.4% were naïve to disease-modifying therapies, 17.8% switched to DMF because of tolerance, 27.4% switched to DMF because of lack of efficacy, and 9.4% switched to DMF because of safety concerns. Median DMF exposure was 17 months (0-33). DMF reduced the annual relapse rate (ARR) by 63.2%. At 12 and 24 months, 85 and 76% of patients were relapse-free. NEDA-3 status after 12 months of DMF treatment was maintained by 47.5% of patients. 89 and 70% of patients at 12 and 24 months regularly continued DMF. Most frequent adverse events (AEs) were flushing (37.2%) and gastro-enteric AEs (31.1%). CONCLUSION Our post-market study corroborated that DMF is a safe and effective drug. Additionally, the study suggested that naïve patients strongly benefit from DMF and that DMF improved ARR also in patients who were horizontally switched from injectable therapies due to tolerability and efficacy issues.
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Affiliation(s)
- Giulia Mallucci
- Inter-department Multiple Sclerosis Research Centre, IRCCS Mondino Mondino, Pavia, Italy.
| | - P Annovazzi
- Multiple Sclerosis Study Centre, ASST Valle Olona, Gallarate, VA, Italy
| | - S Miante
- Department of Neurosciences, The Multiple Sclerosis Centre, University Hospital of Padova, Padua, Italy
| | - V Torri-Clerici
- Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C, Besta IRCCS Foundation, Milan, Italy
| | - M Matta
- Regional Multiple Sclerosis Centre, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - S La Gioia
- SS Malattie Autoimmuni USC Neurologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - R Cavarretta
- Multiple Sclerosis Center, IRRCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - V Mantero
- Neurological Department, A. Manzoni Hospital, Lecco, Italy
| | - G Costantini
- Department of Neuroscience, University of Torino, Turin, Italy
| | - V D'Ambrosio
- Inter-department Multiple Sclerosis Research Centre, IRCCS Mondino Mondino, Pavia, Italy
| | - M Zaffaroni
- Multiple Sclerosis Study Centre, ASST Valle Olona, Gallarate, VA, Italy
| | - A Ghezzi
- Multiple Sclerosis Study Centre, ASST Valle Olona, Gallarate, VA, Italy
| | - P Perini
- Department of Neurosciences, The Multiple Sclerosis Centre, University Hospital of Padova, Padua, Italy
| | - S Rossi
- Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C, Besta IRCCS Foundation, Milan, Italy
| | - A Bertolotto
- Regional Multiple Sclerosis Centre, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - M R Rottoli
- SS Malattie Autoimmuni USC Neurologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M Rovaris
- Multiple Sclerosis Center, IRRCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - R Balgera
- Neurological Department, A. Manzoni Hospital, Lecco, Italy
| | - P Cavalla
- Department of Neuroscience, University of Torino, Turin, Italy
| | - C Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, University of Pavia, Pavia, Italy
| | - R Bergamaschi
- Inter-department Multiple Sclerosis Research Centre, IRCCS Mondino Mondino, Pavia, Italy
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29
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Lanzillo R, Prosperini L, Gasperini C, Moccia M, Fantozzi R, Tortorella C, Nociti V, Annovazzi P, Cavalla P, Radaelli M, Malucchi S, Clerici VT, Boffa L, Buttari F, Ragonese P, Maniscalco GT, Di Filippo M, Buscarinu MC, Pinardi F, Gallo A, Coghe G, Pesci I, Laroni A, Gajofatto A, Calabrese M, Tomassini V, Cocco E, Solaro C. A multicentRE observational analysiS of PErsistenCe to Treatment in the new multiple sclerosis era: the RESPECT study. J Neurol 2018; 265:1174-1183. [PMID: 29549468 DOI: 10.1007/s00415-018-8831-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/11/2018] [Indexed: 11/27/2022]
Abstract
In this independent, multicenter, retrospective study, we investigated the short-term persistence to treatment with first-line self-injectable or oral disease-modifying treatments (DMTs) in patients with relapsing-remitting multiple sclerosis. Data of patients regularly attending 21 Italian MS Centres who started a self-injectable or an oral DMT in 2015 were collected to: (1) estimate the proportion of patients discontinuing the treatment; (3) explore reasons for discontinuation; (3) identify baseline predictors of treatment discontinuation over a follow-up period of 12 months. We analyzed data of 1832 consecutive patients (1289 women, 543 men); 374 (20.4%) of them discontinued the prescribed DMT after a median time of 6 months (range 3 days to 11.5 months) due to poor tolerability (n = 163; 43.6%), disease activity (n = 95; 25.4%), adverse events (n = 64; 17.1%), convenience (i.e. availability of new drug formulations) and pregnancy planning (n = 21; 1.1%). Although the proportion of discontinuers was higher with self-injectable (n = 107; 22.9%) than with oral DMT (n = 215; 16.4%), the Cox regression model revealed no significant between-group difference (p = 0.12). Female sex [hazard ratio (HR) = 1.39, p = 0.01] and previous exposure to ≥ 3 DMTs (HR = 1.71, p = 0.009) were two independent risk factors for treatment discontinuation, regardless of prescribed DMTs. Our study confirms that persistence to treatment represents a clinical challenge, irrespective of the route of administration.
