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Mantero V, Scaccabarozzi C, Botto E, Giussani G, Aliprandi A, Lunghi A, Ciusani E, Brenna G, Salmaggi A. Outcome in lacunar stroke: A cohort study. Acta Neurol Scand 2018; 138:320-326. [PMID: 29770431 DOI: 10.1111/ane.12961] [Citation(s) in RCA: 10] [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] [Accepted: 04/24/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We evaluated a prospective cohort of 150 patients under observation in our centre for lacunar strokes. The purpose of this study was to evaluate the outcome at time of discharge and 6 months after lacunar stroke, as well as the correlation with cardiovascular risk factors and selected biochemical parameters already evaluated on admission. Focus was to identify possible prognostic factors, which might be targeted through appropriate intervention concentrating on reduction in the incidence and impact of early clinical deterioration. METHODS 150 patients with a lacunar stroke were included in the present study. A clinical 6-month follow-up was available for 98.7% of the patients. Infarcts were classified by size, shape and location. RESULTS The most important predictors of high NIHSS score at time of discharge resulted NIHSS on admission (P < .001), leukocytosis (P = .013), in-hospital infections (P = .016) and size of lacunae (P = .005). Similarly, the most important predictors of poor outcome 6 months later were NIHSS on admission (P = .01), leukocytosis (P = .014), elevated CRP (P = .019), in addition to pre-admission Rankin (P < .001). CONCLUSION Although infections are not causatively related to lacunar strokes, their prompt recognition and early treatment, control of inflammatory markers and fever are most important in influencing functional outcome in lacunar stroke.
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Affiliation(s)
- V. Mantero
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - C. Scaccabarozzi
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - E. Botto
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - G. Giussani
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - A. Aliprandi
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - A. Lunghi
- Neuroradiological Unit; “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - E. Ciusani
- Laboratory of Clinical Pathology and Medical Genetics; Fondazione IRCCS Istituto Neurologico C. Besta; Milan Italy
| | - G. Brenna
- Department of Neuroimmunology and Neuromuscular Diseases; Fondazione IRCCS Istituto Neurologico C. Besta; Milan Italy
| | - A. Salmaggi
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
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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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Mosca L, Mantero V, Penco S, La Mantia L, De Benedetti S, Marazzi MR, Spreafico C, Erminio C, Grassi L, Lando G, Zagaria M, Agostoni E, Protti A. HLA-DRB1*15 association with multiple sclerosis is confirmed in a multigenerational Italian family. Funct Neurol 2018; 32:83-88. [PMID: 28676141 DOI: 10.11138/fneur/2017.32.2.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Environmental and genetic factors seem to play a pathogenetic role in multiple sclerosis (MS). The genetic component is partly suggested by familial aggregation of cases; however, MS families with affected subjects over different generations have rarely been described. The aim of this study was to report clinical and genetic features of a multigenerational MS family and to perform a review of the literature on this topic. We describe a multigenerational Italian family with six individuals affected by MS, showing different clinical and neuroradiological findings. HLA-DRB1* typing revealed the presence of the DRB1*15:01 allele in all the MS cases and in 4/5 non-affected subjects. Reports on six multigenerational MS families have previously been published, giving similar results. The HLA-DRB1*15:01 allele was confirmed to be linked to MS disease in this family; moreover, its presence in non-affected subjects suggests the involvement of other susceptibility factors in the development and expression of the disease, in accordance with the complex disease model now attributed to MS.
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Tarlarini C, Lunetta C, Mosca L, Avemaria F, Riva N, Mantero V, Maestri E, Quattrini A, Corbo M, Melazzini MG, Penco S. Novel FUS mutations identified through molecular screening in a large cohort of familial and sporadic amyotrophic lateral sclerosis. Eur J Neurol 2015; 22:1474-81. [DOI: 10.1111/ene.12772] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/27/2015] [Indexed: 02/02/2023]
Affiliation(s)
- C. Tarlarini
- Medical Genetics Unit; Department of Laboratory Medicine; Niguarda Ca' Granda Hospital; Milan Italy
| | - C. Lunetta
- NEuroMuscular Omnicentre (NEMO); Fondazione Serena Onlus; Niguarda Ca' Granda Hospital; Milan Italy
| | - L. Mosca
- Medical Genetics Unit; Department of Laboratory Medicine; Niguarda Ca' Granda Hospital; Milan Italy
| | - F. Avemaria
- Medical Genetics Unit; Department of Laboratory Medicine; Niguarda Ca' Granda Hospital; Milan Italy
| | - N. Riva
- Neuropathology Unit; Institute of Experimental Neurology and Division of Neuroscience; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - V. Mantero
- Neurological Department; A. Manzoni Hospital; Lecco Italy
| | - E. Maestri
- NEuroMuscular Omnicentre (NEMO); Fondazione Serena Onlus; Niguarda Ca' Granda Hospital; Milan Italy
| | - A. Quattrini
- Neuropathology Unit; Institute of Experimental Neurology and Division of Neuroscience; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Corbo
- NEuroMuscular Omnicentre (NEMO); Fondazione Serena Onlus; Niguarda Ca' Granda Hospital; Milan Italy
- Department of Neurorehabilitation Sciences; Casa Cura Policlinico; Milan Italy
| | - M. G. Melazzini
- NEuroMuscular Omnicentre (NEMO); Fondazione Serena Onlus; Niguarda Ca' Granda Hospital; Milan Italy
| | - S. Penco
- Medical Genetics Unit; Department of Laboratory Medicine; Niguarda Ca' Granda Hospital; Milan Italy
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