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Tommasin S, Iakovleva V, Rocca MA, Giannì C, Tedeschi G, De Stefano N, Pozzilli C, Filippi M, Pantano P. Relation of sensorimotor and cognitive cerebellum functional connectivity with brain structural damage in patients with multiple sclerosis and no disability. Eur J Neurol 2022; 29:2036-2046. [PMID: 35298059 PMCID: PMC9323479 DOI: 10.1111/ene.15329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/11/2022] [Accepted: 02/27/2022] [Indexed: 12/01/2022]
Abstract
Background and purpose To investigate the relationship between the functional connectivity (FC) of the sensorimotor and cognitive cerebellum and measures of structural damage in patients with multiple sclerosis (MS) and no physical disability. Methods We selected 144 relapsing–remitting MS patients with an Expanded Disability Status Scale score of ≤1.5 and 98 healthy controls from the Italian Neuroimaging Network Initiative database. From multimodal 3T magnetic resonance imaging (MRI), including functional MRI at rest, we calculated lesion load, cortical thickness, and white matter, cortical gray matter, and caudate, putamen, thalamic, and cerebellar volumes. Voxel‐wise FC of the sensorimotor and cognitive cerebellum was assessed with seed‐based analysis, and multiple regression analysis was used to evaluate the relationship between FC and structural damage. Results Whole brain, white matter, caudate, putamen, and thalamic volumes were reduced in patients compared to controls, whereas cortical gray matter was not significantly different in patients versus controls. Both the sensorimotor and cognitive cerebellum showed a widespread pattern of increased and decreased FC that were negatively associated with structural measures, indicating that the lower the FC, the greater the tissue loss. Lastly, among multiple structural measures, cortical gray matter and white matter volumes were the best predictors of cerebellar FC alterations. Conclusions Increased and decreased cerebellar FC with several brain areas coexist in MS patients with no disability. Our data suggest that white matter loss hampers FC, whereas, in the absence of atrophy, cortical volume represents the framework for FC to increase.
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Affiliation(s)
- Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences and MRI-Center "SUN-FISM", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS NEUROMED, Pozzilli, Italy
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Schriefer D, Ness NH, Haase R, Ziemssen T. Gender disparities in health resource utilization in patients with relapsing-remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients. Ther Adv Neurol Disord 2020; 13:1756286420960274. [PMID: 33178335 PMCID: PMC7592171 DOI: 10.1177/1756286420960274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background: For the case of multiple sclerosis, research on gender differences from a
health economics perspective has not received much attention. However,
cost-of-illness analyses can provide valuable information about the diverse
impact of the disease and thus help decision-makers to allocate scarce
resources. The aim of this study was to describe healthcare resource use and
associated societal costs from a gender perspective. In particular, we aimed
to identify how resource utilization potentially differs in certain cost
components between men and women. Methods: Clinical and economic data were extracted from two prospective, multicentre,
non-interventional, observational studies in Germany. Information on health
resource use was obtained from all patients on a quarterly basis using a
validated questionnaire. Cost analyses were conducted from the societal perspective including all
direct (healthcare-related) and indirect (work-related) costs, regardless of
who bears them. Gender-related differences were analysed by a multivariable
generalized linear model with a negative binomial distribution and log link
function due to the right-skewed distribution pattern of cost data. In
addition, costs for men and women were descriptively analysed within
subgroups of two-year disease activity. Results: In total, 2095 patients (women-to-men ratio of 2.7:1) presented a mean age of
41.85 years and a median Expanded Disability Status Scale of 2
(interquartile range 1–3.5) (p > 0.30 for gender-related
differences). Women and men did not statistically differ in total quarterly
costs (€2329 ± €2570 versus €2361 ± €2612). For both, costs
were higher with advancing disease severity and indirect costs were the main
societal cost driver. Regarding healthcare-related resources, women incurred
higher costs for ambulant consultations [incidence rate ratio (IRR) 1.16,
confidence interval (CI) 1.04–1.31], complementary medicine (IRR 2.41, CI
1.14–5.06), medical consumables (IRR 2.53, CI 1.69–3.79) and informal care
(IRR 2.79, CI 1.56–5.01). Among indirect costs, we found higher costs for
men for presenteeism (IRR 0.62; CI 0.53–0.72) and higher costs for women for
disability pension (IRR 1.62; CI 1.23–2.13). Conclusions: Multiple sclerosis poses a significant economic burden on patients, families
and society. While the total economic burden did not differ between male and
female patients, we found gender differences in specific cost items that are
similar to those in the wider non-MS population.