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Affiliation(s)
- Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Claudio Gasperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Viviana Nociti
- Department of Geriatrics, Neurosciences and Orthopedics, Institute of Neurology, Catholic University, Rome, Italy
| | - Pietro Annovazzi
- MS Study Center, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - Paola Cavalla
- MS Center, Neurology 1 Unit, City of Health and Science University Hospital, Turin, Italy
| | - Marta Radaelli
- Division of Neuroscience, Institute of Experimental Neuroscience (INSpe), S. Raffaele Scientific Institute, Milan, Italy
| | - Simona Malucchi
- SCDO Neurologia 2-Regional Multiple Sclerosis Center, University Hospital San Luigi Gonzaga, Orbassano, TO, Italy
| | - Valentina Torri Clerici
- Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
| | - Laura Boffa
- MS Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabio Buttari
- Department of Neurology, IRCCS NEUROMED, Pozzilli, IS, Italy
- MS Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Paolo Ragonese
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | | | | | - Maria Chiara Buscarinu
- Department of Neurosciences, Center for Experimental Neurological Therapies, S. Andrea Hospital, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy
| | - Federica Pinardi
- MS Centre, Bellaria Hospital, UOSI-SM Rehabilitation, Bellaria, BO, Italy
| | - Antonio Gallo
- I Clinic of Neurology, University of Campania, Naples, Italy
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ilaria Pesci
- MS Centre, Neurology Unit, S. Secondo Hospital, Fidenza, PA, Italy
| | - Alice Laroni
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Claudio Solaro
- Neurology Unit, Centro di Recupero e Rieducazione Funzionale, Moncrivello, VC, Italy
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Portaccio E, Moiola L, Martinelli V, Annovazzi P, Ghezzi A, Zaffaroni M, Lanzillo R, Brescia Morra V, Rinaldi F, Gallo P, Tortorella C, Paolicelli D, Pozzilli C, De Giglio L, Cavalla P, Cocco E, Marrosu MG, Solaro C, Uccelli A, Laroni A, Pastò L, Giannini M, Trojano M, Comi G, Amato MP. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: II: Maternal risks. Neurology 2018; 90:e832-e839. [PMID: 29438041 DOI: 10.1212/wnl.0000000000005068] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/16/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the risk of disease reactivation during pregnancy after natalizumab suspension in women with multiple sclerosis (MS). METHODS Data of all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab and referring to 19 participating sites were collected and compared with those of pregnancies in untreated patients and patients treated with injectable immunomodulatory agents through a 2-factor repeated measures analysis. Predictors of disease activity were assessed through stepwise multivariable logistic regression models. RESULTS A total of 92 pregnancies were tracked in 83 women receiving natalizumab. Among these pregnancies, 74 in 70 women resulted in live births, with a postpartum follow-up of at least 1 year, and were compared with 350 previously published pregnancies. Relapse rate during and after pregnancy was higher in women treated with natalizumab (p < 0.001). In multivariable analysis, longer natalizumab washout period was the only predictor of relapse occurrence during pregnancy (p = 0.001). Relapses in the postpartum year were related to relapses during pregnancy (p = 0.019) and early reintroduction of disease-modifying drugs (DMD; p = 0.021). Disability progression occurred in 16.2% of patients and was reduced by early reintroduction of DMD (p = 0.024). CONCLUSIONS Taken as a whole, our findings indicate that the combination of avoiding natalizumab washout and the early resumption of DMD after delivery could be the best option in the perspective of maternal risk. This approach must take into account possible fetal risks that need to be discussed with the mother and require further investigation. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that in women with MS, the risk of relapses during pregnancy is higher in those who had been using natalizumab as compared to those who had been using interferon-β or no treatment.
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Affiliation(s)
- Emilio Portaccio
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy.
| | - Lucia Moiola
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Vittorio Martinelli
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Pietro Annovazzi
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Angelo Ghezzi
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Mauro Zaffaroni
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Roberta Lanzillo
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Vincenzo Brescia Morra
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Francesca Rinaldi
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Paolo Gallo
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Carla Tortorella
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Damiano Paolicelli
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Carlo Pozzilli
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Laura De Giglio
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Paola Cavalla
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Eleonora Cocco
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Maria Giovanna Marrosu
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Claudio Solaro
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Antonio Uccelli
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Alice Laroni
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Luisa Pastò
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Marta Giannini
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Maria Trojano
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Giancarlo Comi
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Maria Pia Amato
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (C.S.), ASL3 Genovese; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
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Portaccio E, Annovazzi P, Ghezzi A, Zaffaroni M, Moiola L, Martinelli V, Lanzillo R, Brescia Morra V, Rinaldi F, Gallo P, Tortorella C, Paolicelli D, Pozzilli C, De Giglio L, Cavalla P, Cocco E, Marrosu MG, Patti F, Solaro C, Bellantonio P, Uccelli A, Laroni A, Pastò L, Giannini M, Trojano M, Comi G, Amato MP. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: I: Fetal risks. Neurology 2018; 90:e823-e831. [PMID: 29438046 DOI: 10.1212/wnl.0000000000005067] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/16/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess fetal risk after pregnancy exposure to natalizumab in women with multiple sclerosis (MS), with a specific focus on spontaneous abortion (SA) and congenital anomalies (CA). METHODS Data of all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab and referring to 19 participating sites were collected and compared with those of pregnancies in untreated patients and patients treated with injectable immunomodulatory agents. Rates of SA and CA were also compared with those reported in the Italian population. Multivariable logistic and linear regression models were performed. RESULTS A total of 92 pregnancies were tracked in 83 women. In the multivariable analysis, natalizumab exposure was associated with SA (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.9-8.5, p < 0.001). However, the rate of SA (17.4%) was within the estimates for the general population, as well as the rate of major CA (3.7%). Moreover, exposure to natalizumab and interferon-β (IFN-β) was associated with lower length and weight of the babies (p < 0.001). CONCLUSION Our results showed that natalizumab exposure to up 12 weeks of gestation is associated with an increased risk of SA, although within the limits expected in the general population, whereas the risk of CA needs further investigation. Taking into account the high risk of disease reactivation after natalizumab suspension, pregnancy could be planned continuing natalizumab while strictly monitoring conception. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in women with MS, natalizumab exposure increases the risk of spontaneous abortion as compared to IFN-β-exposed or untreated patients (OR 3.9, 95% CI 1.9-8.5).
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Affiliation(s)
- Emilio Portaccio
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy.
| | - Pietro Annovazzi
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Angelo Ghezzi
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Mauro Zaffaroni
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Lucia Moiola
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Vittorio Martinelli
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Roberta Lanzillo
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Vincenzo Brescia Morra
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Francesca Rinaldi
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Paolo Gallo
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Carla Tortorella
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Damiano Paolicelli
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Carlo Pozzilli
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Laura De Giglio
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Paola Cavalla
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Eleonora Cocco
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Maria Giovanna Marrosu
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Francesco Patti
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Claudio Solaro
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Paolo Bellantonio
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Antonio Uccelli
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Alice Laroni
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Luisa Pastò
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Marta Giannini
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Maria Trojano
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Giancarlo Comi
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
| | - Maria Pia Amato
- From IRCCS Don Gnocchi Foundation (E.P.), Florence; Multiple Sclerosis Study Center (P.A., A.G., M.Z.), ASST Valle Olona, Gallarate Hospital (VA); Scientific Institute University Vita-Salute San Raffaele (L.M., V.M., G.C.), Milan; Department of Neurosciences, Reproductive and Odontostomatological Sciences (R.L., V.B.M.), Federico II University of Naples; Department of Neurosciences (F.R., P.G.), Multiple Sclerosis Centre-Veneto Region (CeSMuV), University Hospital of Padova; Department of Neurology (C.T., D.P., M.T.), University of Bari; Department of Neurology and Psychiatry (C.P., L.D.G.), "La Sapienza" University, Rome; Department of Neurology (P.C.), University of Torino; Department of Medical Sciences and Public Health (E.C., M.G.M.), University of Cagliari; Department of Neurology (F.P.), University of Catania; Department of Neurology (C.S.), ASL3 Genovese; Multiple Sclerosis Center (P.B.), IRCCS Neuromed, Pozzilli; Department of Neurology (A.U., A.L.), University of Genova; and Department of NEUROFARBA (L.P., M.G., M.P.A.), University of Florence, Italy
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Laroni A, Signori A, Maniscalco GT, Lanzillo R, Russo CV, Binello E, Lo Fermo S, Repice A, Annovazzi P, Bonavita S, Clerico M, Baroncini D, Prosperini L, La Gioia S, Rossi S, Cocco E, Frau J, Torri Clerici V, Signoriello E, Sartori A, Zarbo IR, Rasia S, Cordioli C, Cerqua R, Di Sapio A, Lavorgna L, Pontecorvo S, Barrilà C, Saccà F, Frigeni B, Esposito S, Ippolito D, Gallo F, Sormani MP. Assessing association of comorbidities with treatment choice and persistence in MS. Neurology 2017; 89:2222-2229. [DOI: 10.1212/wnl.0000000000004686] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/24/2017] [Indexed: 01/09/2023] Open
Abstract
Objective:To assess whether the presence of concomitant diseases at multiple sclerosis (MS) diagnosis is associated with the choice and the treatment persistence in an Italian MS cohort.Methods:We included newly diagnosed patients (2010–2016) followed in 20 MS centers and collected demographic and clinical data. We evaluated baseline factors related to the presence of comorbidities and the association between comorbidities and the clinical course of MS and the time to the first treatment switch.Results:The study cohort included 2,076 patients. Data on comorbidities were available for 1,877/2,076 patients (90.4%). A total of 449/1,877 (23.9%) patients had at least 1 comorbidity at MS diagnosis. Age at diagnosis (odds ratio 1.05, 95% confidence interval [CI] 1.04–1.06; p < 0.001) was the only baseline factor independently related to the presence of comorbidities. Comorbidities were not significantly associated with the choice of the first disease-modifying treatment, but were significantly associated with higher risk to switch from the first treatment due to intolerance (hazard ratio 1.42, CI 1.07–1.87; p = 0.014). Association of comorbidities with risk of switching for intolerance was significantly heterogeneous among treatments (interferon β, glatiramer acetate, natalizumab, or fingolimod; interaction test, p = 0.04).Conclusions:Comorbidities at diagnosis should be taken into account at the first treatment choice because they are associated with lower persistence on treatment.