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Affiliation(s)
- Dirk Schriefer
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Nils-Henning Ness
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Rocco Haase
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Fetscherstr. 74, Dresden, 01307, Germany
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Abstract
Activation of the unfolded protein response in response to endoplasmic reticulum stress preserves cell viability and function under stressful conditions. Nevertheless, persistent, unresolvable activation of the unfolded protein response can trigger apoptosis to eliminate stressed cells. Recent studies show that the unfolded protein response plays an important role in the pathogenesis of various disorders of myelin, including multiples sclerosis, Charcot-Marie-Tooth disease, Pelizaeus-Merzbacher disease, vanishing white matter disease, spinal cord injury, tuberous sclerosis complex, and hypoxia-induced perinatal white matter injury. In this review we summarize the current literature on the unfolded protein response and the evidence for its role in the pathogenesis of myelin disorders.
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Affiliation(s)
- Wensheng Lin
- Department of Neuroscience; Institute for Translational Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Sarrabeth Stone
- Department of Neuroscience; Institute for Translational Neuroscience, University of Minnesota, Minneapolis, MN, USA
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Seth JH, Gonzales G, Haslam C, Pakzad M, Vashisht A, Sahai A, Knowles C, Tucker A, Panicker J. Feasibility of using a novel non-invasive ambulatory tibial nerve stimulation device for the home-based treatment of overactive bladder symptoms. Transl Androl Urol 2018; 7:912-919. [PMID: 30505727 PMCID: PMC6256042 DOI: 10.21037/tau.2018.09.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate safety, acceptability and pilot efficacy of transcutaneous low-frequency tibial nerve stimulation (TNS) using a novel device as home-based neuromodulation. Methods In this single-centre pilot study, 48 patients with overactive bladder (OAB) (24 with neurogenic and 24 with idiopathic OAB) were randomized to use a self-applicating ambulatory skin-adhering device stimulating transcutaneously the tibial nerve at 1 Hz for 30 minutes, either once daily or once weekly, for 12 weeks. Changes in OAB symptoms and QoL were measured at baseline, weeks 4, 8, and 12 using validated scoring instruments (ICIQ-OAB and ICIQ-LUTSqol), 3-day bladder diary and a Global Response Assessment (GRA) at week 12. Results Thirty-four patients completed the study (idiopathic n=15, neurogenic n=19). No significant adverse effects were noted. Patients found the device acceptable. Eighteen patients (53%) reported a moderate or marked improvement in symptoms from the GRA. Between baseline and week-12, ICIQ-OAB part A sub-scores improved from mean (SD) 9.3 (2.5) to 7.5 (3.1), and from 9.1 (1.9) to 5.9 (1.7) in the daily and the weekly arms, respectively. ICIQ-LUTSqol part A sub-scores improved from mean (SD) 51 (12.8) to 44.2 (13.1) and 44.9 (9.0) to 35.9 (8.8) in the daily and the weekly arms, respectively. Bladder diary mean 24-hour frequency episodes improved from 11.5 to 8.8 at week 12 for both arms. Conclusions This novel ambulatory transcutaneous TNS (TTNS) device is safe and acceptable for use in patients reporting OAB symptoms as a form of home-based neuromodulation. A larger study however is required to confirm clinical efficacy.
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Affiliation(s)
- Jai H Seth
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Gwen Gonzales
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Mahreen Pakzad
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Arvind Vashisht
- Department of Uro-gynaecology, University College Hospital, London, UK
| | - Arun Sahai
- Department of Urology, Guy's Hospital, Kings College London, London, UK
| | - Charles Knowles
- Barts & The London SMD, Queen Mary University of London, London, UK
| | - Arthur Tucker
- Barts & The London SMD, Queen Mary University of London, London, UK
| | - Jalesh Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
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