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Rolla S, De Mercanti SF, Bardina V, Horakova D, Habek M, Adamec I, Cocco E, Annovazzi P, Vladic A, Novelli F, Durelli L, Clerico M. Lack of CD4+ T cell percent decrease in alemtuzumab-treated multiple sclerosis patients with persistent relapses. J Neuroimmunol 2017; 313:89-91. [PMID: 29153614 DOI: 10.1016/j.jneuroim.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/04/2017] [Accepted: 10/15/2017] [Indexed: 01/01/2023]
Abstract
Alemtuzumab, a highly effective treatment for relapsing remitting multiple sclerosis (RRMS), induces lymphopenia especially of CD4+ T cells. Here, we report the atypical CD4+ T population behaviour of two patients with persistent disease activity despite repeated alemtuzumab treatments. Whereas lymphocytes count decreased and fluctuated accordingly to alemtuzumab administration, their CD4+ cell percentage was not or just mildly affected and was slightly below the lowest normal limit already before alemtuzumab. These cases anticipate further studies aimed to investigate whether the evaluation of the CD4+ cell percentage could represent a helpful tool to address the individual clinical response to alemtuzumab.
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Affiliation(s)
- Simona Rolla
- Clinical and Biological Sciences Department, University of Torino, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Stefania Federica De Mercanti
- Clinical and Biological Sciences Department, University of Torino, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Valentina Bardina
- Clinical and Biological Sciences Department, University of Torino, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, General University Hospital, Czech Republic
| | - Mario Habek
- Department of Neurology, Referral Center for Autonomic Nervous System, University Hospital Center, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Ivan Adamec
- Department of Neurology, Referral Center for Autonomic Nervous System, University Hospital Center, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Eleonora Cocco
- Multiple Sclerosis Center, Department of Medical Science and Public Health, University of Cagliari, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Study Center, AO S. Antonio Abate, Gallarate (VA), Italy
| | - Anton Vladic
- Department of Neurology, Clinical Hospital Sveti Duh Zagreb, Medical Faculty University, J.J. Strossmayer, Osijek, Croatia
| | - Francesco Novelli
- Center for Experimental Research and Medical Studies (CERMS), Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Luca Durelli
- Clinical and Biological Sciences Department, University of Torino, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Torino, San Luigi Gonzaga Hospital, Orbassano (TO), Italy.
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Abstract
Economic sustainability is of paramount importance in the rapidly evolving therapeutic scenario of multiple sclerosis (MS). Glatiramoids are a class of drugs whose forefather, glatiramer acetate, has been used as a disease modifying drug (DMD) in patients with MS for over 20 years. Its patent expired in 2015; new versions of such drug are nowadays available on the market, potentially contributing to lowering prices and enhancing a better allocation of economic resources. In this review, we analyze the recommendations underlying the approval of both generic drugs and biosimilars by regulatory authorities, and we provide methodological tools to contextualize the design of studies on these new classes of drugs. We examine in more detail the preclinical and clinical data of Copemyl®, a new member of the glatiramoid class, focusing on its biological and immunological properties and illustrating randomized controlled trials that led to its authorization.
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Affiliation(s)
- Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy.
| | - Antonio Bertolotto
- Neurology and Multiple Sclerosis Regional Reference Center (CRESM), AOU San Luigi, Orbassano, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Departement of Neuroscience (NSRO), Federico II University, Naples, Italy
| | - Claudio Gasperini
- Multiple Sclerosis Center, S. Camillo-Forlanini Hospital Rome, Rome, Italy
| | | | - Pierluigi Navarra
- Institute of Pharmacology, Catholic University Medical School, Largo F. Vito 1, 00168, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences, and Advanced Technologies, GF Ingrassia, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
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35
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Novi G, Ghezzi A, Pizzorno M, Lapucci C, Bandini F, Annovazzi P, Mancardi GL, Uccelli A. Dramatic rebounds of MS during pregnancy following fingolimod withdrawal. Neurol Neuroimmunol Neuroinflamm 2017; 4:e377. [PMID: 28804745 PMCID: PMC5532747 DOI: 10.1212/nxi.0000000000000377] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/11/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Giovanni Novi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Angelo Ghezzi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Matteo Pizzorno
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Caterina Lapucci
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Fabio Bandini
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Pietro Annovazzi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Giovanni L Mancardi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
| | - Antonio Uccelli
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (N.G., C.L., G.L.M., A.U.), University of Genoa, Italy; Multiple Sclerosis Study Center (A.G., P.A.), Hospital of Gallarate, Italy; San Paolo Hospital (M.P., F.B.), Savona, Italy; and IRCCS AUO San Martino-IST (G.L.M., A.U.), Genoa, Italy
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Baroncini D, Annovazzi P, Minonzio G, Franzetti I, Zaffaroni M. Hypomagnesaemia as a trigger of relapsing non-alcoholic Wernicke encephalopathy: a case report. Neurol Sci 2017; 38:2069-2071. [PMID: 28730572 DOI: 10.1007/s10072-017-3062-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Damiano Baroncini
- Multiple Sclerosis Study Center, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy.
| | - Pietro Annovazzi
- Multiple Sclerosis Study Center, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy
| | - Giorgio Minonzio
- Department of neuroradiology, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy
| | - Ivano Franzetti
- Department of endocrinology, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Study Center, Gallarate Hospital, ASST Valle Olona, Gallarate, Italy
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37
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Benoit A, Durand-Dubief F, Amato MP, Portaccio E, Casey R, Roggerone S, Androdias G, Gignoux L, Ionescu I, Marrosu MG, Cocco E, Ghezzi A, Annovazzi P, Trojano M, Simone M, Marignier R, Confavreux C, Vukusic S. History of multiple sclerosis in 2 successive pregnancies. Neurology 2016; 87:1360-7. [DOI: 10.1212/wnl.0000000000003036] [Citation(s) in RCA: 14] [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: 12/29/2015] [Accepted: 04/28/2016] [Indexed: 11/15/2022] Open
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38
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Annovazzi P, Capobianco M, Moiola L, Patti F, Frau J, Uccelli A, Centonze D, Perini P, Tortorella C, Prosperini L, Lus G, Fuiani A, Falcini M, Martinelli V, Comi G, Ghezzi A. Rituximab in the treatment of Neuromyelitis optica: a multicentre Italian observational study. J Neurol 2016; 263:1727-35. [PMID: 27286847 DOI: 10.1007/s00415-016-8188-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 03/16/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 01/10/2023]
Abstract
Rituximab (RTX) efficacy in NMO is suggested by several case series. No consensus exists on optimal dosing strategies. At present the treatment schedules more frequently used are 375 mg/m2/week iv for 4 weeks (RTX-A) and 1000 mg iv twice, 2 weeks apart (RTX-B). Aim of this study is to confirm RTX efficacy and safety in the treatment of NMO and to evaluate whether a most favourable dosage regimen exists. Data on RTX-treated NMO patients were collected from 13 Italian Hospitals. 73 patients (64 F), were enlisted. RTX-A was administered in 42/73 patients, RTX-B in 31/73. Median follow-up was 27 months (range 7-106). Mean relapse rate in the previous year before RTX start was 2.2 ± 1.3 for RTX-A and 2.3 ± 1.2 for RTX-B. ARR in the first year of treatment was 0.8 ± 0.9 for RTX-A and 0.2 ± 0.4 for RTX-B, in the second year of treatment was 0.9 ± 1.5 for RTX-A and 0.4 ± 0.8 for RTX-B patients (p = 0.001 for the first year, ns (0.09) for the second year). RTX-B was more effective in delaying the occurrence of a relapse (HR 2.2 (95 % IC 1.08-4.53) p = 0.02). Adverse events were described in 19/73 patients (mainly urinary tract and respiratory infections, and infusion reactions). Two deaths were reported in severely disabled patients. Though with the limitations of an observational study, our data support RTX efficacy in NMO and suggest that high dose pulses might be more effective than a more fractioned dose.
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Affiliation(s)
- Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy.
| | - M Capobianco
- Regional MS Center, University Hospital S. Luigi Gonzaga, Orbassano (TO), Italy
| | - L Moiola
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - F Patti
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - J Frau
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - A Uccelli
- Department of Neurosciences Ophtalmology and Genetics, University of Genoa, Genoa, Italy
| | - D Centonze
- Department of Neurology I and neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - P Perini
- Department of Neurology, AO University of Padova, Padua, Italy
| | - C Tortorella
- Departments of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - L Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - G Lus
- Department of Neurological Sciences, School of Medicine, Second University of Naples, Policlinico Federico II, Naples, Italy
| | - A Fuiani
- Department of Neurosciences, Multiple Sclerosis Unit, General Hospital, "OORR", Foggia, Italy
| | - M Falcini
- Multiple Sclerosis Center, Ospedale Misericordia e Dolce, Prato, Italy
| | - V Martinelli
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - G Comi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - A Ghezzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy
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De Mercanti S, Rolla S, Cucci A, Bardina V, Cocco E, Vladic A, Soldo-Butkovic S, Habek M, Adamec I, Horakova D, Annovazzi P, Novelli F, Durelli L, Clerico M. Alemtuzumab long-term immunologic effect: Treg suppressor function increases up to 24 months. Neurol Neuroimmunol Neuroinflamm 2016; 3:e194. [PMID: 26819963 PMCID: PMC4723135 DOI: 10.1212/nxi.0000000000000194] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/30/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To analyze changes in T-helper (Th) subsets, T-regulatory (Treg) cell percentages and function, and mRNA levels of immunologically relevant molecules during a 24-month follow-up after alemtuzumab treatment in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS Multicenter follow-up of 29 alemtuzumab-treated patients with RRMS in the Comparison of Alemtuzumab and Rebif Efficacy in Multiple Sclerosis (CARE-MS) I and CARE-MS II trials. Peripheral blood (PB) samples were obtained at months 0, 6, 12, 18, and 24. We evaluated (1) mRNA levels of 26 immunologic molecules (cytokines, chemokines, chemokine receptors, and transcriptional factors); (2) Th1, Th17, and Treg cell percentages; and (3) myelin basic protein (MBP)-specific Treg suppressor activity. RESULTS We observed 12 relapses in 9 patients. mRNA levels of the anti-inflammatory cytokines interleukin (IL)-10, IL-27, and transforming growth factor-β persistently increased whereas those of proinflammatory molecules related to the Th1 or Th17 subsets persistently decreased after alemtuzumab administration throughout the follow-up period. PB CD4+ cell percentage remained significantly lower than baseline while that of Th1 and Th17 cells did not significantly change. A significant increase in Treg cell percentage was observed at month 24 and was accompanied by an increase in Treg cell suppressive activity against MBP-specific Th1 and Th17 cells. CONCLUSIONS The long-lasting therapeutic benefit of alemtuzumab in RRMS may involve a shift in the cytokine balance towards inhibition of inflammation associated with a reconstitution of the PB CD4+ T-cell subsets that includes expansion of Treg cells with increased suppressive function.
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Affiliation(s)
- Stefania De Mercanti
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Simona Rolla
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Angele Cucci
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Valentina Bardina
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Eleonora Cocco
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Anton Vladic
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Silva Soldo-Butkovic
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Mario Habek
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Ivan Adamec
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Dana Horakova
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Pietro Annovazzi
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Francesco Novelli
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Luca Durelli
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Marinella Clerico
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
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Amato M, Tortorella C, Trojano M, Cocco E, Marrosu M, Lugaresi A, Annovazzi P, Ghezzi A, Gasperini C, Iudice A, Bellantonio P, Patti F, Cavalla P, Totaro R, Pozzilli C, Bosco A, Uccelli A, Lanzillo R, Brescia Morra V, Portaccio E, for T. Disease re-activation during pregnancy after natalizumab suspension in patients with multiple sclerosis. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Prosperini L, Annovazzi P, Capobianco M, Capra R, Buttari F, Gasperini C, Galgani S, Solaro C, Centonze D, Bertolotto A, Pozzilli C, Ghezzi A. Natalizumab discontinuation in patients with multiple sclerosis: Profiling risk and benefits at therapeutic crossroads. Mult Scler 2015; 21:1713-22. [PMID: 25698174 DOI: 10.1177/1352458515570768] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 11/21/2014] [Accepted: 12/21/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this paper is to estimate the risk of reaching well-established disability milestones after withdrawal of natalizumab (NTZ) due to concern about the risk of progressive multifocal leukoencephalopathy in patients with multiple sclerosis (MS). METHODS Data from 415 patients with MS followed-up for six years after starting NTZ were collected from seven tertiary MS centers. The risk of disability worsening, i.e. reaching Expanded Disability Status Scale (EDSS) scores of 4.0 or 6.0, and the likelihood of experiencing a disability reduction of one EDSS point (or more), were assessed by propensity score-adjusted analyses in patients who discontinued and in those still on treatment at the end of follow-up. RESULTS A total of 318 patients who received standard NTZ treatment without experiencing evidence of disability worsening in the first two years were included in the six-year follow-up analysis, with 196 (61.6%) still on treatment and 122 (38.4%) discontinuing after a median time of 3.5 years. Patients in the discontinuing group had a more than two-fold increased risk of disability worsening (p = 0.007), and a 68% decreased likelihood of experiencing disability reduction (p = 0.009) compared with the continuing group. CONCLUSION While discussing the overall risk/benefit profile of NTZ, patients should be advised that, in case of treatment discontinuation, the risk of disability worsening is one in three, and increases to one in two if the EDSS score at NTZ start is above 3.0.
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Affiliation(s)
- Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Italy
| | | | - Marco Capobianco
- Neurologia 2 - CRESM (Centro Riferimento Regionale Sclerosi Multipla), University Hospital San Luigi Gonzaga, Italy
| | - Ruggero Capra
- Regional Referring MS Center, Spedali Civili of Brescia, Montichiari Hospital, Italy
| | - Fabio Buttari
- Department of Neurosciences Tor Vergata University, Italy/IRCCS Neuromed, Italy
| | | | | | - Claudio Solaro
- Neurology Unit, Department Head and Neck, ASL 3 genovese, Genova, Italy
| | - Diego Centonze
- Department of Neurosciences Tor Vergata University, Italy/S. Lucia Foundation IRCCS, Italy
| | - Antonio Bertolotto
- Neurologia 2 - CRESM (Centro Riferimento Regionale Sclerosi Multipla), University Hospital San Luigi Gonzaga, Italy
| | - Carlo Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Italy
| | - Angelo Ghezzi
- Department of Neurology and Psychiatry, Sapienza University, ItalyMS Centre, S. Antonio Abate Hospital, ItalyNeurologia 2 - CRESM (Centro Riferimento Regionale Sclerosi Multipla), University Hospital San Luigi Gonzaga, ItalyRegional Referring MS Center, Spedali Civili of Brescia, Montichiari Hospital, ItalyDepartment of Neurosciences Tor Vergata University, Italy/IRCCS Neuromed, ItalyDepartment of Neurosciences, S. Camillo-Forlanini Hospital, ItalyDepartment of Neurosciences, S. Camillo-Forlanini Hospital, ItalyNeurology Unit, Department Head and Neck, ASL 3 genovese, Genova, ItalyDepartment of Neurosciences Tor Vergata University, Italy/S. Lucia Foundation IRCCS, ItalyNeurologia 2 - CRESM (Centro Riferimento Regionale Sclerosi Multipla), University Hospital San Luigi Gonzaga, ItalyDepartment of Neurology and Psychiatry, Sapienza University, ItalyMS Centre, S. Antonio Abate Hospital, Italy
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Baroncini D, Zaffaroni M, Minonzio G, Annovazzi P, Baldini SM, Comi G, Ghezzi A. Uhthoff's phenomena and brain MRI suggesting demyelinating lesions: RIS or CIS? A case report. J Neurol Sci 2014; 345:262-4. [PMID: 25064443 DOI: 10.1016/j.jns.2014.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Damiano Baroncini
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, Hospital S. Raffaele, Milan, Italy; Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital of Gallarate, Italy.
| | - Mauro Zaffaroni
- Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital of Gallarate, Italy
| | | | - Pietro Annovazzi
- Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital of Gallarate, Italy
| | - Silvana M Baldini
- Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital of Gallarate, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, Hospital S. Raffaele, Milan, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital of Gallarate, Italy
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Ghezzi A, Annovazzi P, Portaccio E, Cesari E, Amato MP. Current recommendations for multiple sclerosis treatment in pregnancy and puerperium. Expert Rev Clin Immunol 2014; 9:683-91; quiz 692. [PMID: 23899239 DOI: 10.1586/1744666x.2013.811046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
As multiple sclerosis (MS) typically starts at about 30 years of age, and is twice more frequent in females than in males, women with MS frequently face issues related to pregnancy and to the effects of medications commonly used in MS treatment. In this review, the authors provide and summarize literature data addressing the effect of MS and its treatments on pregnancy, delivery, postpartum and conception. There is a strong evidence that relapses are fewer during pregnancy but more frequent during postpartum, and that IFN-β and glatiramer acetate do not expose patients and their babies to relevant adverse events; nevertheless, these drugs should be discontinued during pregnancy and before conception. However, if their preventive withdrawal exposes patients to a high risk of disease activity, these medications could be continued until proven conception. Little information is available on the effect of natalizumab and fingolimod.
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Affiliation(s)
- Angelo Ghezzi
- UO Neurologia 2 - Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013 Gallarate, Italy.
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Frisullo G, Calabrese M, Tortorella C, Paolicelli D, Ragonese P, Annovazzi P, Radaelli M, Malucchi S, Gallo A, Tomassini V, Nociti V, D'Onghia M, Lo Re V, Rodegher M, Solaro C, Gasperini C. Thyroid autoimmunity and dysfunction in multiple sclerosis patients during long-term treatment with interferon beta or glatiramer acetate: an Italian multicenter study. Mult Scler 2014; 20:1265-8. [PMID: 24515732 DOI: 10.1177/1352458514521311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 12/22/2013] [Indexed: 11/16/2022]
Abstract
Few long-term follow-up data are available on thyroid dysfunction (TD) in multiple sclerosis (MS) patients treated with glatiramer acetate (GA) or with interferon-beta (IFNb). In a cohort of 787 relapsing-remitting MS (RRMS) patients whom were followed up for 8 years, we observed an increased prevalence of TD and thyroid autoimmunity (TA) within the first year of IFNb treatment, regardless of the dose or frequency of administration, while no change was observed with GA treatment. The increased prevalence of TD and TA within the first year of IFNb treatment suggested the need for close monitoring of thyroid function and autoimmunity, though only during the first year of IFNb treatment.
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Affiliation(s)
| | | | - Carla Tortorella
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Paolo Ragonese
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
| | | | - Marta Radaelli
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Simona Malucchi
- Centro di Riferimento Regionale per la Sclerosi Multipla-Neurologia 2, A.O.U. San Luigi Gonzaga, Orbassano, Italy
| | - Antonio Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - Valentina Tomassini
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, University Hospital of Wales, Cardiff University, UK
| | - Viviana Nociti
- Department of Neurosciences, Catholic University of Rome, Italy Don Carlo Gnocchi Foundation, Rome, Italy
| | - Mariangela D'Onghia
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Vincenzina Lo Re
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
| | | | - Claudio Solaro
- Neurology Unit - Azienda Sanitaria Locale 3, Genovese, Genoa, Italy
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Gonzalez-Rosa JJ, Inuggi A, Blasi V, Cursi M, Annovazzi P, Comi G, Falini A, Leocani L. Response competition and response inhibition during different choice-discrimination tasks: Evidence from ERP measured inside MRI scanner. Int J Psychophysiol 2013; 89:37-47. [DOI: 10.1016/j.ijpsycho.2013.04.021] [Citation(s) in RCA: 20] [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: 10/29/2012] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 01/23/2023]
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46
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Ghezzi A, Annovazzi P, Amato MP, Capello E, Cavalla P, Cocco E, Falcini M, Gallo A, Patti F, Perini P, Rodegher ME, Rovaris M, Rottoli MR, Comi G. Adverse events after endovascular treatment of chronic cerebro-spinal venous insufficiency (CCSVI) in patients with multiple sclerosis. Mult Scler 2013; 19:961-3. [PMID: 23380649 DOI: 10.1177/1352458513475491] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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
Although it is debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients undergo endovascular treatment (ET) of CCSVI. A study is ongoing in Italy to evaluate the clinical outcome of ET. Severe adverse events (AEs) occurred in 15/462 subjects at a variable interval after ET: jugular thrombosis in seven patients, tetraventricular hydrocephalus, stroke, paroxysmal atrial fibrillation, status epilepticus, aspiration pneumonia, hypertension with tachicardia, or bleeding of bedsore in the remaining seven cases. One patient died because of myocardial infarction 10 weeks after ET. The risk of severe AEs related to ET for CCSVI must be carefully considered.
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Affiliation(s)
- A Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Italy.
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47
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Ghezzi A, Annovazzi P, Cocco E, Coarelli G, Lugaresi A, Rovaris M, Patti F, Capello E, Rodegher ME, Moiola L, Malucchi S, Salemi G, De Rossi N, Provinciali L, Perini P, Bergamaschi R, Scarpini E, Lus G, Gallo A, Tola MR, Amato MP, Rottoli MR, Bianchi A, Comi G. Endovascular treatment of CCSVI in patients with multiple sclerosis: clinical outcome of 462 cases. Neurol Sci 2013; 34:1633-7. [PMID: 23354606 DOI: 10.1007/s10072-013-1300-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/07/2013] [Indexed: 11/30/2022]
Abstract
Although it is still debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients underwent endovascular treatment (ET) of CCSVI. The objective of the study is to evaluate the outcome and safety of ET in Italian MS patients. Italian MS centers that are part of the Italian MS Study Group were all invited to participate to this retrospective study. A structured questionnaire was used to collect detailed clinical data before and after the ET. Data from 462 patients were collected in 33 centers. ET consisted of balloon dilatation (93 % of cases) or stent application. The mean follow-up duration after ET was 31 weeks. Mean EDSS remained unchanged after ET (5.2 vs. 4.9), 144 relapses occurred in 98/462 cases (21 %), mainly in RR-MS patients. Fifteen severe adverse events were recorded in 3.2 % of cases. Given the risk of severe adverse events and the lack of objective beneficial effects, our findings confirm that at present ET should not be recommended to patients with MS.
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Affiliation(s)
- A Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Italy,
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48
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Ghezzi A, Rocca MA, Baroncini D, Annovazzi P, Zaffaroni M, Minonzio G, Comi G, Filippi M. Disease reactivation after fingolimod discontinuation in two multiple sclerosis patients. J Neurol 2012; 260:327-9. [PMID: 23161460 DOI: 10.1007/s00415-012-6744-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 11/26/2022]
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49
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De Mercanti S, Cucci A, Viglietta E, Giai Via A, Taverna D, Cimino D, Rolla S, Bardina V, Novelli F, Vargas J, Gibbin M, Piazza F, Vladic A, Brinar V, Habek M, Cocco E, Annovazzi P, Horakova D, Kovarova I, Clerico M, Durelli L. T Regulatories (Tregs) and Suppressor Cytokine mRNA (IL-10, TGF , IL-27) Increase after Alemtuzumab in MS: First 24 Month Immunological Report on 323 and 324 Genzyme Trials (P02.088). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Martinelli V, Rocca MA, Annovazzi P, Pulizzi A, Rodegher M, Boneschi FM, Scotti R, Falini A, Sormani MP, Comi G, Filippi M. A short-term randomized MRI study of high-dose oral vs intravenous methylprednisolone in MS. Neurology 2009; 73:1842-8. [DOI: 10.1212/wnl.0b013e3181c3fd5b] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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